经直肠滴入中药治疗手足口病的临床疗效及对病毒的清除作用研究

Clinical Effect of Treating Hand Foot Mouth Disease with Transrectal Drip of Traditional Chinese Medicine and Role Study on Virus Clearance

目的:观察经直肠滴入中药治疗手足口病的临床疗效及对手足口病病毒的清除作用。方法:选择西安大兴医院儿科在2017年1月~2018年6月期间收治的100例手足口病患儿为研究对象,随机分为对照组和治疗组。两组患儿入院后均接受对症治疗,在此基础上给予对照组患儿利巴韦林静脉滴注治疗,给予治疗组患儿经直肠滴入手足口病方煎剂,两组均连续治疗5d。比较两组患儿临床疗效、主要临床症状(发热、皮疹、口腔疱疹)消退时间治疗期间不良反应发生情况。分别于治疗前和治疗后炎性因子[白细胞介素-6(IL-6)、IL-8、IL-10、肿瘤坏死因子-α(TNF-α)]、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+))分布以及柯萨奇病毒A组16型(Cox A16)和肠道病毒EV71型(EV71)RNA检测结果。结果:治疗组患儿治疗总有效率(98.00%vs.86.00%)和EV71 RNA转阴率(100.00%vs.78.95%)明显高于对照组(P<0.05),不良反应发生率明显低于对照组(4.00%vs.16.00%,P<0.05)。两组Cox A16 RNA转阴率比较无明显差异(100.00%vs.85.71%,P>0.05)。治疗组患儿发热、皮疹和口腔疱疹等主要症状消退时间都明显少于对照组(P<0.05)。两组患儿治疗后血清炎症因子IL-6、IL-8、IL-10和TNF-α水平均较治疗前显著降低,CD3^(+)、CD4^(+)、CD8^(+)水平则显著升高(P<0.05)。而与对照组治疗后相比,治疗组患儿治疗后血清炎症因子和T淋巴细胞亚群水平均显著改善(P<0.05)。结论:经直肠滴入手足口病方煎剂能够明显提高手足口病患儿临床疗效,加快症状缓解,改善免疫功能,减轻炎症反应,杀灭病毒,安全性好,值得临床应用。

Objective: To investigate the clinical efficacy of treating hand foot mouth disease with transrectal drip of traditional Chinese medicine and role study on virus clearance.Methods: 100 cases of hand foot mouth disease in Children’s Department of Pediatrics of Xi’an Daxing Hospital from March 2019 to June 2020 were selected as the research object, and they were randomly divided into controlled group and treatment group.The patients in the controlled group were given Ribavirin Intravenous Drip, and on this basis, the treatment group were given the decoction of hand foot mouth disease through rectum.Both groups were treated for 5 days.The clinical efficacy, main clinical symptoms(fever, rash, oral herpes) subsided time between the two groups were compared.The distribution of inflammatory factors(IL-6,IL-8,IL-10,TNF-α),T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+) and CD4^(+)/CD8^(+)) were measured before and after treatment, and the results of Coxsackievirus group A 16(Cox A16) and Enterovirus EV71(EV71) RNA were detected before and after treatment.Results: The total effective rate(98.00% vs.86.00%) and EV71 RNA negative conversion rate(100.00% vs.78.95%) in the treatment group were significantly higher than those in the controlled group(P<0.05),and there was no significant difference in the Cox A16 RNA negative conversion rate between the two groups(100.00% vs.85.71%,P>0.05).The disappearance time of fever, rash and oral herpes in the treatment group was significantly shorter than that in the controlled group(P<0.05).After treatment, the serum levels of IL-6,IL-8,IL-10 and TNF-α in the two groups were significantly lower than those before treatment, and the levels of CD3^(+),CD4^(+),CD8^(+) were significantly higher than those before treatment(P<0.05).Compared with the controlled group after treatment, the serum inflammatory factors and T lymphocyte subsets levels in the treatment group were significantly improved after treatment(P<0.05).Conclusion: Transrectal instillation of HFMD Decoction can significantly improve the clinical efficacy of HFMD children, speed up the remission of symptoms, improve immune function, reduce inflammatory reaction, and kill virus with good safety, which is worthy of clinical application.