目的:探讨不同剂量静脉用丙种球蛋白(IVIG)在新生儿肺炎中疗效及免疫机制.方法:选取2015年1月~2016年12月我院收治的肺炎新生儿163例为研究对象,按治疗方案分为对照组(n=53,常规治疗)、常规剂量组(IVIG 500mg/kg,n=55)、大剂量组(IVIG 1000mg/kg,n=55),比较三组治疗有效率及症状消失时间、啰音消失时间、住院时间,测定其治疗前后T淋巴细胞CD3+、CD4+、CD4+/CD8+及免疫球蛋白IgG、IgA、IgM水平,并观察不良反应.结果:大剂量组治疗有效率96.36%明显高于常规剂量组83.64%、对照组83.03%;大剂量组症状消失时间(1.56 ±0.27)d、啰音消失时间(4.35±0.26)d、住院时间(6.15±1.23)d较常规剂量组、对照组明显缩短;治疗后大剂量组CD3+(72.15±1.63)%、CD4+(43.55±1.79)%、CD4+/CD8+(1.92±0.07)及血清IgG(8.39±1.28)g/L、IgA(1.22±0.13) g/L、IgM(1.20±0.15)g/L较常规剂量组、对照组显著升高,常规剂量组、对照组上述指标比较也有统计学意义;常规剂量组、大剂量组不良反应发生率1.82%、3.64%明显低于对照组13.21%.结论:1000mg/kg IVIG辅助治疗新生儿肺炎疗效较500mg/kg剂量及常规治疗好,可明显改善患儿症状、体征,缩短住院时间,不良反应少,可能通过上调CD3+、CD4+、CD4+/CD8+、IgG、IgA、IgM而发挥作用,值得在临床推广应用.%Objective To investigate the curative effect and immune mechanism of different doses of intravenous immu-noglobulin (IVIG) in neonatal pneumonia. Methods 163 cases of neonatal pneumonia treated in our hospital from January 2015 to December 2016 were enrolled in the study. According to the treatment methods, they were divided into the control group (n=53, treated by routine therapy), routine dose group (treated with IVIG of 500mg/kg, n=55) and high-dose group (treated with IVIG of 1000mg/kg, n=53). The effective rate of treatment, time of symptoms disappearing, time of rales disappearing and hospitalization time were compared among the three groups. The T lymphocytes CD3+, CD4+, CD4+/CD8+and immunoglobulin IgG, IgA and IgM levels were determined, and adverse reactions were observed. Results The effective rate of treatment in high-dose group (96.36%) was higher than that in routine dose group (83.64%) and control group (83.03%). The time of symptoms disappearing, time of rales disappearing and hospitalization time were significantly shorter in high-dose group than routine dose group and control group. After treatment, CD3+, CD4+, CD4+/CD8+and serum IgG, IgA and IgM levels were significantly higher in high-dose group than routine dose group and control group, and there were significant differences in above indexes between routine dose group and control group. The incidence rates of adverse reactions in routine dose group and high-dose group (1.82%, 36.4%) were significantly lower than that in control group (13.21%). Conclusion The curative effect of 1000mg/kg IVIG adju-vant treatment is better than 500mg/kg and conventional treatment in neonatal pneumonia. The former can significantly improve symptoms and signs and shorten the hospitalization time, with few adverse reactions. It may play a role by upregulation of CD3+, CD4+, CD4+/CD8+, serum IgG, IgA and IgM levels.
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