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目的:探讨利巴韦林与干扰素α1b在小儿手足口病中的应用价值。方法:选择2012年5-8月在杭州市儿童医院住院治疗确诊为手足口病(HFMD)的患儿488例,其中轻症349例,重症139例,分别按治疗用药情况分为干扰素组、利巴韦林组和对照组。对照组仅给予对症治疗,包括补液,静脉滴注能量合剂、维生素C,体温>38.5℃时口服布洛芬或用冰袋等物理降温等;干扰素组在对症治疗的基础上,给予干扰素α1b 0.5μg/(kg·d)肌肉注射,连续5 d;利巴韦林组在对症治疗的基础上,给予利巴韦林10.0 mg/(kg·d)静脉滴注,连续7 d。比较三组症状体征消退时间及住院时间,评价疗效,并采用流式细胞微球阵列术检测重症患儿脑脊液中各细胞因子水平。结果:同一病情的三组患儿退热时间、皮疹消退时间、口腔溃疡消退时间、住院时间比较差异均无统计学意义(P均>0.05)。同一病情的三组患儿总有效率比较差异均无统计学意义(P均>0.05)。三组重症患儿恢复期脑脊液IL-1β、IL-12p70水平均未见明显下降(P均>0.05)。干扰素组和利巴韦林组恢复期CCL2/MCP-1、CCL5/RANTES、IL-10水平较急性期明显下降(P均<0.05),但对照组恢复期脑脊液CCL2/MCP-1水平较急性期升高(P<0.05),CCL5/RANTES、IL-10水平未见明显变化(P均>0.05)。结论:在对症治疗的基础上,应用利巴韦林或干扰素对小儿HFMD进行抗病毒治疗的效果不明显,但是否对单核细胞趋化因子-1(MCP-1)有影响,有待进一步研究。
Objective: To investigate the value of ribavirin and interferon alb in children with HFMD. Methods: 488 children diagnosed HFMD in Hangzhou Children’s Hospital from May to August in 2012 were selected, of which 349 cases were mild and 139 cases were severe. The patients were divided into interferon group , Ribavirin group and control group. The control group was given only symptomatic treatment, including rehydration, intravenous infusion of energy mixture, vitamin C, body temperature> 38.5 ℃, oral ibuprofen or with ice packs and other physical cooling; interferon group on symptomatic treatment, given interferon α1b 0.5μg / (kg · d) intramuscularly for 5 days. Ribavirin was given ribavirin 10.0 mg / (kg · d) intravenously for 7 days on the basis of symptomatic treatment. Three groups of symptoms and signs of subsidence time and hospital stay were compared to evaluate the curative effect. The levels of cytokines in cerebrospinal fluid of severe children were detected by flow cytometry. Results: There was no significant difference in the antipyretic time, rash subsidence time, oral ulcer subsidence time and hospital stay among the three groups with the same condition (all P> 0.05). The same illness in the three groups of children with no significant difference in the total effective rate (P all> 0.05). The levels of IL-1β and IL-12p70 in cerebrospinal fluid of three groups of severe children during convalescence were not significantly decreased (all P> 0.05). The level of CCL2 / MCP-1, CCL5 / RANTES and IL-10 in convalescent group and ribavirin group were significantly lower than those in acute phase (P <0.05), but the levels of CCL2 / MCP-1 in cerebrospinal fluid Acute phase (P <0.05), CCL5 / RANTES, IL-10 levels did not change significantly (all P> 0.05). Conclusion: Based on the symptomatic treatment, the effect of ribavirin or interferon on antiviral treatment of pediatric HFMD is not obvious. However, whether MCP-1 is affected by ribavirin or interferon remains to be further studied the study.