小儿化毒胶囊联合利巴韦林治疗儿童EV71感染手足口病的临床效果  

Clinical effect of Xiaoer Huadu capsule combined with ribavirin on treatment of hand,foot and mouth disease children with EV71 infection

作　　者：王佳[1] 张龙 张晶 刘春霞[1] 白华[1] WANG Jia;ZHANG Long;ZHANG Jing;LIU Chun-xia;BAI Hua(General Hospital of Ningxia Medical University,Yinchuan,Ningxia 750004,China)

机构地区：[1]宁夏医科大学总医院儿科,宁夏银川750004

出　　处：《中华医院感染学杂志》2021年第10期1486-1491,共6页Chinese Journal of Nosocomiology

基　　金：宁夏回族自治区卫生计生系统重点研究基金资助项目(2017-NW-014)。

摘　　要：目的探讨小儿化毒胶囊联合利巴韦林治疗儿童肠道病毒71型(EV71)感染手足口病(HFMD)的效果.方法选取2019年1月-2020年6月宁夏医科大学总医院儿科114例EV71感染HFMD患儿为研究对象,依据治疗方案不同分为单药组及联合组,每组57例.单药组采用利巴韦林治疗,联合组在单药组基础上加用小儿化毒胶囊,两组均治疗4d.统计两组患儿临床疗效、症状缓解时间、不良反应发生率,治疗前后血清炎性因子[白细胞介素-6(IL-6)、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)]水平,心肌酶谱[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(α-HBDH)]水平,免疫功能[T淋巴细胞亚群(CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+))、免疫球蛋白(IgM、IgA、IgG)]水平,中枢神经系统[神经元特异性烯醇化酶(NSE)、S-100β蛋白]指标水平.结果联合组总有效率(92.98%)高于单药组(78.95%),两组比较差异有统计学意义(P<0.05);联合组发热、疱疹及手足皮疹消退时间、口腔黏膜愈合时间均短于单药组(P<0.05);治疗后联合组血清IL-6(2.21±0.69)μg/L、CRP(1.19±0.37)mg/L、TNF-α(1.01±0.30)μg/L、PCT(7.89±1.64)mg/L水平低于单药组(P<0.05);血清CK(125.61±26.15)U/L、CK-MB(15.01±3.46)U/L、α-HBDH(156.63±10.55)U/L均低于单药组(P<0.05);T淋巴细胞亚群CD_(3)^(+)(55.15±6.10)%、CD_(4)^(+)(36.45±3.69)%、CD_(4)^(+)/CD_(8)^(+)(1.58±0.26),IgM(1.89±0.35)、IgA(1.32±0.30)、IgG(13.20±2.81)水平均高于单药组(P<0.05);治疗后联合组S-100β(0.94±0.21)μg/L、NSE(14.32±2.12)μg/L均低于单药组(P<0.05);联合组不良反应发生率为10.53%,单药组为7.02%,两组比较无显著差异.结论小儿化毒胶囊联合利巴韦林治疗EV71感染HFMD患儿效果显著,能提高免疫功能,减轻炎症反应,保护心肌细胞,减轻脑损伤,促进症状控制,且安全性高.OBJECTIVE To explore the effect of Xiaoer Huadu capsule combined with ribavirin on treatment of the hand,foot and mouth disease(HFMD)patients with enterovirus 71(EV71)infection.METHODS A total of 114 HFMD children with EV71 infection who were treated in the pediatrics department of General Hospital of Ningxia Medical University from Jan 2019 to Jun 2020 were recruited as the study subjects and divided into the monotherapy group and the combined group according to the treatment plans,with 57 cases in each group.The monotherapy group was treated with ribavirin,while the combined group was given additional Xiaoer Huadu capsule on basis of the therapy of the monotherapy group,and both groups were treated for 4 days.The clinical curative effects,time of remission of symptoms and incidence of adverse reactions were statistically analyzed;the levels of serum inflammatory factors[interleukin-6(IL-6),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),procalcitonin(PCT)],myocardial enzyme spectrum[creatine kinase(CK),creatine kinase isoenzyme(CK-MB),α-hydroxybutyrate dehydrogenase(α-HBDH)]and immune function[T lymphocyte subsets(CD_(3)^(+),CD_(4)^(+),CD_(4)^(+)/CD_(8)^(+)),immunoglobulins(IgM,IgA,IgG)]as well as central nervous system[neuron-specific enolase(NSE),S-100βprotein]were observed and compared between the two groups of children before and after the treatment.RESULTS The total effective rate of the combined group was 92.98%,significantly higher than 78.95%of the monotherapy group(P<0.05).The subsidence time of fever,herpes and hand and foot rash as well as healing time of oral mucosa was significantly shorter in the combined group than in the monotherapy group(P<0.05).The levels of serum IL-6,CRP,TNF-αand PCT of the combined group were respectively(2.21±0.69)ug/L,(1.19±0.37)mg/L,(1.01±0.30)ug/L and(7.89±1.64)mg/L after the treatment,significantly lower than those of the monotherapy group(P<0.05).The levels of serum CK,CK-MB andα-HBDH of the combined group were respectively(125.61±26.15)U/L,(15.01±

关 键 词：小儿化毒胶囊 肠道病毒71型感染 手足口病 免疫功能 心肌酶谱 肿瘤坏死因子-α 

分 类 号：R373.2[医药卫生—病原生物学]