糖皮质激素治疗重症EV71感染疗效观察

Effect of glucocorticoid in treatment of severe enterovirm 71 infection

目的探讨糖皮质激素在肠道病毒71型(EV71)感染重症病例治疗中的作用和价值。方法采用非同期、非随机的方法对2009年—2011年我院儿童重症监护病房收治的38例经病原学确诊为EV71感染重症病例进行回顾性分析。将2009年—2010年应用糖皮质激素治疗的20例作为对照组,2011年未应用糖皮质激素治疗的18例作为观察组。结果观察组平均发热时间为(3.9±3.0)d,肢体抖动和(或)肢体无力消失时间为(11.0±4.7)d,平均肺水肿消失时间为(3.8±1.6)d,病死率为22.2%,与对照组比较差异均无统计学意义(P>0.05)。入院治疗3 d后观察组外周血白细胞总数为(10.6±2.8)×109/L,外周血血小板计数为(297±76)×109/L,血糖为(7.3±2.4)mmol/L,与入院时比较差异有统计学意义(P<0.05);对照组外周血白细胞总数为(12.3±2.9)×109/L,外周血血小板计数为(378±107)×109/L,血糖为(10.2±2.4)mmol/L,与入院时比较差异无统计学意义(P>0.05)。结论小剂量糖皮质激素不能有效缓解EV71感染重症病例的临床症状,且并不能使白细胞、血糖、血小板显著降低。

Objective To investigate the curative effect of glucocorticoid in the treatment of severe EVT1 infection cases. Methods A retrospective analysis was based on the clinical records, laboratory data and treatment effects which were collected from 38 severe EV71 infected.All cases admitted to the pediatric intensive care unit between 2009 and 2011 on the basis of EVT1 infection were retrospective analyzed. Patients were grouped into compared group （which treated with methylprednisoion 2rag/（kg·d ）during 2009 and 2010, n= 18） and observation group （which treated without glucocorticoid in 2011, n=20）.The clinical manifestations and outcomes of the observation group compared with those of the compared group. Results Among the observation group which were treated without any glucocorticoid,the mean hyperthermic duration was （3.9 ± 3.0）days with peak temperature over 39 ℃ ,mean acute flaccid paralysis duration was （11.0±4.7）day,and mean pulmonary and/or hemorrhage duration was （3.8 ±1.6）day,the ratio of died was 22.2% （4/18）,there was no significant difference compared with 20 cases of compared group which treated with methylprednisoion 2 rag/ （ kg· d ）.Of the 18 cases after 3 days, the mean of white blood ceil, blood sugar and platolet were （ 10.6 ±2.8 ） × 10^9/L, （297± 76 ） × 10^9/L and （297 ± 76 ）mmol/L, there were significant difference compared with which in admission, respectively. However, there were no significant difference compared with which in first admitted among compared group. Conclusion Glucocorticoid cannot relive the clinical manifestations in severe EV71 infection cases, and there are risk of promotion in white blood ceil, blood sugar and platelet.