不同剂量甲基泼尼松龙治疗自身免疫性脑炎儿童的效果

摘要
图/表
参考文献(20)
相关文章 (15)

全文: PDF (514 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的研究不同剂量甲基泼尼松龙治疗儿童自身免疫性脑炎的效果。方法选取2014年2月～2018年2月河北省儿童医院收治的自身免疫性脑炎患儿180例作为研究对象，均接受甲基泼尼松龙治疗，同时采用随机数字表法将其分为低剂量组[10 mg/（kg·d），60例]、中剂量组[20 mg/（kg·d），60例]和高剂量组[30 mg/（kg·d），60例]。比较三组患儿治疗前后血清和脑脊液中抗N-甲基-D-天冬氨酸受体（NMDAR）抗体水平、免疫球蛋白指标水平，记录三组患儿治疗期间的不良反应发生率和死亡率。结果治疗后6、12个月，三组患儿血清和脑脊液中抗NMDAR抗体水平均低于治疗前和治疗后1、3个月（P ＜ 0.05），且高、中剂量组均明显低于低剂量组（P ＜ 0.05），但高剂量组和中剂量组组间比较，差异无统计学意义（P ＞ 0.05）；治疗后6个月，三组患儿血清中免疫球蛋白A、免疫球蛋白G、免疫球蛋白M水平均低于治疗前（P ＜ 0.05），且高、中剂量组均明显低于低剂量组（P ＜ 0.05），但高剂量组和中剂量组组间比较，差异无统计学意义（P ＞ 0.05）；三组皮肤瘙痒、肝肾功能受损、胃肠道出血的发生率及死亡率比较，差异均无统计学意义（P ＞ 0.05），但高、中剂量组血压升高和体重增加的发生率高于低剂量组（P ＜ 0.05）。结论 20、30 mg/（kg·d）甲基泼尼松龙治疗儿童自身免疫性脑炎能在保证免疫疗效的同时，使激素副作用处于耐受范围内，值得临床推广。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	陈芳孙素真王薇杜雅坤马贵林唐洪侠张晓青刘康

关键词 ：甲基泼尼松龙, 儿童, 自身免疫性脑炎, 不良反应

Abstract：Objective To study the effect of different doses of Methylprednisolone in children with autoimmune encephalitis. Methods One hundred and eighty patients with autoimmune encephalitis admitted to Children′s Hospital of Hebei Province from February 2014 to February 2018 were selected as research objects and treated with Methylprednisolone, in addition, they were divided into low dose group [10 mg/(kg·d), 60 cases], medium dose group [20 mg/(kg·d), 60 cases] and high dose group [30 mg/(kg·d), 60 cases] by random number table method. The levels of against N-methyl-Daspartic acid receptor (NMDAR) antibody in serum and cerebrospinal fluid and the levels of immunoglobulin indices before and after treatment were compared among the three groups. The incidence of adverse reactions and mortality rate during treatment was recorded among the three groups. Results Six and twelve months after treatment, the levels of anti NMDAR antibodies in serum and cerebrospinal fluid of three groups were lower than those before treatment and 1 month, 3 months after treatment (P ＜ 0.05), which of the high, medium dose group were significantly lower than the low dose group (P ＜ 0.05), however, there was no significant difference between the high dose group and the medium dose group (P ＞ 0.05). Six months after treatment, the levels of immunoglobulin A, immunoglobulin G and immunoglobulin M in serum of the three groups were lower than those before treatment (P ＜ 0.05), which of the high dose group and medium dose group were significantly lower than the low dose group (P ＜ 0.05), however, there was no significant difference between the high dose group and the medium dose group (P ＞ 0.05). There were no significant differences in the incidence of cutaneous pruritus, impaired liver and kidney function, gastrointestinal bleeding and mortality rate among the three groups (P ＞ 0.05). How ever, the incidence of increased blood pressure and weight gain in the high dose group and medium dose group was higher than that in the low dose group (P ＜ 0.05). Conclusion The 20, 30 mg/(kg·d) doses of Methylprednisolone in the treatment of children with autoimmune encephalitis can ensure the efficacy of immunotherapy, and make the side effects of hormones within the tolerance range, which is worthy of clinical promotion.

Key words： Methylprednisolone Children Autoimmune encephalitis Adverse reactions

基金资助:河北省重点研发计划自筹项目（172777159）。

作者简介: 陈芳（1981.9-），女，硕士，副主任医师，主要从事儿科专业、小儿神经内科方向的研究。

引用本文:

陈芳孙素真王薇杜雅坤马贵林唐洪侠张晓青刘康. 不同剂量甲基泼尼松龙治疗自身免疫性脑炎儿童的效果[J]. 中国医药导报, 2019, 16(23): 73-77,81.
CHEN Fang SUN Suzhen WANG Wei DU Yakun MA Guilin TANG Hongxia ZHANG Xiaoqing LIU Kang. Effect of different doses of Methylprednisolone in children with autoimmune encephalitis. 中国医药导报, 2019, 16(23): 73-77,81.

链接本文:

http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2019/V16/I23/73

[1] 陆卉，张雅静.自身免疫性脑炎临床鉴别诊断及治疗研究[J].中华医院感染学杂志，2014，24（6）：1423-1425.
[2] 王晓慧，方方，丁昌红，等.儿童抗N-甲基-D-天冬氨酸受体脑炎20例诊治分析[J].山东医药，2016，56（20）：43-45.
[3] Wang Y，Zhang W，Yin J，et al. Anti-N-methyl-d-aspartate receptor encephalitis in children of Central South China：Clinical features，treatment，influencing factors，and outcomes [J]. J Neuroimmunol，2017，312：59-65.
[4] Nagappa M，Bindu PS，Mahadevan A，et al. Clinical Features，Therapeutic Response，and Follow-Up in Pediatric Anti-N-Methyl-d-Aspartate Receptor Encephalitis：Experience from a Tertiary Care University Hospital in India [J]. Neuropediatrics，2016，47（1）：24-32.
[5] 邓波，陈向军，李翔，等.抗N-甲基-D-天冬氨酸受体脑炎患者的脑脊液指标异常及其与病程相关性分析[J].中国临床神经科学，2016，24（5）：528-534.
[6] 李小毛，蒋慧云，陆正齐，等.抗N-甲基-D-天冬氨酸受体脑炎27例分析[J].广东医学，2017，38（7）：1035-1038.
[7] Kahn I，Helman G，Vanderver A，et al. Anti-N-Methyl-d-Aspartate（NMDA）Receptor Encephalitis：A Survey of Treatment Progress and Prospects From Pediatric Neurologists [J]. J Child Neurol，2017，32（2）：243-245.
[8] 张琴，曾丽.儿童和成人抗N-甲基-D-天冬氨酸受体脑炎的临床特征[J].中国神经精神疾病杂志，2016，42（11）：658-663.
[9] Huang Q，Wu Y，Qin R，et al. Clinical characteristics and outcomes between children and adults with anti-N-Methyl- d -Aspartate receptor encephalitis [J]. J Neurol，2016，263（12）：2446-2455.
[10] 吴颖颖，张杰文.抗N-甲基-D-天门冬氨酸受体脑炎与肿瘤关系的研究进展[J].中国神经免疫学和神经病学杂志，2016，23（2）：125-128.
[11] Brenton JN，Kim J，Schwartz RH. Approach to the Management of Pediatric-Onset Anti-N-Methyl-d-Aspartate （Anti-NMDA）Receptor Encephalitis：A Case Series [J]. J Child Neurol，2016，31（9）：1150-1155.
[12] 季涛云，张月华，吴晔，等.儿童抗N-甲基-D-天门冬氨酸受体脑炎17例临床研究[J].中国实用儿科杂志，2014，29（7）：515-519.
[13] Sunwoo JS，Jung DC，Choi JY，et al. Successful Treatment of Refractory Dyskinesia Secondary to Anti-N-Methyl-D-Aspartate Receptor Encephalitis With Electroconvulsive Therapy [J]. J ECT，2016，32（3）：e13-e14.
[14] Ellul MA，Griffiths MJ，Iyer A，et al. Anti-N-Methyl-D-Aspartate Receptor Encephalitis in a Young Child with Histological Evidence on Brain Biopsy of Co-existent Herpes Simplex Virus Type 1 Infection [J]. Pediatr Infect Dis J，2016，35（3）：347-349.
[15] 彭晓音，董静静，高志杰，等.儿童抗N-甲基-D-天冬氨酸受体脑炎临床特点及治疗随访[J].中华实用儿科临床杂志，2015，30（5）：374-378.
[16] 赵曼曼.抗N-甲基-D-天门冬氨酸受体脑炎与病毒性脑炎的关系[J].国际儿科学杂志，2016，43（6）：453-456.
[17] Millichap JJ，Goldstein JL，Laux LC，et al. Ictal asystole and anti-N-methyl-D-aspartate receptor antibody encephalitis [J]. Pediatrics，2011，127（3）：e781-e786.
[18] Peng Y，Liu X，Pan S，et al. Anti-N-methyl-D-aspartate receptor encephalitis associated with intracranial Angiostrongylus cantonensis infection：a case report [J]. Neurol Sci，2017，38（4）：703-706.
[19] 刘青，熊李，熊倩倩，等.抗神经元细胞内抗原抗体相关自身免疫性脑炎临床分析[J].中华神经科杂志，2017， 50（2）：112-115.
[20] 武运红，唐宇辉，张艳芝.儿童抗NMDA受体脑炎20例临床特点及随访研究[J].山西医药杂志，2017，46（15）：1865-1867.