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目的观察米力农联合甲基泼尼松龙治疗手足口病合并脑炎患儿的临床疗效及作用机制。方法 86例手足口病合并脑炎患儿随机分为对照组43例和试验组43例。对照组用米力农治疗,首次剂量为0.5 mg·kg~(-1),于5~10 min匀速静脉推注,之后每分钟0.25~1.0 mg·kg~(-1)等量维持,持续治疗1~3 d。试验组在对照组的基础上每天静脉滴注甲基泼尼松龙1.0~3.0 mg·kg~(-1),持续治疗3~5 d。观察2组患者的症状消失时间、临床疗效及治疗前后血清白细胞介素(IL)-6、IL-12及干扰素-γ(INF-γ)水平。结果治疗后,试验组和对照组的总有效率分别为95.35%(41/43例)和72.09%(31/43例),差异有统计学意义(P<0.05)。试验组和对照组的发热消失时间分别为(3.01±0.32),(4.23±0.35)d;皮疹消失时间分别为(6.13±0.96),(8.67±1.02)d;意识模糊消失时间分别为(1.26±0.15),(2.01±0.23)d;血压异常消失时间分别为(4.03±0.62),(6.31±0.78)d;面色苍灰消失时间分别为(2.49±0.36),(4.58±0.42)d;脉搏浅速或减弱症状消失时间分别为(4.12±0.65),(7.05±0.83)d,差异均有统计学意义(均P<0.05)。治疗后,试验组和对照组的血清IL-6分别为(123.46±10.53),(132.68±10.49)ng·L~(-1);IL-12分别为(61.76±5.43),(68.79±5.61)ng·L~(-1);IFN-γ分别为(46.67±3.88),(49.32±3.96)ng·L~(-1),差异均有统计学意义(P<0.05)。2组均未出现药物不良反应。结论米力农联合甲基泼尼松龙治疗手足口病合并脑炎患儿临床疗效显著,能够显著下调血清IL-6、IL-12、IFN-γ水平。
Objective To observe the clinical efficacy and mechanism of Milrinone combined with methylprednisolone in treating children with hand-foot-mouth disease combined with encephalitis. Methods Totally 86 children with HFMD and encephalitis were randomly divided into control group (43 cases) and experimental group (43 cases). The control group with Milrinone treatment, the first dose of 0.5 mg · kg ~ (-1), at 5 ~ 10 min uniform intravenous injection, and then 0.25 ~ 1.0 mg · kg -1 Treatment of 1 ~ 3 d. On the basis of the control group, the test group was given methylprednisolone 1.0-3.0 mg · kg -1 every day for 3 to 5 days. The symptom disappearance time, clinical curative effect and the levels of serum IL-6, IL-12 and INF-γ before and after treatment were observed in two groups. Results After treatment, the total effective rate was 95.35% (41/43 cases) and 72.09% (31/43 cases) in the experimental group and the control group, respectively. The difference was statistically significant (P <0.05). The disappearance time of fever was (3.01 ± 0.32) and (4.23 ± 0.35) days respectively in the experimental group and the control group; the disappearance time of the rash were (6.13 ± 0.96) and (8.67 ± 1.02) d, respectively; ± (2.01 ± 0.23) d, (4.01 ± 0.62) d and (4.51 ± 0.42) d, respectively. The disappearance time of pale gray was (4.03 ± 0.62) and The disappearance time of pulse speed or weakening symptom were (4.12 ± 0.65) and (7.05 ± 0.83) d respectively, the difference was statistically significant (all P <0.05). After treatment, the levels of IL-6 in the test group and the control group were (123.46 ± 10.53) and (132.68 ± 10.49) ng · L -1, respectively. The IL-12 levels were 61.76 ± 5.43 and 68.79 ± 5.61 ) ng · L -1 and IFN-γ were (46.67 ± 3.88) and (49.32 ± 3.96) ng · L -1, respectively, with statistical significance (P <0.05). Two groups did not appear adverse drug reactions. Conclusion Milrinone combined methylprednisolone treatment of children with hand, foot and mouth disease complicated with encephalitis clinical significant effect, can significantly reduce serum IL-6, IL-12, IFN-γ levels.