鼠神经生长因子联合丙种球蛋白治疗小儿脱髓鞘型吉兰—巴雷综合征的临床和神经电生理研究

发布时间：2018-06-03 03:17

本文选题：吉兰-巴雷综合征 + 丙种球蛋白　；参考：《山东大学》2012年硕士论文

【摘要】：目的探讨鼠神经生长因子(mNGF)联合丙种球蛋白(IVIG)治疗小儿脱髓鞘型吉兰-巴雷综合征(GBS)的疗效。方法对自1995年1月至2011年12月期间我院收治的共51例脱髓鞘型GBS患儿的临床资料进行回顾性比较分析,临床表现、体征及辅助检查结果等均符合国际GBS的诊断标准。根据既往的治疗方案共分为两组,mNGF+IVIG组32例：男20例,女12例；IVIG组19例：男11例,女8例。IVIG组给予IVIG0.4g/(kg·d)静脉滴注,连用5d,并辅以维生素B6、B1和胞二磷胆碱等营养神经治疗以及针灸、按摩等康复治疗,防止感染及其他对症支持治疗；mNGF+IVIG组在IVIG组治疗的基础上,加用mNGF20ug im qd治疗,连用4周。两组定期行Hughes肢体运动功能评分及神经电生理检查(包括运动神经传导速度及F波潜伏期),观察记录疗效及药物不良反应情况,将结果进行统计学分析。结果两组病例在一般临床资料,如年龄、性别、前驱感染等方面进行比较(P0.05),具有可比性。全部患儿治疗4周后行肢体运动功能评分,mNGF+IVIG组恢复明显好于IVIG组(P0.05)；mNGF+IVIG组恢复至能独立行走5m所用的时间较单纯IVIG组明显缩短(P0.05)；治疗后3个月,神经电生理检测显示mNGF+IVIG组运动神经传导速度及F波平均潜伏期恢复均较IVIG组快(P0.05)。两组病例在治疗过程中均未见严重的不良反应发生。结论mNGF联合IVIG治疗小儿脱髓鞘型吉兰-巴雷综合征的疗效较单纯应用丙种球蛋白治疗效果更显著,运动功能恢复增快,明显缩短病程,改善神经电生理指标,并且无严重不良反应,值得临床广泛推广应用。
[Abstract]:Objective to investigate the effect of nerve growth factor NGF (NGF) combined with immunoglobulin (IVIGG) on demyelinating Guillain-Barre syndrome (GBS) in children. Methods the clinical data of 51 cases of demyelinating type GBS from January 1995 to December 2011 were analyzed retrospectively. The clinical manifestations, signs and auxiliary examination results were in accordance with the diagnostic criteria of international GBS. According to the previous treatment regimen, 32 patients in the IVIG group were divided into two groups: male 20, female 12: M 11, F 8. IVIG group were given IVIG0.4g/(kg d intravenous drip for 5 days, supplemented with nutritional nerve therapy such as vitamin B6 and citicoline, as well as acupuncture and moxibustion. IVIG group was treated with mNGF20ug im QD for 4 weeks on the basis of IVIG treatment. Hughes motor function score and electrophysiologic examination (including motor nerve conduction velocity and F-wave latency) were performed regularly in both groups. The curative effects and adverse drug reactions were recorded and the results were analyzed statistically. Results the two groups were compared in general clinical data, such as age, sex, preinfection and so on. After 4 weeks of treatment, the recovery time to 5 m in the IVIG group was significantly better than that in the IVIG group, and the recovery time to 5 m in the IVIG group was significantly shorter than that in the IVIG group, 3 months after the treatment, the recovery time was significantly shorter than that in the simple IVIG group, 3 months after the treatment, the recovery time was significantly shorter than that in the IVIG group, and the recovery time was significantly shorter than that in the IVIG group. Nerve electrophysiological examination showed that motor nerve conduction velocity and average latency of F wave recovered faster in mNGF IVIG group than in IVIG group (P 0.05). There were no serious adverse reactions in both groups. Conclusion the curative effect of mNGF combined with IVIG in the treatment of children's demyelinating type Guillain-Barre syndrome is more obvious than that of the simple application of gamma globulin, the recovery of motor function is faster, the course of disease is shortened obviously, and the electrophysiological indexes of nerve are improved. And no serious adverse reactions, worthy of clinical wide application.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R745.43

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