梁森全　莫庆仪　梁桂明　黄晓雯　葛晓宁

【摘要】 目的：研究布洛芬聯合甲强龙及丙种球蛋白对手足口病合并脑炎患儿免疫自稳及预后影响。方法：选择124例于2015年10月-2020年9月在本院住院治疗的手足口病合并脑炎患儿为研究对象。按随机数字表法将患儿分为研究组和对照组，每组62例。对照组实施甲强龙联合丙种球蛋白治疗，研究组在对照组的基础上加用布洛芬治疗。比较两组临床疗效、临床体征消失时间以及治疗前后免疫球蛋白、降钙素原（PCT）和腺苷脱氨酶（ADA）、C反应蛋白（CRP）水平。结果：对照组治疗后的总有效率为82.26%，低于研究组的96.77%，差异有统计学意义（P<0.05）。研究组治疗后的热退、手足肛周部疱疹消退、口腔溃疡愈合时间均明显短于对照组，差异均有统计学意义（P<0.05）。治疗后，两组患者的IgA、IgG、IgM水平均上升，且研究组上述指标均高于对照组，差异均有统计学意义（P<0.05）。治疗后，两组患者的PCT、ADA、CRP水平均明显下降，且研究组上述指标均低于对照组，差异均有统计学意义（P<0.05）。结论：布洛芬联合甲强龙及丙种球蛋白在治疗手足口病合并脑炎患儿中具有较好的临床效果，可显著改善其免疫球蛋白、炎症因子水平，值得临床推广使用。

【关键词】 布洛芬 甲强龙 丙种球蛋白 手足口病 脑炎 免疫自稳 预后

[Abstract] Objective： To study the effect of Ibuprofen combined with Methylprednisolone and Gamma Globulin on immune homeostasis and prognosis in patients with hand-foot-mouth disease complicated with encephalitis. Method： A total of 124 patients with hand-foot-mouth disease complicated with encephalitis who hospitalized in our hospital from October 2015 to September 2020 were selected as the research subjects. According to random number table method， the patients were divided into study group and control group， 62 cases in each group. The control group was treated with Methylprednisolone combined with Gamma Globulin， and the research group was treated with Ibuprofen on the basis of the control group. Clinical efficacy， disappearance time of clinical signs， levels of immunoglobulin， procalcitonin （PCT）， adenosine deaminase （ADA） and C-reactive protein （CRP） before and after treatment were compared between two groups. Result： The total effective rate of the control group was 82.26%， which was lower than 96.77% of the study group， the difference was statistically significant （P<0.05）. After treatment， the fever subsidence， herpes subsidence in the hand， foot and anus region and the healing time of oral ulcer in the study group were significantly shorter than those in the control group， the differences were statistically significant （P<0.05）. After treatment， the levels of IgA， IgG and IgM in both groups were increased， and the above indexes in the study group were higher than those in the control group， the differences were statistically significant （P<0.05）. After treatment， the levels of PCT， ADA and CRP in two groups were significantly decreased， and the above indexes in the study group were lower than those in the control group， the differences were statistically significant （P<0.05）. Conclusion： Ibuprofen combined with Methylprednisolone combined with Gamma Globulin has a good clinical effect in the treatment of patients with hand-foot-mouth disease complicated with encephalitis， and can significantly improve the levels of immunoglobulin and inflammatory factors， which is worthy of clinical promotion.

[Key words] Ibuprofen Methylprednisolone Gamma Globulin Hand-foot-mouth disease Encephalitis Immune homeostasis Prognosis

First-authors address： Boai Hospital， Zhongshan 528400， China

doi：10.3969/j.issn.1674-4985.2021.09.010

手足口病通常是指肠道病毒进入人体内导致的一类以儿童群体发病为主的急性传染病，可通过粪口途径进行传播，其临床特征为手、足等处的皮肤出现疱疹、口腔黏膜发生溃疡。大部分患者发病时临床症状较轻微，少数患者会合并出现脑膜炎、急性弛缓性麻痹以及心肌炎等症状，极少数患者疾病开始时进展快速，甚至出现死亡[1]。随着人们生活水平的不断提高，我国的手足口病发病率开始逐年下降，但是近年来部分地区出现手足口病常呈暴发的情况，其中合并脑炎的患者数量明显增加[2]。调查发现手足口病极大地影响患者身心健康，若不及时治疗患者可能发生死亡，重症患者在发病5 d内病情进展迅速，故短时间内的及时准确治疗，对于降低患者病死率意义重大[3]。……