90例手足口病并发中枢神经系统感染的中医证治研究

发布时间：2018-08-19 18:49

【摘要】：重症手足口病多由肠道病毒71型感染,肠道病毒71型有明显的嗜神经性,可导致无菌性脑膜炎、脑炎、脑干脑炎、脑脊髓炎、脊髓灰质炎样综合征等神经系统病变。近年来手足口病发病率及死亡率很高,引起了我们高度的关注。然而对于手足口病的研究,尤其是手足口病重症的研究,无论是发病机制还是治疗,中医还是西医均尚不完全清楚。本课题研究是北京市中医药管理局“手足口病并发中枢神经系统感染的中医药证治研究”课题的一部分,旨在了解临沂地区的手足口病并发中枢神经系统感染的发病特点,评价中医药临床疗效,进一步探索重症手足口病的病因病机。目的：对山东省临沂市人民医院收治的手足口病并发中枢神经系统感染病例的临床资料进行整理,了解临沂地区的手足口病并发中枢神经系统感染的发病特点,评价中医药临床疗效,进一步探索重症手足口病的病因病机。方法：本研究是在北京市中医管理局传染病重大专项项目——手足口病并发中枢神经系统感染的中医药证治研究基础上完成的。手足口病并发中枢神经系统感染的中医药证治研究重大专项项目是前瞻性、多中心、随机对照的临床研究,共有6家中心,是统一制定调查表对手足口病并发中枢神经系统感染的患儿进行调查研究,采集符合纳入标准的手足口病并发中枢神经系统感染患儿的一般情况、中医四诊信息以及相关的实验室检查。本研究采用回顾性方法对2010年7月-2010年9月山东临沂人民医院(6家中心之一)收治的90例手足口病并发中枢神经系统感染的病例进行研究,运用SPSS统计软件进行中西医临床资料的整理,了解临沂地区的手足口病并发中枢神经系统的发病特点,评价中医药临床疗效,进一步探索重症手足口病的病因病机。结果： 1.临沂地区手足口病合并中枢神经系统感染的重症患儿,病原学以EV71型感染为主,并有EV71型和CoxA16型共同感染,大多数患儿发病前没有明确的手足口病接触史,发病人群以幼儿男童为主。 2.临沂地区手足口病合并中枢神经系统感染的重症患儿的中医证候表现发生率从高到低依次为手足口皮疹,纳差,易惊,精神不振,口干,烦躁哭闹,发热等,辅助检查白细胞值较正常范围高。 3.从体温降至正常时间方面,A组(西医治疗)、B组(西医治疗+痰热清)与A组(西医治疗)、C组(西医治疗+痰热清+中药治疗)组间有统计学差异(P0.05),表明B组与C组体温降至正常时间较A组短。A组、B组、C组时间分别为49.85±19.38小时、39.33±17.91小时、40.14±12.85小时。比较经3天治疗后神经系统症状方面,A组、C组有统计学差异(P=0.0160.0167),表明C组在神经系统症状缓解率上较A组高。其中神经系统症状缓解有效率C组为70%,B组64.3%,A组51.7%。比较缓解中医症状方面,A组、C组间有统计学差异(P=0.010.0167),表明C组在中医症状缓解率上较A组高。其中总显效率C组为76.7%,B组为66.7%,A组为40%。结论：采用西医治疗+痰热清组,及西医治疗+痰热清+中药组在治疗手足口病合并中枢神经系统感染的重症患儿疗效显著,在退热时间方面优于单纯西医组；西医治疗+痰热清+中药组在改善神经系统症状及缓解中医症状上优于单纯西医组。
[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.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.1

【参考文献】