| Viral encephalitis is a common disease in children. Especially severe viral encephalitis, its pathological changes such as brain ischemia and edema are very significant because of its long coma and frequent seizures. Without specific therapy method , it is easy to lead to neurological sequela. But with the development of Immunology, people found the high correlation between CNS inflammation and IL - 1 ,TNF - a. NSE is an enzyme to quantitively judge the neuron injuries . This report wants to evaluate the effect of IVIG by comparing the changes of NSE,IL - 1,TNF - a levels in CSF before and after the treatment with IVIG in 42 patients with severe viral encephalitis.Materials and MethodsThe diagnostic criteria of viral encephalitis is according to the 6th edition of 《Textbook of Pediatrics》 of Fu Tang Zhu. We chose the patients of coma or frequent seizures as object. The 42 patients from 2002.3 to 2003. 3 are divided into 2 groups; the therapy group and the control group. Therapy group; 26 patients, 15 male, 11 female, Age; 1.5 ~ 13 year, mean age is 7. 8 year. Control group ; 16 patients, 9 male, 7 female,age; 0. 8 ~ 14year,mean age is 6.3year. The controlgroup only adopted the basic therapy measurement such as antiinflam-mation, antiviraltreatment, dehydration, decreasing ICP,brain cell nutrition. The therapy group also used IVIG(400mg/kg/d, x5d ) on the base of basic treatment. All patients were given lumbar puncture at 3 ~5day after disease. After first lumbar puncture, the treatment group immediately added IVIG(400mg/kg/d , x5d). One week later, two group patients reexamine lumbar puncture. Each time we gathered CSF 2ml, storge at -20℃. NSE was automatically detected by 1010 chemiluminescent analyzer . IL - 1 and TNF - a were automatically detected by Immulite chemiluminescent analyzer.Results一, The changes of NSE IL - 1.TNF - a levels in CSF before and after the treatment with IVIG.In A group, the levels of NSE IL - 1 ,TNF - a were 122. 54 ± 105.09(ng/ml),6.86±2.29(pg/ml),85.8 ±23.4 (pg/ml)before treatment respectively; After the treatment they were 10. 74 ± 6. 37 (ng/ml),1.71 ±0.48(pg/ml),18.0±9.2(pg/ml). In B group, the levels of NSE JL - 1 ,TNF - a were 118. 30 ± 100. 18( ng/ml) ,5. 88 ± 3. 24 ( pg/ml) , 83. 9 ± 28. 4 ( pg/ml) ; After the treatment they were 24. 79 ± 11. 96 ( ng/ml) , 1. 77 ±0. 10 ( pg/ml) ,24. 7 ±10.3 (pg/ml).The levels of NSE ,IL - 1,TNF - a befor treatment were obviously higher than those after treatment. There is no statistical significance by comprising between A group and B group before treatment(P >0. 50) ; After treatment, the levels of NSE,IL - 1,TNF - a were degraded greatly. The comparison between levels of NSE ,IL - 1, TNF - abefore treatment and those after treatment was significant(P <0. 01) . After treatment the comparison between levels of NSE,IL - 1 ,TNF - a in A group and B group was significant (P <0. 05) .二, The data from clinical observationWe can see from clinical observation, the lasting time of fever, coma and seizure in therapy group was shorter than those in control group. In therapy group, 19patients' temperature were degraded to normal at the 2nd day of using IVIG, 5 pati ents at the 3nd day of using IVIG, and 2 patients at the 4th day, While in control group fever lasts from 3 to 10 days. In treatment group the coma last from 0. 5 to 5 days, mean 3.4days, while in control group lasting 3 ~22days, mean 13days, The seizure lasts 1 ~ 7days in therapy group, mean 3 days, but in control group lasting 4 ~ 26 days, mean 12 days.Conclusion1. There were the increase of IL - 1, TNF - a and NSE in the early stage of the serious viral encephalitis.2. Using IVIG for 5 days, 400mg/kg/d, it can reduce the levels of IL - 1,TNF - a and NSE and shorten the lasting time of fever , coma and seizures. We should use IVIG as soon as possible in the early serious viral encephalitis to relieve the inflammation reaction and reduce the neuron injury.
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