Yen Meng-Hsiu, Huang Yhu-Chering, Chen Min-Chi, Liu Ching-Chuan, Chiu Nan-Chang, Lien Reyin, Chang Luan-Yin, Chiu Cheng-Hsun, Tsao Kuo-Chien, Lin Tzou-Yien
Departments of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Science, Chang Gung University School of Medicine, Taoyuan, Taiwan.
Departments of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
J Clin Virol. 2015 Mar;64:92-6. doi: 10.1016/j.jcv.2015.01.013. Epub 2015 Jan 21.
The benefits of intravenous immunoglobulin (IVIG) therapy for severe neonatal enterovirus infections are still controversial.
To evaluate whether timing of IVIG administration might affect clinical outcomes of neonates with severe enteroviral infections.
We retrospectively analyzed 67 neonates with culture-confirmed severe enteroviral infection, defined as hepatitis with coagulopathy and thrombocytopenia. Clinical features, outcomes and the usage of IVIG therapy were collected and analyzed. IVIG administered within 3 days of illness onset was classified as early IVIG therapy.
Of the 67 cases, 38 (57%) were male, 27 (40%) were premature, 57 (85%) had disease onset within 7 days of life and all but 2 cases were caused by coxsackievirus B group. Ten infants (15%) had clinically evident myocarditis. 41 infants (61%) received IVIG therapy and 29 were early IVIG therapy. Fifteen infants (22%) eventually died, without IVIG therapy for 7 infants. The deceased had a significantly higher peak serum aspartate aminotransferase (AST) level than the survivors (3539 vs. 866 IU/L, p<0.01). The timing of IVIG therapy was highly correlated with the timing of peak AST level in patients with early IVIG therapy. Multiple logistic regression analysis showed that a higher nadir hemoglobin level (adjusted odds ratio 2.8, 95% confidence interval: 1.4-5.4), no concurrent myocarditis (42.6 [3.4-5289]) and early IVIG therapy (14.7 [1.3-163]) were independently associated with a favorable prognosis.
In defined severe neonatal enterovirus infections, serum AST level correlated with the disease severity. Early IVIG therapy, if needed, may be beneficial for survival.
静脉注射免疫球蛋白（IVIG）治疗重症新生儿肠道病毒感染的益处仍存在争议。
评估IVIG给药时机是否会影响重症肠道病毒感染新生儿的临床结局。
我们回顾性分析了67例经培养确诊为重症肠道病毒感染的新生儿，定义为伴有凝血病和血小板减少的肝炎。收集并分析临床特征、结局及IVIG治疗的使用情况。在发病3天内给予IVIG被归类为早期IVIG治疗。
67例病例中，38例（57%）为男性，27例（40%）为早产儿，57例（85%）在出生后7天内发病，除2例病例外均由B组柯萨奇病毒引起。10例婴儿（15%）有临床明显的心肌炎。41例婴儿（61%）接受了IVIG治疗，其中29例为早期IVIG治疗。15例婴儿（22%）最终死亡，7例未接受IVIG治疗。死亡者的血清天冬氨酸氨基转移酶（AST）峰值水平显著高于存活者（3539对866 IU/L，p<0.01）。在早期IVIG治疗的患者中，IVIG治疗时机与AST峰值水平的时机高度相关。多因素逻辑回归分析显示，较低的血红蛋白最低点水平（校正比值比2.8，95%置信区间：1.4 - 5.4）、无并发心肌炎（42.6 [3.4 - 5289]）和早期IVIG治疗（14.7 [1.3 - 163]）与良好预后独立相关。
在明确的重症新生儿肠道病毒感染中，血清AST水平与疾病严重程度相关。如有需要，早期IVIG治疗可能有利于存活。
