α2b干扰素联合利巴韦林气雾剂治疗手足口病

目的探讨α2b干扰素联合利巴韦林气雾剂治疗手足口病的疗效和安全性。方法将80例手足口病患者随机分为治疗组和对照组,每组各40例。治疗组采用肌注α2b干扰素加利巴韦林气雾剂喷雾吸入治疗,对照组采用静脉滴注利巴韦林再联合蒙脱石散涂布口腔,然后对两组的治疗效果进行比较。结果治疗组的有效率是87.5%,对照组的有效率是62.5%,两组比较,差异有统计学意义(P<0.05);治疗组在退热时间、口腔溃疡愈合时间及进食时间方面比对照组有明显的优势。结论α2b干扰素联合利巴韦林气雾剂治疗手足口病有显著的疗效,并且安全可靠,没有明显不良反应。     

Topical analgesic added to paraffin enhances paraffin bath treatment of individuals with hand osteoarthritis

Purpose.?To compare treating patients with symptomatic hand osteoarthritis (OA) with paraffin baths only (PO) (100% wax) or paraffin baths 80% wax with 20% topical analgesic (PTA).

Methods.?Subjects met criteria of the American College of Rheumatology for classifying symptomatic hand OA and had a Dreiser's index score >5 points. Current and average pain at rest and with movement was assessed with visual analogue scales. Hand function was assessed by the functional index for hand OA (FIHOA).

Results.?Both groups had a significant reduction in their ‘current’ pain 15?min after the first and twelfth treatments compared to pre-treatment but there was no difference between groups (t?=?0.10, p?>?0.05). The PTA group had greater improvement over the 12 treatment sessions for their pain at rest (t?=?2.92, p?<?0.05) and with movement (t?=?4.73, p?<?0.05) than the PO group. The PTA group also showed greater improvement in their FIHOA following 12 treatments than the PO group (t?=?3.52, p?<?0.05).

Conclusion.?Our results indicate that the addition of a topical analgesic to paraffin produced significantly greater pain relief at rest and during movement than paraffin baths alone after 12 treatments. Additionally, the PTA group experienced greater improved hand function.     

左卡尼汀对柯萨奇A16型病毒感染手足口病的心肌保护作用

目的探讨左卡尼汀对柯萨奇病毒A16型感染所致手足口病(HFMD)的心肌保护作用及机制。方法 60例心肌酶谱异常的HFMD患儿随机分为左卡尼汀治疗组(左卡组)和1,6-二磷酸果糖治疗组(果糖组),每组30例,在抗病毒、退热等基础上分别给予左卡尼汀或果糖二磷酸钠治疗,并以同期体检的健康儿童30例为对照组。比较HFMD患儿治疗前后的心肌酶谱、丙二醛(MDA)、超氧化物岐化酶(SOD)、细胞凋亡因子sFas和sFasL的变化。结果两组HFMD患儿治疗有效性的差异无统计学意义(P0.05),仅果糖组1例进展为危重型。治疗前,左卡组和果糖组心肌酶谱、MDA、sFas、sFasL水平高于对照组(P0.05),SOD低于对照组(P0.05),但HFMD的两组间心肌酶谱、MDA、SOD、sFas、sFasL的差异无统计学意义(P0.05)。治疗后,左卡组和果糖组的心肌酶谱以及MDA、sFas、sFasL浓度均下降(P0.05),SOD水平增高(P0.05);治疗后除果糖组的CK高于对照组和左卡组,其余心肌酶指标及MDA、sFas、sFasl在两组间及与对照组的差异均无统计学意义(P0.05)。SOD水平与AST、LDH、CK、CK-MB呈负相关(r分别为-0.437、-0.364、-0.397、-0.519,P0.05),MDA水平与LDH、CK-MB呈正相关(r分别为0.382、0.411,P0.05)。结论左卡尼汀对柯萨奇病毒A16型感染所致HFMD有较好的心肌保护作用,可能与清除氧自由基和抑制心肌细胞凋亡有关。     

反复感染手足口病患儿的预防和治疗

目的探讨消毒隔离结合免疫及营养治疗在预防和治疗反复感染手足口病患儿中的作用。 方法收集初次就诊的手足口病患儿共400例，利用随机数字表将患者分为治疗组与对照组各200例，治疗组患儿定期给予消毒隔离健康教育及营养随访，再次患病后给予个体化营养支持治疗。对照组患儿仅在感染手足口病后给予常规治疗。比较两组患儿手足口病再发率和重症率等指标。 结果治疗组患儿平均退热时间为（1.7 ± 1.1）d、皮疹消退时间为（4.0 ± 1.3）d、平均住院天数为（5.6 ± 2.4）d、抗菌药物使用率为19%（38/200）、激素使用率为8%（16/200），均显著低于对照组，差异具有统计学意义（t = 10.028、8.677、8.353、20.650、11.312，P = 0.015、0.032、0.001、0.004、0.011）。治疗组患儿1年内再发率、重症率和并发症发生率分别为12%（24/200）、1%（2/200）和5%（10/200），显著低于对照组患儿，差异均有统计学意义（χ² = 9.21、0.88、7.24，P = 0.010、0.002、0.007）。 结论健康教育、营养随访及个体化营养支持治疗可降低手足口病的再发率及重症率，改善临床结局。