作者：成亚渝，高航

单位：

1.430000 湖北省武汉市，武汉大学人民医院儿科 2.430000 湖北省武汉市，武汉大学人民医院重症医学科 通信作者：高航，E-mail：gaohangv11@163.com

Units：

1.Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan 430000, China 2.Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430000, China Corresponding author: GAO Hang, E-mail: gaohangv11@163.com

关键词：

病毒性脑炎; 精神行为异常; 儿童; 更昔洛韦; 单唾液酸四己糖神经节苷脂; 临床症状; 神经营养因子类; 免疫功能;

Keywords：

Viral encephalitis; Abnormal mental behavior; Child; Ganciclovir; Monosialotetrahexosylganglioside;Clinical symptoms; Neurotrophic factors; Immune function

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.242

Funds：

摘要：

背景研究表明,病毒性脑炎（VE）早期即可导致脑神经不可逆损伤,而仅给予抗病毒治疗常难达到较好的治疗效果,仍需探索新的治疗方案。目的探讨更昔洛韦联合单唾液酸四己糖神经节苷脂对VE伴精神行为异常患儿临床症状、神经营养分子及免疫功能的影响。方法选取2019年9月至2020年10月武汉大学人民医院收治的83例VE伴精神行为异常患儿作为研究对象,采用随机数字表法将其分为治疗组（n=42）和对照组（n=41）。对照组患儿在常规治疗基础上给予更昔洛韦注射液治疗,治疗组患儿在常规治疗基础上给予更昔洛韦注射液联合单唾液酸四己糖神经节苷脂钠注射液治疗,两组患儿均连续治疗14 d。比较两组患儿临床疗效、临床症状消失时间,治疗前后血清神经营养因子[脑源性神经营养因子（BDNF）和神经营养因子3（NT-3）]水平、免疫指标（CD3+T淋巴细胞百分比、CD4+T淋巴细胞百分比、CD8+T淋巴细胞百分比）及血清炎性因子[肿瘤坏死因子α（TNF-α）、白介素（IL）-6、IL-8]水平;并记录两组患者治疗期间不良反应发生情况。结果治疗组患儿临床疗效优于对照组（P<0.05）。治疗组患儿意识障碍、精神症状、脑膜刺激征、呕吐、发热、抽搐消失时间均短于对照组（P<0.05）。治疗后,治疗组患儿血清BDNF、NT-3水平及CD3+T淋巴细胞百分比、CD4+T淋巴细胞百分比高于对照组,CD8+T淋巴细胞百分比及血清TNF-α、IL-6、IL-8水平低于对照组（P<0.05）。两组患儿治疗期间均未出现明显不良反应。结论更昔洛韦联合单唾液酸四己糖神经节苷脂治疗VE伴精神行为异常患儿的临床疗效确切,可有效减轻患儿临床症状,提高患儿神经营养因子水平,改善患儿免疫功能,降低患儿炎性因子水平,且未增加药物相关不良反应。

Abstract：

【Abstract】　Background Studies have found that viral encephalitis (VE) can lead to irreversible brain nerve damagein the early stage, but it is often difficult to achieve good therapeutic effect only by antiviral treatment, and new treatment schemesstill need to be explored. Objective To investigate the impact of ganciclovir combined with monosialotetrahexosylgangliosideon clinical symptoms, neurotrophic factors and immune function in children with VE and mental behavior disorder. Methods Atotal of 83 children with VE and abnormal mental behavior treated in the Renmin Hospital of Wuhan University from September2019 to October 2020 were selected as research objects. They were randomly divided into treatment group (n=42) and controlgroup (n=41) using random number table method. Children in the control group were treated with ganciclovir injection on the basisof routine treatment, and the children in the treatment group were treated with ganciclovir injection combined with monosialotetrahexosylganglioside sodium injection on the basis of routine treatment. Both groups were treated for 14 days. The clinical efficacy,disappearance time of clinical symptoms, serum levels of neurotrophic factors [brain-derived neurotrophic factor (BDNF) andneurotrophic factor 3 (NT-3) ] , immune indexes (percentage of CD3+ T lymphocytes, CD4+ T lymphocytes and CD8+ T lymphocytes)and serum levels of inflammatory factors [tumor necrosis factor alpha (TNF-α) , interleukin (IL)-6 and IL-8] were comparedbetween the two groups; and the adverse reactions of the two groups during treatment were recorded.Results The clinicalefficacy of the treatment group was better than that of the control group (P< 0.05) . The disappearance time of consciousnessdisorder, mental symptoms, meningeal irritation, vomiting, fever and convulsion in the treatment group were shorter than thosein the control group (P < 0.05) . After treatment, the serum levels of BDNF and NT-3, the percentage of CD3+ T lymphocytes andCD4+ T lymphocytes in the treatment group were higher than those in the control group (P < 0.05) ; after treatment, the percentageof CD8+ T lymphocytes, the serum levels of TNF-α, IL-6 and IL-8 in the control group were lower than those in the control group(P< 0.05) . There were no obvious adverse reactions in the two groups during treatment.Conclusion Ganciclovir combined withmonosialotetrahexosylganglioside in the treatment of children with VE and mental behavior disorder has a definite clinical effect.It can effectively reduce the clinical symptoms, improve the level of neurotrophic factors and immune function, reduce the level ofinflammatory factors, and does not increase drug-related adverse reactions.

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