中医辨证证素与惠州市儿童手足口病的病原学相关性研究

Study on Correlation Between Syndrome Elements of Chinese Medicine Syndrome Differentiation and Etiology of Hand-Foot-Mouth Disease in Children in Huizhou

目的:分析中医辨证证素与惠州市儿童手足口病(HFMD)病原学的相关性。方法:选取2250例HFMD患儿,其中轻症1847例,重症403例。统计中医辨证证素的频数分布,检测肠道病毒71型(EV71)、柯萨奇病毒A组(CoxA)16、CoxA6及其他肠道病毒(EV),比较轻症与重症HFMD患儿中医辨证证素、病原学检查结果,分析中医辨证证素与病原学的相关性。结果:2250例HFMD患儿中医辨证证素有风热、湿热、气机逆乱、内风、厥证、阴虚、亡阳气脱、气虚,其中风热(98.00%)、湿热(86.98%)、气机逆乱(48.98%)、亡阳气脱(43.02%)较为常见。病原学检查结果显示,EV71(47.69%)、CoxA16(25.29%)、CoxA6(14.76%)为常见病原体。重症HFMD患儿气机逆乱、内风、厥证、阴虚、亡阳气脱、气虚占比高于轻症患儿(P<0.01),风热、湿热占比低于轻症患儿(P<0.01);重症HFMD患儿EV71、≥2种病原体阳性占比高于轻症患儿(P<0.01),CoxA16、CoxA6、其他EV占比低于轻症患儿(P<0.01)。厥证、亡阳气脱与EV71、≥2种病原体阳性呈正相关(P<0.01),气机逆乱与≥2种病原体阳性呈正相关(P<0.01)。结论:惠州市儿童HFMD中医辨证证素较常见的有风热、湿热、气机逆乱及亡阳气脱,病原体主要为EV71、CoxA16、CoxA6,对出现厥证、亡阳气脱患儿在中医辨证治疗基础上,应警惕≥2种病原体感染,给予EV71等病毒针对性治疗。

Objective:To analyze the correlation between syndrome elements of Chinese medicine syndrome differentiation and etiology of hand-foot-mouth disease(HFMD)in children in Huizhou.Methods:A total of 2250 cases of HFMD children were selected,including 1847 mild cases and 403 severe cases.The frequency distribution of syndrome elements of Chinese medicine syndrome differentiation was counted;the enterovirus 71(EV71),Coxsackievirus A 16(CoxA16),CoxA6 and other enteroviruses(EV)were detected;the syndrome elements of Chinese medicine syndrome differentiation and the results of etiology in children with mild and severe HFMD were compared;the correlation between syndrome elements of Chinese medicine syndrome differentiation and etiology was analyzed.Results:The syndrome elements of Chinese medicine syndrome differentiation in 2250 cases of HFMD children included wind-heat,dampness-heat,derangement of qi movement,internal wind,syncope,yin deficiency,yang and qi collapse,and qi deficiency,among which wind-heat(98.00%),dampness-heat(86.98%),derangement of qi movement(48.98%),and yang and qi collapse(43.02%)are relatively common.The results of etiology showed that EV71(47.69%),CoxA16(25.29%)and CoxA6(14.76%)were common pathogens.The proportion of derangement of qi movement,internal wind,syncope,yin deficiency,yang and qi collapse,and qi deficiency in children with severe HFMD were higher than those in children with mild HFMD(P<0.01),and the proportion of wind-heat and dampness-heat were lower(P<0.01).The proportion of EV71 and more than two positive pathogens in children with severe HFMD were higher than those in children with mild HFMD(P<0.01),and the proportion of CoxA16,CoxA6 and other EV were lower(P<0.01).There were positive correlations being found between syncope as well as yang and qi collapse and EV71 as well as more than two positive pathogens(P<0.01);the derangement of qi movement and more than two positive pathogens showed a positive correlation(P<0.01).Conclusion:The syndrome elements of Chinese medicine syndrome differentiation of HFMD in children in Huizhou are commonly characterized by wind-heat,dampnessheat,derangement of qi movement and yang and qi collapse;the main pathogens are EV71,CoxA16 and CoxA6.Based on Chinese medicine syndrome differentiation and treatment for children with syncope and yang and qi collapse,specific treatments for viruses like EV71 should be given,with vigilance for infection with more than two pathogens.