手足口病并发中枢神经系统感染327例中医证候及核心病机分析

目的探索手足口病并发中枢神经系统感染的中医证候特征及核心病机。方法采用前瞻性的临床研究方法,纳入327例手足口病并发中枢神经系统感染的住院病例,按照统一的中医证候观察表进行动态观察,主要根据舌象将证候分为湿热证、温热证,湿热证又分为湿重于热证、热重于湿证,由两名主治医师根据临床资料确定本病的中医证候分型和核心病机。结果 327例患儿证候分型为:湿重于热证208例(63.8%)、热重于湿证79例(24.2%)、温热证40例(12.2%);热重于湿证与温热证的入组前最高体温高于湿重于热证(P<0.01);湿重于热证入组前病程长于热重于湿证(P<0.05);湿重于热证的住院天数较温热证有延长的趋势(P=0.083);热重于湿证皮疹色泽较红,口腔皮疹比例高于湿重于热证及温热证(P<0.05);温热证出现嗜睡及颈项强直比例要高于湿重于热证及热重于湿证(P<0.05);湿重于热证及热重于湿证出现易惊的比例要高于温热证(P<0.05)。不同证型的病原学分布频率无差异。结论手足口病并发中枢神经系统感染病因是以湿热疫疠毒邪为主,病位主要在脾、心、肝,核心病机为湿热动风。湿重于热证及热重于湿证易见易惊等动风表现,湿重于热证热像不显,热势不彰,病情发展较缓,缠绵难愈;热重于湿证疹色较红且口腔皮疹多见;温热证则易见颈项强直、嗜睡表现。

TCM syndromes and etiology-pathogenesis in 327 cases of hand-foot-mouth disease with central nervous system infections

Objective To explore the traditional Chinese medicine syndromes and etiology-pathogenesis of hand-foot-mouth disease(HFMD) with central nervous system infections.Methods With prospective clinical research,327 inpatients of HFMD were enrolled and observed with unified TCM syndrome form,they were divided into damp-heat syndrome and warm-heat syndrome mainly according to tongue presentations,and the damp-heat syndrome is divided into wet more than hot syndrome and hot more than wet syndrome.The syndrome was determined by two attending physicians of TCM.Results There were 208 cases in wet more than hot syndrome(63.8%),79 cases in hot more than wet syndrome(24.2%),40 cases in warm-heat syndrome(12.2%);The highest temperature before enrolled of hot more than wet syndrome and warm-heat syndrome was higher than wet more than hot syndrome(P<0.01);The course of disease in wet more than hot syndrome before enrolled was longer than hot more than wet syndrome(P<0.05);The hospital day seems to be longer in wet more than hot syndrome compared to warm-heat syndrome(P=0.083);The color of rash are redder in hot more than wet syndrome,and the ratio of oral rashes was higher than wet more than hot syndrome and warm-heat syndrome(P<0.05);The ratio of stiff neck and drowsiness in warm-heat syndrome was higher than wet more than hot syndrome and hot more than wet syndrome;The ratio of hyperarousal in wet more than hot syndrome and hot more than wet syndrome was higher than warm-heat syndrome(P<0.05).There is no significance in distribution frequency of etiology in different syndromes.Conclusion Dampness-heat was the main etiological factor of HFMD with central nervous system infections,the illness positions were spleen heart and liver,the core pathogenesis was wind symptom caused by dampness-heat.Hyperarousal was common in wet more than hot syndrome and hot more than wet syndrome.The hot was not significant and it had longer courses in wet more than hot syndrome.The rash are redder in hot more than wet syndrome,and there were more rashes in hot more than wet syndrome.And stiff neck and drowsiness were more common in warm-heat syndrome.