小剂量短疗程甲泼尼龙联合利巴韦林、丙种免疫球蛋白对重症手足口病患儿的疗效

Application Effect of Low-Dose Short-Course Methylprednisone Combined with Ribavirin and Gamma Immunoglobulin in Children with Severe Hand Foot Mouth Disease

目的探讨小剂量短疗程甲泼尼龙联合利巴韦林、静脉丙种球蛋白(IVIG)对重症手足口病(HFMD)患儿的疗效。方法收集2016年5月至2018年12月焦作市妇幼保健院收治的92例重症HFMD患儿,采用随机数表法进行分组,每组46例。常规组接受利巴韦林、IVIG治疗,联合组接受小剂量短疗程甲泼尼龙联合利巴韦林、IVIG治疗。对比两组疗效、症状消失时间、治疗前后免疫功能[免疫球蛋白(Ig)G、IgA、IgM]、炎症因子[降钙素原(PCT)、白细胞介素6(IL-6)、超敏C反应蛋白(hs-CRP)]及不良反应发生情况。结果联合组总有效率[93.48%(43/46)]高于常规组[78.26%(36/46)](P<0.05);联合组临床症状(发热、皮疹、溃疡、神经系统症状)消失时间短于常规组(P<0.05);治疗后,联合组血清IgG、IgM、IgA水平高于常规组,血清PCT、IL-6、hs-CRP水平低于常规组(P<0.05);联合组不良反应总发生率[13.04%(6/46)]高于常规组[10.87%(5/46)],但差异无统计学意义(P>0.05)。结论采用小剂量短疗程甲泼尼龙联合利巴韦林、IVIG治疗重症HFMD患儿能改善免疫功能,减轻炎症反应,利于病情恢复,促使症状消失,且安全性可。

Objective To explore the application effect of low-dose short-course methylprednisone combined with ribavirin and intravenous immunoglobulin(IVIG)in the treatment of children with hand food mouth disease(HFMD).Methods A total of 92 children with severe HFMD in Jiaozuo Maternal and Child Health Hospital from May 2016 to December 2018 were selected as the research objects,and they were divided into observation group and control group by random number table method,with 46 cases in each group.The control group was given ribavirin and IVIG,while the observation group was given low-dose short-course methylprednisone combined with ribavirin and IVIG.The clinical effect,symptom disappearance time,immune function[immunoglobulin(Ig)G,IgA,IgM],inflammatory factors[procalcitonin(PCT),interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP)]and adverse reactions were compared.Results The total effective rate in the observation group[93.48%(43/46)]was higher than that in the control group[78.26%(36/46)](P<0.05).The disappearance time of clinical symptoms(fever,rash,ulcer and nervous system symptoms)in the observation group was shorter than that in the control group group(P<0.05).Serum IgG,IgM and IgA levels in the two groups after treatment were higher than those before treatment,and the levels in the observation group were higher than those in the control group(P<0.05).Serum PCT,IL-6,hs-CRP levels were lower than those before treatment,and the levels in the observation group were lower than those in the control group(P<0.05).The total incidence of adverse reactions in the observation group[13.04%(6/46)]was higher that in the control group[10.87%(5/46)],but the difference was not statistically significant(P>0.05).Conclusion The use of low-dose short-course methylprednisone combined with ribavirin and IVIG can improve immune function of children with severe HFMD,reduce inflammatory response,facilitate the recovery of the disease,promote the disappearance of symptoms and the safety is acceptable.