90例手足口病并發(fā)中樞神經(jīng)系統(tǒng)感染的中醫(yī)證治研究
發(fā)布時間：2018-08-19 18:49
【摘要】：重癥手足口病多由腸道病毒71型感染,腸道病毒71型有明顯的嗜神經(jīng)性,可導(dǎo)致無菌性腦膜炎、腦炎、腦干腦炎、腦脊髓炎、脊髓灰質(zhì)炎樣綜合征等神經(jīng)系統(tǒng)病變。近年來手足口病發(fā)病率及死亡率很高,引起了我們高度的關(guān)注。然而對于手足口病的研究,尤其是手足口病重癥的研究,無論是發(fā)病機制還是治療,中醫(yī)還是西醫(yī)均尚不完全清楚。本課題研究是北京市中醫(yī)藥管理局“手足口病并發(fā)中樞神經(jīng)系統(tǒng)感染的中醫(yī)藥證治研究”課題的一部分,旨在了解臨沂地區(qū)的手足口病并發(fā)中樞神經(jīng)系統(tǒng)感染的發(fā)病特點,評價中醫(yī)藥臨床療效,進一步探索重癥手足口病的病因病機。 目的：對山東省臨沂市人民醫(yī)院收治的手足口病并發(fā)中樞神經(jīng)系統(tǒng)感染病例的臨床資料進行整理,了解臨沂地區(qū)的手足口病并發(fā)中樞神經(jīng)系統(tǒng)感染的發(fā)病特點,評價中醫(yī)藥臨床療效,進一步探索重癥手足口病的病因病機。 方法：本研究是在北京市中醫(yī)管理局傳染病重大專項項目——手足口病并發(fā)中樞神經(jīng)系統(tǒng)感染的中醫(yī)藥證治研究基礎(chǔ)上完成的。手足口病并發(fā)中樞神經(jīng)系統(tǒng)感染的中醫(yī)藥證治研究重大專項項目是前瞻性、多中心、隨機對照的臨床研究,共有6家中心,是統(tǒng)一制定調(diào)查表對手足口病并發(fā)中樞神經(jīng)系統(tǒng)感染的患兒進行調(diào)查研究,采集符合納入標(biāo)準(zhǔn)的手足口病并發(fā)中樞神經(jīng)系統(tǒng)感染患兒的一般情況、中醫(yī)四診信息以及相關(guān)的實驗室檢查。 本研究采用回顧性方法對2010年7月-2010年9月山東臨沂人民醫(yī)院(6家中心之一)收治的90例手足口病并發(fā)中樞神經(jīng)系統(tǒng)感染的病例進行研究,運用SPSS統(tǒng)計軟件進行中西醫(yī)臨床資料的整理,了解臨沂地區(qū)的手足口病并發(fā)中樞神經(jīng)系統(tǒng)的發(fā)病特點,評價中醫(yī)藥臨床療效,進一步探索重癥手足口病的病因病機。 結(jié)果： 1.臨沂地區(qū)手足口病合并中樞神經(jīng)系統(tǒng)感染的重癥患兒,病原學(xué)以EV71型感染為主,并有EV71型和CoxA16型共同感染,大多數(shù)患兒發(fā)病前沒有明確的手足口病接觸史,發(fā)病人群以幼兒男童為主。 2.臨沂地區(qū)手足口病合并中樞神經(jīng)系統(tǒng)感染的重癥患兒的中醫(yī)證候表現(xiàn)發(fā)生率從高到低依次為手足口皮疹,納差,易驚,精神不振,口干,煩躁哭鬧,發(fā)熱等,輔助檢查白細胞值較正常范圍高。 3.從體溫降至正常時間方面,A組(西醫(yī)治療)、B組(西醫(yī)治療+痰熱清)與A組(西醫(yī)治療)、C組(西醫(yī)治療+痰熱清+中藥治療)組間有統(tǒng)計學(xué)差異(P0.05),表明B組與C組體溫降至正常時間較A組短。A組、B組、C組時間分別為49.85±19.38小時、39.33±17.91小時、40.14±12.85小時。比較經(jīng)3天治療后神經(jīng)系統(tǒng)癥狀方面,A組、C組有統(tǒng)計學(xué)差異(P=0.0160.0167),表明C組在神經(jīng)系統(tǒng)癥狀緩解率上較A組高。其中神經(jīng)系統(tǒng)癥狀緩解有效率C組為70%,B組64.3%,A組51.7%。比較緩解中醫(yī)癥狀方面,A組、C組間有統(tǒng)計學(xué)差異(P=0.010.0167),表明C組在中醫(yī)癥狀緩解率上較A組高。其中總顯效率C組為76.7%,B組為66.7%,A組為40%。 結(jié)論：采用西醫(yī)治療+痰熱清組,及西醫(yī)治療+痰熱清+中藥組在治療手足口病合并中樞神經(jīng)系統(tǒng)感染的重癥患兒療效顯著,在退熱時間方面優(yōu)于單純西醫(yī)組；西醫(yī)治療+痰熱清+中藥組在改善神經(jīng)系統(tǒng)癥狀及緩解中醫(yī)癥狀上優(yōu)于單純西醫(yī)組。
[Abstract]:Severe hand-foot-mouth disease is mostly caused by enterovirus 71. Enterovirus 71 has obvious neurotropism, which can lead to aseptic meningitis, encephalitis, brainstem encephalitis, encephalomyelitis, poliomyelitis-like syndrome and other neurological diseases. In recent years, the incidence and mortality of hand-foot-mouth disease is very high, which has aroused our great concern. The study of mouth disease, especially the study of severe hand-foot-mouth disease (HFMD), is not completely clear whether it is pathogenesis or treatment. This study is part of the project of "TCM Syndrome and Treatment of HFMD Complicated with Central Nervous System Infection" of Beijing Administration of Traditional Chinese Medicine, aiming to understand the hand-foot-mouth disease in Linyi area. To evaluate the clinical efficacy of traditional Chinese medicine and further explore the etiology and pathogenesis of severe hand-foot-mouth disease.
Objective: To collect the clinical data of patients with hand-foot-mouth disease complicated with central nervous system infection in Linyi People's Hospital of Shandong Province, understand the characteristics of the incidence of hand-foot-mouth disease complicated with central nervous system infection, evaluate the clinical efficacy of traditional Chinese medicine, and further explore the etiology and pathogenesis of severe hand-foot-mouth disease.
METHODS: This study was completed on the basis of a major project of the Beijing Administration of Traditional Chinese Medicine on the treatment of infectious diseases - hand-foot-mouth disease complicated with central nervous system infection. A total of 6 centers were set up to investigate the children with HFMD complicated with central nervous system infection, collect the general information of HFMD complicated with central nervous system infection, four diagnostic information of traditional Chinese medicine and related laboratory examinations.
In this study, 90 cases of hand-foot-mouth disease complicated with central nervous system infection admitted to Shandong Linyi People's Hospital (one of the six centers) from July 2010 to September 2010 were studied retrospectively. The clinical data of Chinese and Western medicine were collected by SPSS statistical software to understand the incidence of hand-foot-mouth disease complicated with central nervous system infection in Linyi area. Disease characteristics, evaluation of clinical efficacy of Chinese medicine, and further explore the etiology and pathogenesis of severe hand foot mouth disease.
Result:
1. EV71 and CoxA16 were the main pathogens of HFMD complicated with central nervous system infection in Linyi area. Most of the children had no definite contact history with HFMD before the onset of the disease, and most of them were boys.
2. The occurrence rate of TCM syndromes of children with HFMD complicated with central nervous system infection in Linyi area was from high to low as follows: hand-foot-mouth rash, poor appetite, frightening, listlessness, dry mouth, irritability, crying, fever and so on.
3. There was significant difference between group A (western medicine treatment), group B (western medicine treatment + Tanreqing) and group A (western medicine treatment), group C (western medicine treatment + Tanreqing + traditional Chinese medicine treatment), indicating that group B and group C had shorter time of body temperature falling to normal than group A. Group A, group B, group C had 49.85 (+ 19.38), 39.33 (+ 17.91), 40.05, respectively. Comparing the nervous system symptoms of group A and group C after 3 days treatment, there was statistical difference (P = 0.0160.0167), indicating that the remission rate of nervous system symptoms in group C was higher than that in group A. The remission rate of nervous system symptoms was 70% in group C, 64.3% in group B and 51.7% in group A. The total effective rate of group C was 76.7%, group B was 66.7%, and group A was 40%.
Conclusion: Western medicine + Tanreqing group, and Western medicine + Tanreqing + Chinese medicine group in the treatment of hand-foot-mouth disease complicated with central nervous system infection in children with severe curative effect, in the antipyretic time is better than simple Western medicine group; Western medicine + Tanreqing + Chinese medicine group in improving nervous system symptoms and alleviating the symptoms of traditional Chinese medicine is better than simple Western medicine group. Medical group.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R725.1
本文編號：2192507
[Abstract]:Severe hand-foot-mouth disease is mostly caused by enterovirus 71. Enterovirus 71 has obvious neurotropism, which can lead to aseptic meningitis, encephalitis, brainstem encephalitis, encephalomyelitis, poliomyelitis-like syndrome and other neurological diseases. In recent years, the incidence and mortality of hand-foot-mouth disease is very high, which has aroused our great concern. The study of mouth disease, especially the study of severe hand-foot-mouth disease (HFMD), is not completely clear whether it is pathogenesis or treatment. This study is part of the project of "TCM Syndrome and Treatment of HFMD Complicated with Central Nervous System Infection" of Beijing Administration of Traditional Chinese Medicine, aiming to understand the hand-foot-mouth disease in Linyi area. To evaluate the clinical efficacy of traditional Chinese medicine and further explore the etiology and pathogenesis of severe hand-foot-mouth disease.
Objective: To collect the clinical data of patients with hand-foot-mouth disease complicated with central nervous system infection in Linyi People's Hospital of Shandong Province, understand the characteristics of the incidence of hand-foot-mouth disease complicated with central nervous system infection, evaluate the clinical efficacy of traditional Chinese medicine, and further explore the etiology and pathogenesis of severe hand-foot-mouth disease.
METHODS: This study was completed on the basis of a major project of the Beijing Administration of Traditional Chinese Medicine on the treatment of infectious diseases - hand-foot-mouth disease complicated with central nervous system infection. A total of 6 centers were set up to investigate the children with HFMD complicated with central nervous system infection, collect the general information of HFMD complicated with central nervous system infection, four diagnostic information of traditional Chinese medicine and related laboratory examinations.
In this study, 90 cases of hand-foot-mouth disease complicated with central nervous system infection admitted to Shandong Linyi People's Hospital (one of the six centers) from July 2010 to September 2010 were studied retrospectively. The clinical data of Chinese and Western medicine were collected by SPSS statistical software to understand the incidence of hand-foot-mouth disease complicated with central nervous system infection in Linyi area. Disease characteristics, evaluation of clinical efficacy of Chinese medicine, and further explore the etiology and pathogenesis of severe hand foot mouth disease.
Result:
1. EV71 and CoxA16 were the main pathogens of HFMD complicated with central nervous system infection in Linyi area. Most of the children had no definite contact history with HFMD before the onset of the disease, and most of them were boys.
2. The occurrence rate of TCM syndromes of children with HFMD complicated with central nervous system infection in Linyi area was from high to low as follows: hand-foot-mouth rash, poor appetite, frightening, listlessness, dry mouth, irritability, crying, fever and so on.
3. There was significant difference between group A (western medicine treatment), group B (western medicine treatment + Tanreqing) and group A (western medicine treatment), group C (western medicine treatment + Tanreqing + traditional Chinese medicine treatment), indicating that group B and group C had shorter time of body temperature falling to normal than group A. Group A, group B, group C had 49.85 (+ 19.38), 39.33 (+ 17.91), 40.05, respectively. Comparing the nervous system symptoms of group A and group C after 3 days treatment, there was statistical difference (P = 0.0160.0167), indicating that the remission rate of nervous system symptoms in group C was higher than that in group A. The remission rate of nervous system symptoms was 70% in group C, 64.3% in group B and 51.7% in group A. The total effective rate of group C was 76.7%, group B was 66.7%, and group A was 40%.
Conclusion: Western medicine + Tanreqing group, and Western medicine + Tanreqing + Chinese medicine group in the treatment of hand-foot-mouth disease complicated with central nervous system infection in children with severe curative effect, in the antipyretic time is better than simple Western medicine group; Western medicine + Tanreqing + Chinese medicine group in improving nervous system symptoms and alleviating the symptoms of traditional Chinese medicine is better than simple Western medicine group. Medical group.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R725.1
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