重型乙型腦炎患者腎上腺皮質激素的作用

林建英

【摘要】 目的 探討地塞米松對乙型腦炎患兒的病情、預后及腦脊液α-腫瘤壞死因子(TNF-α)與干擾素(IFN)的影響。方法 把33例重型極期乙腦患兒隨機分為兩組,地塞米松組18例給予靜脈地塞米松針4~5 d; 對照組15例則不用地塞米松。觀察比較兩組的臨床過程和腦脊液TNF-α與IFN的變化。結果 入院時兩組的主要臨床特點和腦脊液TNF-α與IFN的水平相似, 4~5 d后地塞米松組的臨床癥狀改善情況優于對照組,但兩組的腦脊液TNF-α與IFN的水平卻無明顯改變,并經過1個月的觀察地塞米松組的恢復期癥狀發生率也低于對照組。結論 對重型極期乙腦患兒給予靜脈地塞米松可以改善病情,減輕癥狀,減少恢復期癥狀的發生。

【關鍵詞】乙腦; 地塞米松; 病情; 預后; TNF-α; IFN

Effect of adrenal cortical hormone on the severe type of patients with epidemic encephalitis B

LIN Jian-ying.

The First Affiliated Hospital of Henan Medical University,xinxiang, 453100,China

【Abstract】 Objective To investigate the influence of adrenal cortical hormone on the patients condition, prognosis and the levels of TNF-α and TNF-γ in cerebrospinal fluid in children with epidemic encephalitis B.Methods 33 cases of severe type of patients with epidemic encephalitis B were divided into two groups randomly, i e dexamethasone-treated group (18) and the control group(15) . In the treated group, patients were treated with intravenous injection of dexamethasone at a dosage of 8 mg/(kgday） for 0.4~0.8 or 5 days; while in the control, no dexammethasone was given. The clinical courses and the changes on levels of TNF-α and IFN-γ in cerebrospinal fluid were compared between these two groups of patients.Results It was demonstrated that the clinical courses and the levels of cytokines in cerebrospinal fluid at time of admission appeared to be similar, however, the improvement of clinical course in the-treated group was better than those of the control group. As to the levels of cytokines in cerebrospinal fluid, there were no significant difference between these two groups. In addition, after one month observation, the rate of symptom development in the convalescence of the treated group was lower than that of the control group.Conclusion From the above observations, it is evident that treatment with intravenous injection of dexamethasone in severe cases with epidemic encephalitis B can improve the clinical course, lessen the clinical symptoms and reduce the rate of development of symptoms in convalescence.

【Key words】 Epidemic encephalris B; Dexamethasone; Patients condition; Prognosis; Tumor

necrosis factor-α; Interferon

流行性乙型腦炎(epidemic encephalitis B,簡稱乙腦)由乙型腦炎病毒引起的以腦實質炎性反應為主要病變的人獸共患的急性傳染病;重型患兒病死率仍在10%左右,并且多數發生在極期。由于乙腦沒有特效的治療方法,主要是積極對癥治療和護理。目前激素在乙腦中的作用仍有不同看法,Hoke等^［1］報道使用大劑量激素沒有滿意療效;而何時軍等^［2］報道大劑量激素能抑制顱內炎癥反應水平,阻止病情惡化。因此激素的應用及其作用機制有待進一步探討。

1 材料與方法

1.1 一般資料 33例重型乙腦患兒均來自2007年11~12月新鄉醫學院第一附屬醫院感染科住院病例。患兒血清乙腦特異性IgM抗體均陽性,符合乙腦診斷及分型標準^［3］。將33例隨機分為地塞米松組18例,男10例,女8例;對照組15例,男9例,女6例;年齡2~11歲。

1.2 方法 兩組年齡、最高體溫、GCS評分及腦脊液TNF-α與IFN水平均具可比性,見表1。地塞米松組給予靜脈地塞米松針0.4~0.8 mg/(kgd),2次/d，4~5 d;對照組則不用地塞米松;其余治療相同。停用地塞米松后比較兩組最高體溫、GCS評分及腦脊液TNF-α與IFN水平;極期后經過1個月觀察比較恢復期癥狀的發生率。TNF-α與IFN檢測采用ELISA法,試劑盒購自深圳晶美生物工程有限公司,按說明書操作。

1.3 統計學方法 采用SPSS 14.0軟件包進行統計學分析,計量資料用t檢驗,計數資料用χ²檢驗。以P<0.05為差異有統計學意義。

2 結果

經治后,地塞米松組的最高體溫明顯低于對照組,GCS評分則明顯高于對照組,差異均有統計學意義,地塞米松組恢復期癥狀發生率要低于對照組,但差異無統計學意義,兩組的腦脊液TNF-α與IFN的水平卻無明顯改變,差異無統計學意義,見表2、3。