2022 年第 7 期 第 17 卷

丙种球蛋白联合糖皮质激素治疗儿童扩张型心肌病的临床效果观察

Clinical effect of gamma globulin combined with glucocorticoids on dilated cardiomyopathy in children 

作者：王莹雪郝京霞李博陈敬师张英谦

英文作者：Wang Yingxue Hao Jingxia Li Bo Chen Jingshi Zhang Yingqian

单位：河北省儿童医院心内科河北省小儿心血管重点实验室，石家庄050000

英文单位：Department of Cardiology Hebei Children′s Hospital Hebei Provincial Key Laboratory of Pediatric Cardiovascular Disease Shijiazhuang 050000 China

关键词：扩张型心肌病；丙种球蛋白；糖皮质激素

英文关键词：Dilatedcardiomyopathy;Gammaglobulin;Glucocorticoids 

• 摘要：

• 目的 观察丙种球蛋白联合糖皮质激素治疗儿童扩张型心肌病（DCM）的效果。方法 回顾性分析2017年1月至2021年12月河北省儿童医院收治的59例DCM患儿的临床资料，依据历史治疗方式的不同分为常规治疗组（24例）、联合治疗组（35例）。常规治疗组接受强心、利尿、扩血管、抗感染等治疗，联合治疗组在常规治疗的基础上联合应用丙种球蛋白和糖皮质激素。比较2组近期血清学指标、左心室射血分数（LVEF）、不良反应发生情况及治疗后1、2年临床疗效、左心室舒张末期内径（LVEDD）改善情况及再住院率。进一步探讨联合治疗后LVEDD改善情况与治疗前血清白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、IL-10水平的关系。结果 治疗后，2组血清B型脑钠肽、肌酸激酶同工酶、心肌肌钙蛋白I、红细胞沉降率、C反应蛋白水平均低于治疗前、且联合治疗组低于常规治疗组，LVEF均高于治疗前，且联合治疗组高于常规治疗组，差异均有统计学意义（均P＜0.05）。2组患儿不良反应发生率比较差异无统计学意义（P>0.05）。治疗后1、2年，联合治疗组总有效率高于常规治疗组［70.6%（24/34）比42.9%（9/21）、82.6%（19/23）比50.0%（8/16）］，差异均有统计学意义（均P<0.05）。治疗后1、2年，联合治疗组LVEDD改善率高于常规治疗组，差异均有统计学意义（均P<0.05）。LVEDD有改善者治疗前IL-6、TNF-α水平高于无改善者，差异均有统计学意义（均P<0.05）。治疗后1、2年，联合治疗组再住院率低于常规治疗组，差异均有统计学意义（均P<0.05）。结论 丙种球蛋白联合糖皮质激素治疗儿童DCM临床效果确切，可有效降低炎性指标，改善LVEF及LVEDD、降低再住院率，且用药安全性较高。

• Objective To observe the clinical effect of gamma globulin combined with glucocorticoids on dilated cardiomyopathy in children. Methods The clinical data of 59 children with dilated cardiomyopathy admitted to Hebei Children′s Hospital from January 2017 to December 2021 were analyzed retrospectively. According to different historical therapy, they were divided into routine treatment group(24 cases) and combined treatment group(35 cases). The routine treatment group was treated with cardiotonic, diuretic, vasodilation, and anti-infection measures. The combined group was treated with gamma globulin and glucocorticoids based on routine treatment. The recent serological indexes, left ventricular ejection fraction(LVEF), adverse reactions, clinical efficacy, improvement of left ventricular end diastolic diameter(LVEDD) and readmission rate 2 years after treatment were compared between the two groups. The relationship between the improvement of LVEDD after combined treatment and levels of interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), and IL-10 before treatment was analyzed. Results After treatment, the levels of serum brain-natriuretic peptide, creatine kinase isoenzyme, cardiac troponin I, erythrocyte sedimentation rate and C-reactive protein in both groups were lower than those before treatment, and the levels in the combined treatment group were lower than those in the routine treatment group; the levels of LVEF in both groups were higher than those before treatment, and the level of LVEF in the combined group was higher than that in the routine treatment group(all P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). After 1 and 2 years of treatment, the total effective rates of the combined treatment group were higher than those of the routine treatment group［70.6%(24/34) vs 42.9%(9/21), 82.6%(19/23) vs 50.0%(8/16)］(both P<0.05). After 1 and 2 years of treatment, the improvement rates of LVEDD in the combined treatment group were higher than those in the routine treatment group(both P<0.05); the levels of IL-6 and TNF-α before treatment in patients with improved LVEDD was significantly higher than that without improvement(all P<0.05); the readmission rates in the combined treatment group were lower than those in the routine treatment group(both P<0.05). Conclusions The treatment of gamma globulin combined with glucocorticoids in children with dilated cardiomyopathy has definite clinical efficacy, which can effectively reduce inflammatory indicators, improve LVEF and LVEDD, reduce the readmission rate, and has high safety.