不同剂量甲泼尼龙治疗儿童重症手足口病的疗效比较

Treatment of Severe Hand-Foot-Mouth Disease in Children

目的观察使用不同剂量的甲泼尼龙对重症手足口病的治疗效果。方法以2013-1~12本院确诊累及神经系统的56例住院重症手足口病患儿为研究对象,回顾性分析患儿使用了不同剂量的甲泼尼龙的临床治疗效果：分为大剂量A组,普通剂量B组,和无使用激素对照C组。所有患儿都给予利巴韦林10 mg·kg-1·d-1,人免疫球蛋白1~2 g/kg及常规调节免疫和支持治疗。结果 3组患儿神经系统受累持续时间和住院时间、治愈率差异无统计学意义。3组患儿发热持续时间差异有统计学意义,无使用激素对照C组发热天数高于使用激素的A组和B组。大剂量A组患儿的呼吸频率、血糖均数对比C组有明显的增高,而B组则没有出现该情况。结论累及神经系统的重症手足口病使用糖皮质激素并不能缩短病程,但可以缩短发热持续时间,减轻患儿痛苦和家长焦虑情绪,有利于临床治疗工作。而大剂量激素由于易引起不良反应且对疗程和后遗症无明显的影响,不建议临床使用。

Objective To observe the effect of different does of methylprednisolone for severe hand-foot-mouth disease （HFMD）. Methods The data of hospitalized children with HFMD of neurological involvement from January to December in 2013 were collected and studied. The patients were randomly divided into high dose A group, ordinary dose B group and without hormone application dose C group. All patients were treated with comprehensive therapies. On the base of nutritional support, the children received ribavirin 10 mg · kg-1· d-1 and immunoglobulin injection 1-2 g/kg.Results The CNS involvement duration, time of hospitalization, the cure rate in 3 groups were not significantly different （P 〉 0. 05）. But the febrile duration was shorter in the non-hormone group than those of other groups, which demonstrated a significant difference（ P 〈 0.05 ）. The respiratory frequency and mean blood glucose of patients in high dose group A increased significantly compared with those in the group C, while Group B showed no such situation. Conclusion Glucocorticoid in the therapy of HFMD phase 2 can not shorten the course and improves prognosis. But, glucocorticoid can reduce the fever duration, which lightens the suffering of sick children and anxiety of parents and in favor of clinic treatment. Big dose of hormone could easily lead to untoward effect, so it is not recommended to be applied in clinic.