Research Center of Translational Medicine, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515040, People's Republic of China.
Shantou-Oxford Clinical Research Unit, Shantou University Medical College, Shantou, Guangdong, 515040, People's Republic of China.
BMC Complement Altern Med. 2018 Jun 20;18(1):190. doi: 10.1186/s12906-018-2259-9.
In contrast to the guidelines of World Health Organization (WHO) and United States-Centers for Disease Control and prevention (US-CDC), the Chinese national guidelines recommend the use of steroids, intravenous immunoglobulin (IVIG), or traditional Chinese herbs (TCHs) in hand-foot-mouth disease (HFMD) management. Their use and therapeutic efficacies are, however, unclear. We aimed to describe their use in and the clinical outcomes of hospitalized HFMD cases.
A retrospective review of hospital medical records for HFMD cases during 2008-2016 was conducted in a medical school-affiliated tertiary hospital in Shantou, Guangdong, China.
Hospitalized children with the discharge diagnosis of HFMD (n = 3778), comprising mild (58.4%), severe (41.5%), and very severe (0.1%) cases, were enrolled in the study. Steroids, IVIG, and antiviral TCH Lan-Qin were respectively prescribed in 60.5, 37.1, and 71.0% of cases. Most cases (99.8%) recovered and six died. Recovery rate was lower with the use of IVIG and higher with Lan-Qin (alone or in combination with steroid) in the mild cases (Ps < 0.05). Longer hospital stay was observed with steroid/IVIG with or without Lan-Qin in the severe cases (Ps < 0.05).
This nine-year retrospective review shows 1) an increase in the incidence of HFMD as well as the use of steroids, IVIG, and TCH over time, 2) no significant advantage of using steroids and IVIG, either alone or in combination, in the management of mild HFMD cases, and 3) a higher recovery rate in mild HFMD cases with the use of antiviral TCH (Lan-Qin). Our findings need verification in a larger prospect study with cases from hospitals in other regions of China. Lan-Qin efficacy should be evaluated in randomized trials. Meanwhile, caution should be exercised in the extensive use of steroids and IVIG in HFMD management.
与世界卫生组织（WHO）和美国疾病控制与预防中心（US-CDC）的指南形成对比的是，中国国家指南建议在手足口病（HFMD）管理中使用类固醇、静脉注射免疫球蛋白（IVIG）或中药（TCHs）。然而，它们的使用和治疗效果尚不清楚。我们旨在描述其在住院 HFMD 病例中的使用情况和临床结果。
对中国广东省汕头市某医学院附属医院 2008 年至 2016 年住院 HFMD 病例的病历进行回顾性分析。
本研究共纳入 3778 例出院诊断为 HFMD 的住院患儿，包括轻症（58.4%）、重症（41.5%）和极重症（0.1%）病例。分别有 60.5%、37.1%和 71.0%的患儿使用了类固醇、IVIG 和抗病毒中药蓝芩。大多数病例（99.8%）康复，6 例死亡。轻症病例使用 IVIG 和蓝芩（单独或联合使用类固醇）的康复率较低（P<0.05）。重症病例使用类固醇/IVIG 联合或不联合蓝芩的住院时间较长（P<0.05）。
本研究通过对 9 年的回顾性分析发现：1）HFMD 的发病率以及类固醇、IVIG 和 TCH 的使用呈上升趋势；2）单独或联合使用类固醇和 IVIG 对轻症 HFMD 患儿的管理没有明显优势；3）在使用抗病毒中药（蓝芩）的轻症 HFMD 患儿中，康复率较高。我们的研究结果需要在更大的、来自中国其他地区医院的病例前瞻性研究中进行验证，同时需要在随机对照试验中评估蓝芩的疗效。此外，在 HFMD 管理中应谨慎使用类固醇和 IVIG 的广泛应用。
