富含IgM免疫球蛋白用于极低出生体重儿院内感染败血症的辅助治疗研究

中国临床药理学与治疗学 ›› 2017, Vol. 22 ›› Issue (2): 174-178.

富含IgM免疫球蛋白用于极低出生体重儿院内感染败血症的辅助治疗研究

杨祖钦¹，汪盈²，陈赢赢¹

¹温州医科大学附属第二医院新生儿科，温州 325000，浙江；²浙江大学国际医院新生儿科，杭州 310006，浙江

收稿日期:2016-10-14 修回日期:2016-12-16 出版日期:2017-02-26 发布日期:2017-03-02
作者简介:杨祖钦，男，硕士，主治医师，研究方向：新生儿院内感染。 Tel：13738775891 E-mail：ghs0412@163.com
基金资助:
温州市科技局课题(Y20100248)

Study on the adjuvant therapy of low birth weight infants with sepsis by IgM-rich immunoglobulin

YANG Zuqin ¹, WANG Ying², CHEN Yingying¹

¹The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China; ² the International Hospital of Zhejiang University, Hangzhou 310006, Zhejiang, China

Received:2016-10-14 Revised:2016-12-16 Online:2017-02-26 Published:2017-03-02

摘要/Abstract

摘要：

目的:评估富含IgM免疫球蛋白辅助治疗极低出生体重儿院内感染败血症的临床和实验室参数。方法: 选取2015年2月至2016年2月入住本院共53例院内感染败血症的极低出生体重儿为研究对象，将所有患儿分为治疗组28例，对照组25例，治疗组患儿在传统抗生素治疗方案的基础上，进行连续3 d，每日4 h内静注富含IgM免疫球蛋白5 mL/kg，对照组患儿则只进行传统抗生素治疗方案，观察对比两组治疗前后的临床及实验室参数。结果: 两组患儿于治疗前在C-反应蛋白、体温、白细胞计数、未成熟白细胞占总白细胞比值等方面比较，差异无统计学意义，观察治疗后两组患儿上述参数相比治疗前明显改善且治疗组优于对照组，差异具有统计学意义（P＜0.05)；两组患儿治疗结束总有效率分别为82.1%、64.0%，治疗组明显优于对照组，差异具有统计学意义（P＜0.05）；治疗组与对照组治疗中均出现低血糖、消化道出血、贫血、呼吸暂停、休克等并发症，且并发症发病率分别为28.6%、44.0%，治疗组显著低于对照组，差异具有统计学意义（P＜0.05）。结论:富含IgM免疫球蛋白可以用于极低出生体重儿院内感染败血症的辅助治疗。

关键词: 富含IgM免疫球蛋白, 败血症, 极低出生体重儿, 辅助治疗

Abstract:

AIM: To evaluate the effect of IgM-enriched immunoglobulin treatment on clinical and laboratory parameters in very low birthweight neonates with nosocomial sepsis after pentaglobin treatment. METHODS: A total of 53 very low birth weight childern who were treated in the hospital from February 2015 to February 2016 were recruited as the study objects and divided into two groups; the control group was treated with conventional therapies, while the treatment group was given IgM-enriched immunoglobulin as a support therapy in addition to antibiotics; 5 mL/kg per day of pentaglobin was infused over a 4-hour period on 3 consecutive days. Clinical and laboratory parameters were recorded before and after treatment. RESULTS: The indicators of both groups were significantly improved after treatment, but they were improved more significantly in the treatment than in the control group, there was significant difference (P＜0.05). The total effective rate of treatment was 82.1% in the treatment group, higher than that in the control group (64.0%), there was significant difference (P＜0.05). The incidence of complication was 28.6% in the treatment group during therapy, while 44.0% in the control group, there was significant difference (P＜0.05). CONCLUSION: Pentaglobin treatment of nosocomial sepsis could be used as an adjunct therapy in very low birthweight neonates.

Key words: IgM-enriched immunoglobulins, sepsis, very low birthweight neonates, adjuvant therapy

中图分类号:

R722

杨祖钦，汪盈，陈赢赢. 富含IgM免疫球蛋白用于极低出生体重儿院内感染败血症的辅助治疗研究[J]. 中国临床药理学与治疗学, 2017, 22(2): 174-178.

YANG Zuqin, WANG Ying, CHEN Yingying. Study on the adjuvant therapy of low birth weight infants with sepsis by IgM-rich immunoglobulin[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2017, 22(2): 174-178.

参考文献

［1］Chirico G, Cortinovis S, Fonte C, et al. Bacterial sepsis［J］. Chemother, 2007, 19 Suppl 2(2): 28-30.
［2］Oba Y, Iwata K. Treatment of neonatal sepsis with immune globulin［J］. N Engl J Med, 2012, 366(1): 91.
［3］胡小华, 傅建平, 杨磊, 等. 低分子肝素治疗新生儿败血症的临床疗效评估［J］. 医学理论与实践, 2016, 29(11): 1489-1491.
［4］马友凤, 唐军, 李志博, 等. 免疫球蛋白对极低出生体重儿预防感染的临床研究［J］. 中华医院感染学杂志, 2015, 25(2): 455-457.
［5］马爱萍. 益气活血运脾方对反复呼吸道感染患儿免疫功能的影响［J］. 长春中医药大学学报, 2016, 32(3): 589-561.
［6］李素华, 陈益平, 王洪姣, 等. 免疫球蛋白治疗重症EV71感染疗效评估［J］. 中国基层医药, 2013, 20(17): 2569-2571.
［7］Ohlsson A, Lacy JB. Intravenous immunoglobulin for suspected or proven infection in neonates［J］. Cochrane Database Syst Rev, 2015, 27(3): CD001239.
［8］Capasso L, Borrelli AC, Ferrara T, et al. Immunoglobulins in neonatal sepsis: has the final word been said［J］. Early Hum Dev, 2014, 90 Suppl 2: S47-S49.
［9］Di Rosa R, Pietrosanti M, Luzi G, et al. Polyclonal intravenous immunoglobulin: an important additional strategy in sepsis［J］. Eur J Intern Med, 2014, 25(6): 511-516.
［10］Ohlsson A, Lacy JB. Intravenous immunoglobulin for suspected or proven infection in neonates［J］. Cochrane Database Syst Rev, 2013, 2(7): CD001239.
［11］Akdag A, Dilmen U, Haque K, et al. Role of pentoxifylline and/or IgM-enriched intravenous immunoglobulin in the management of neonatal sepsis［J］. Am J Perinatol, 2014, 31(10): 905-912.
［12］Shane AL, Stoll BJ. Recent developments and current issues in the epidemiology, diagnosis, and management of bacterial and fungal neonatal sepsis［J］. Am J Perinatol, 2013, 30(2): 131-141.
［13］Capasso L, Borrelli AC, Parrella C, et al. Are IgM-enriched immunoglobulins an effective adjuvant septic VLBW infants［J］. Ital J Pediatr, 2013, 39(1): 1-4.
［14］Shah BA, Padbury JF. Neonatal sepsis: an old problem with new insights［J］. Virulence, 2014, 5(1): 170-178.
［15］Shane AL, Stoll BJ. Neonatal sepsis: progress towards improved outcomes［J］. J Infect, 2014, 68 Suppl 1: S24-S32.

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