标题：丙种球蛋白联合甲泼尼龙治疗系统性红斑狼疮的疗效及其对患儿Th细胞因子的影响

      作者：方钰，张伟，李莎，彭媛媛    成都市妇女儿童中心医院风湿免疫科，四川 成都 610091

      卷次： 2019年30卷8期

      【摘要】 目的 观察丙种球蛋白联合甲泼尼龙治疗系统性红斑狼疮(SLE)的疗效及其对患儿Th细胞因子的影响。方法 选取2016年2月至2018年2月成都市妇女儿童中心医院收治且确诊为SLE的40例住院患儿，根据随机抽签法将患儿分为观察组和对照组，每组20例，观察组患儿在糖皮质激素治疗基础上加入丙种球蛋白联合甲泼尼龙辅助治疗，对照组患儿在糖皮质激素治疗基础上加入丙种球蛋白辅助治疗，均治疗3个月，对两组患儿治疗后的系统性红斑狼疮活动指数(SLEDAI)进行评估，对两组患儿治疗后的体温、皮损、疼痛、白细胞(WBC)、血小板(PLT)、蛋白尿、抗核抗体(ANA)、抗ds-DNA抗体、红细胞沉降率(ESR)、补体C3、C4等指标及血清γ干扰素(IFN-γ)、白细胞介素 4 (IL-4)及白细胞介素 10 (IL-10)细胞因子进行化验并记录，比较两组患儿的临床治疗效果及治疗前后的Th细胞因子水平。结果 治疗后，观察组患儿的SLEDAI评分为(3.56±1.2)分，明显低于对照组的(7.78±1.6)分，且观察组患儿治疗有效率为90.0%，明显高于对照组的40.0%，差异均有统计学意义(P<0.05)；治疗后观察组患儿的WBC、PLT、尿蛋白、补体C3、C4化验指标达标时间均低于对照组，且观察组患儿的体温降低、皮损减轻、疼痛缓解等临床症状改善时间也均快于对照组，差异均有统计学意义(P<0.05)；治疗后观察组患儿的血清 IFN-γ、IL-4及 IL-10细胞因子水平分别为(7.1±4.0) pg/mL、(15.9±7.2) pg/mL、(39.1±20.2) pg/mL，均低于对照组的(9.3±4.2) pg/mL、(21.1±8.3) pg/mL、(52.9±20.4) pg/mL，差异均有统计学意义(P<0.05)。结论 SLE患儿在糖皮质激素治疗的基础上加入丙种球蛋白联合甲泼尼龙的辅助治疗，临床效果更佳，患儿临床症状能较短时间内得到改善，并且能够促使Th细胞因子趋于平衡，值得在临床治疗中应用。
      【关键词】 系统性红斑狼疮；丙种球蛋白；糖皮质激素；甲泼尼龙；疗效；Th细胞因子
      【中图分类号】 R593.24+1 【文献标识码】 A 【文章编号】 1003—6350（2019）08—1031—04

Clinical efficacy of gamma globulin combined with methylprednisolone in the treatment of children with systemiclupus erythematosus and its effect on Th cytokine.
FANG Yu, ZHANG Wei, LI Sha, PENG Yuan-yuan. Chengdu Women's& Children's Central Hospital, Chengdu 610091, Sichuan, CHINA
【Abstract】 Objective To observe the therapeutic effect of gamma globulin combined with methylprednisolonein the treatment of systemic lupus erythematosus (SLE) and its effect on Th cytokines in children. Methods A total of40 hospitalized children who diagnosed with SLE in Chengdu Women’s & Children’s Central Hospital from February2016 to February 2018 were selected. They were divided into observation group and control group according to randomdrawing of lots, with 20 cases in each group. The children in the control group were treated with methylprednisolone,and those in the observation group were treated with gamma globulin on the basis of the control group. All of them weretreated for 3 months. The activity index of systemic lupus erythematosus (SLEDAI) after treatment was evaluated be-tween two groups. The body temperature, skin lesions, pain, white blood cells (WBC), platelet (PLT), proteinuria, antinu-clear antibody (ANA), ds-DNA antibody resistance, erythrocyte sedimentation rate (ESR), complement C3, complementC4, and serum gamma interferon (IFN-γ), interleukin 4 (IL-4), and interleukin 10 (IL-10) were tested and recorded af-ter treatment between the two groups. The clinical therapeutic effect and the level of Th cytokines before and after treat-ment were compared between the two groups. Results After treatment, the SLEDAI score of the children in observa-tion group was 3.56±1.2, which was significantly lower than 7.78±1.6 in the control group, and the effective rate was90.0% in the observation group, which was significantly higher than 40.0% in the control group (P<0.05). After treat-ment, the WBC, PLT, urine protein, complement C3, and complement C4 in the observation group were all significantlylower than those in the control group. In addition, the improvement time of clinical symptoms such as hypothermia, skinlesions, and pain relief in the observation group was also better than that in the control group, with statistically signifi-cant differences (P<0.05). After treatment, the serum levels of IFN-γ, IL-4, and IL-10 in the observation group were (7.1±4.0) pg/mL, (15.9±7.2) pg/mL, (39.1±20.2) pg/mL, respectively, which were significantly lower than (9.3±4.2) pg/mL,(21.1±8.3) pg/mL, (52.9±20.4) pg/mL in the control group (P<0.05). Conclusion On the basis of glucocorticoid thera-