CAJ | 학술논문

目的对静脉注射免疫球蛋白(INIG)临床治疗儿童癫痫的疗效及可能机制进行分析,为临床应用IVIG治疗儿童癫痫提供依据.方法回顾性分析98例癫痫患儿应用IVIG治疗癫痫的疗效、耐受性、安全性及治疗前后的免疫指标改变.免疫指标包括淋巴细胞亚群和血清免疫球蛋白,前者用流式细胞仪检测,后者用免疫比浊法检测.设健康体检儿童66例为对照组,测定其免疫指标.结果 IVIG治疗癫痫总体治疗有效率为78.57%.部分发作有效率为77.27%,全面发作有效率为79.63%.两者差异无统计学意义(P>0.05).特发性癫痫有效率68.09%,症状性癫痫有效率为88.23%,差异有统计学意义(P<0.05).首次单药治疗组有效率89.29%,二次单药组有效率69.23%,添加治疗组有效率75.43%,3组间差异无统计学意义(P>0.05).45例头颅MRI异常的患儿治疗后半年复查,31例病灶有改善,总有效率为68.89%;13例患者出现药物副作用,发生率为13.27%,但症状轻微,没有因不能耐受而停用的情况.治疗前,癫痫组CD19~+B、CD20~+B细胞比例较对照组增高,CD3~+CD4~+T细胞比例较对照组低,差异有统计学意义(P<0.05).治疗后CD19~+B和CD20~+B细胞比例较治疗前明显降低,差异有统计学意义(P<0.05);而CD3~+CD4~+较治疗前明显升高,差异有统计学意义(P<0.05).治疗后3周末、6个月时2组患儿的血清IgG水平明显增高,与治疗前比较差异有统计学意义(P<0.05).结论 IVIG对癫痫患儿增高的CD19~+B和CD20~+B细胞有下调作用,对伴有免疫紊乱的症状性癫痫有较好的疗效.
목적 대정맥주사면역구단백(INIG)림상치료인동전간적료효급가능궤제진행분석,위림상응용IVIG치료인동전간제공의거.방법 회고성분석98례전간환인응용IVIG치료전간적료효、내수성、안전성급치료전후적면역지표개변.면역지표포괄림파세포아군화혈청면역구단백,전자용류식세포의검측,후자용면역비탁법검측.설건강체검인동66례위대조조,측정기면역지표.결과 IVIG치료전간총체치료유효솔위78.57%.부분발작유효솔위77.27%,전면발작유효솔위79.63%.량자차이무통계학의의(P>0.05).특발성전간유효솔68.09%,증상성전간유효솔위88.23%,차이유통계학의의(P<0.05).수차단약치료조유효솔89.29%,이차단약조유효솔69.23%,첨가치료조유효솔75.43%,3조간차이무통계학의의(P>0.05).45례두로MRI이상적환인치료후반년복사,31례병조유개선,총유효솔위68.89%;13례환자출현약물부작용,발생솔위13.27%,단증상경미,몰유인불능내수이정용적정황.치료전,전간조CD19~+B、CD20~+B세포비례교대조조증고,CD3~+CD4~+T세포비례교대조조저,차이유통계학의의(P<0.05).치료후CD19~+B화CD20~+B세포비례교치료전명현강저,차이유통계학의의(P<0.05);이CD3~+CD4~+교치료전명현승고,차이유통계학의의(P<0.05).치료후3주말、6개월시2조환인적혈청IgG수평명현증고,여치료전비교차이유통계학의의(P<0.05).결론 IVIG대전간환인증고적CD19~+B화CD20~+B세포유하조작용,대반유면역문란적증상성전간유교호적료효.
Objective To explore the therapeutic effect of intravenous immunoglobulin(IVIG)on children with epilepsy and its mechanism to provide evidence for clinical application of IVIG into the management of children with epilepsy.Methods We retrospectively reviewed the data of 98 children with childhood-onset epilepsy treated with IVIG.Sixty-six health children were chosen as control group.The efficacy,tolerability,safety and serum immunological parameters of these patients were mainly evaluated and the serum immunologicla parameters,including T-1ymphocyte subsets and serum immunoglobulin,were detected by flow cytometry and immunoturbidimetry,respectively.Results The total effective rotes were 78.57%.Partial seizures-free rate(77.27%)and generalized seizures-free rate(79.63%)were not statistically different(P>0.05).The effective rate of symptomatic epilepsy (88.23%)and that of idiopathic epilepsy(68.09%)were significantly different(P<0.05).No significant difference of effective rates was found among the patients with new onset epilepsy having IVIG as first-line treatment(89.29%),the patients with monotherapy of MG after withdrawing AEDs(69.23%)and the patients with IVIG adjunct to other AEDs(75.43%,P>0.05).Thirty-one out of 45 patients with abnormal MRI on the brain showed improvement 6 months after treatment with IVIG.Thirteen patients had drug reactions,but could be tolerable for all these patients.Compared with the control group,epileptic groups showed significantly increased expressions of CD19~+B and CD20~+B cells and significantly decreased CD3~+CD4~+T cells.After the treatment with IVIG,epileptic groups showed significantly decreased expressions of CD19~+B and CD20~+B cells and significantly increased CD3~+CD4~+T cells as compared with the epileptic groups before the treatment.Three weeks and six months after the IVIG treatments,the level of serum IgG in the epileptic groups was significantly elevated as compared with that before treatment.Conclusion IVIG treatment,decreasing the expressions of CD19~+B and CD20~+B,is effective in treating patients with symptomatic epilepsy following immune disorders.