摘要
目的观察硫酸镁治疗对重症手足口病(hand,foot,and mouth disease,HFMD)神经损伤的保护作用及对临床及预后的影响。方法收集240例肠道病毒71型(enterovirus A71,EV-A71)感染伴神经受累的HFMD患者,按照随机数字表法随机分为常规治疗组(对照组)和硫酸镁辅助治疗组(治疗组),每组120例。对照组给予常规治疗,治疗组在常规治疗基础上给予硫酸镁辅助治疗。观察治疗前后两组患儿神经系统受累症状、体征恢复情况,以及临床疗效和预后影响。分析治疗前后血和脑脊液神经元特异性烯醇化酶(neuron-specific enolase,NSE)、S100-β蛋白、神经肽Y(neuropeptide Y,NPY)水平变化,振幅整合脑电图(amplitude integrated electroencephalogram,aEEG)监测检测脑电异常恢复情况。定量资料的比较采用t检验,定性资料采用χ^2检验。结果两组重症HFMD患儿治疗后,对照组痊愈83例、好转29例、无效8例,总有效率为93.3%;治疗组痊愈101例、好转18例、无效1例,总有效率为99.2%,两组疗效(Z=2.918,P=0.004)和总有效率(χ^2=4.156,P=0.041)的差异均有统计学意义。治疗后3 d,治疗组血清NSE、S100-β蛋白、NPY平均水平较对照组明显降低,差异均有统计学意义(t值分别为-7.239、-10.020和-11.053,均P<0.01)。治疗后5 d,治疗组脑脊液NSE、S100-β蛋白、NPY水平明显低于对照组,差异均有统计学意义(t值分别为-6.546、-13.308和-10.258,均P<0.01)。治疗后,治疗组神经功能评分显著低于对照组和治疗前,差异均有统计学意义(t值分别为-9.473和12.162,均P<0.01)。治疗组神经系统受累主要症状和体征恢复正常时间为(2.33±0.76)d,较对照组的(3.21±0.82)d明显缩短,差异有统计学意义(t=-12.52,P<0.05)。治疗组住院时间为(5.79±1.42)d,低于对照组的(6.71±1.46)d,差异有统计学意义(t=-4.932,P<0.05)。240例重症HFMD患儿中,经aEEG监测共有194例(80.8%)存在异常。治疗前,对照组aEEG异常率79.2%(95例),治疗组为82.5%(99例),两组比较差异无统计学意义(χ^2=0.430,P>0.05);治疗3 d后,治疗组有76例恢复正常,aEEG恢复正常率76.8%,高于对照组的50例(52.6%),差异有统计学意义(χ^2=12.406,P<0.05)。结论硫酸镁辅助治疗可降低血和脑脊液NSE、S100-β蛋白、NPY异常水平,缓解临床症状、缩短病程和平均住院天数,改善神经功能评分,促进脑电aEEG异常的恢复,对伴有神经系统受累的重症HFMD,具有较好的神经保护作用。
Objective To explore the protective effect of magnesium sulfate on the nerve injury in severe hand,foot and mouth disease(HFMD)caused by enterovirus A71(EV-A71)and to investigate its clinical and prognostic effects.Methods A total of 240 cases of severe HFMD with EV-A71 infection and nerve injury were enrolled.According to the random number table method,the patients were randomly divided into conventional treatment group(control group)and magnesium sulfate treatment group(treatment group),with 120 cases in each group.The control group was given the routine treatment,and the treatment group was given the magnesium sulfate adjuvant treatment on the basis of routine treatment.The neurological symptoms and signs,clinical efficacy and prognosis were observed before and after treatment in the two groups.The blood and cerebrospinal fluid neuron-specific enolase(NSE),S100-βprotein and neuropeptide Y(NPY)were analyzed before and after treatment.The amplitude integrated electroencephalogram(aEEG)was used to monitor the abnormal recovery of EEG.The t-test was applied to analyze quantitative data,and the chi-square test was used for qualitative data comparison.Results Among children with severe HFMD,there were 83 cured cases,29 improved cases and 8 ineffective cases in control group,with the total effective rate of 93.3%;while in the treatment group,101 cases were cured,18 cases were improved and 1 case was ineffective,the total effective rate was 99.2%.The therapeutic effects(Z=2.918,P=0.004)and the total effective rate(χ^2=4.156,P=0.041)were statistically significantly different between the two groups.Three days after treatment,the average levels of serum NSE,S100-βprotein and NPY in magnesium sulfate treatment group were significantly lower than those in control group(t=-7.239,-10.020 and-11.053,respectively,all P<0.01).Five days after treatment,the average levels of cerebrospinal fluid NSE,S100-βprotein and NPY in magnesium sulfate treatment group were significantly lower than those in control group(t=-6.546,-13.308 and-10.258,respectively,all P<0.01).After treatment,the neurological function score in treatment group was significantly lower than that in control group and that before treatment,and the differences were statistically significant(t=-9.473 and 12.162,respectively,both P<0.01).The recovery time of the main symptoms and signs in treatment group was(2.33±0.76)d,which was significantly shorter than that of control group([3.21±0.82]d),the difference was statistically significant(t=-12.52,P<0.05).The average length of hospital stay in treatment group was(5.79±1.42)d,which was shorter than that in control group([6.71±1.46]d),and the difference was statistically significant(t=-4.932,P<0.05).Of the 240 children with severe HFMD,194(80.8%)patients had abnormal aEEG.Before treatment,the aEEG abnormal rates in control group and the magnesium sulfate treatment group were 79.2%(95 cases)and 82.5%(99 cases),respectively,there was no significant difference(χ^2=0.430,P>0.05);while after treatment for 3 days,76 cases in treatment group returned to normal,and the recovery rate of aEEG was 76.8%,which was higher than that in control group(52.6%).The difference was statistically significant(χ^2=12.406,P<0.05).Conclusions Magnesium sulfate adjuvant therapy can reduce the abnormal levels of NSE,S100-βand NPY in blood and cerebrospinal fluid,relieve clinical symptoms,shorten the course of disease and average length of hospital stay,improve the neurological function score,and promote the recovery of abnormal aEEG.Thus,it has neuroprotective effect on severe HFMD with nervous system lesion.
作者
崔亚杰
宋春兰
李鹏
朱琳
陈芳
李利平
成怡冰
Cui Yajie;Song Chunlan;Li Peng;Zhu Lin;Chen Fang;Li Liping;Cheng Yibing(Department of Emergency and Critical Care Medicine,Children′s Hospital Affiliated to Zhengzhou University,Zhengzhou 450003,China;Zhengzhou Key Laboratory of Children′s Emergency and Critical Care Medicine,Zhengzhou 450003,China)
出处
《中华传染病杂志》
CAS
CSCD
2019年第6期332-337,共6页
Chinese Journal of Infectious Diseases
基金
河南省医学科技攻关计划(201702326)
关键词
手足口病
硫酸镁
神经保护
Hand,foot and mouth disease
Magnesium Sulfate
Neuroprotection
