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投稿时间：2023-06-05 网络发布日期：2024-04-20
投稿时间：2023-06-05 网络发布日期：2024-04-20
中文摘要: 目的 分析五味消毒饮治疗手足口病儿童的临床疗效、血清核因子-κB（NF-κB）变化及NF-κB对病毒性脑炎（VE）的预测效能。
方法 选择上海儿童医学中心2020年12月至2022年12月就诊的116例手足口病患儿进行回顾性研究，根据治疗方法的不同将其分为两组，各58例，对照组给予常规西药治疗，观察组在对照组基础上给予五味消毒饮治疗，比较两组临床疗效、临床症状消失时间、血清NF-κB水平、血清炎性因子指标［肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、C反应蛋白（CRP）］、不良反应总发生率、VE发生率。治疗结束后，根据116例患儿是否发生VE分为VE组（n=11）、非VE组(n=105)，比较两组入院24 h内血清NF-κB水平，绘制受试者工作特征曲线（ROC），计算曲线下面积（AUC），分析血清NF-κB对VE的预测效能。
结果 观察组临床总有效率（96.55%）高于对照组（77.59%， χ2=9.265, P＜0.01）。观察组不良反应总发生率（5.17%）与对照组（8.62%）比较差异无统计学意义（P＞0.05），观察组VE发生率（1.72%）低于对照组（17.24%，P＜0.05）。非VE组入院24 h内血清NF-κB水平低于VE组［（2.99±0.34）μg/mL vs（3.85±0.51）μg/mL，t=7.590，P＜0.01）。血清NF-κB截断值取1.65 μg/mL时，预测VE的AUC最佳，为0.826（95%CI： 0.731~0.952），灵敏度为94.28%，特异度为90.06%。
结论 五味消毒饮可有效缓解手足口病患儿手足皮疹、口腔溃疡等症状，降低血清NF-κB含量，减轻炎症反应，降低VE发生率，安全有效。血清NF-κB在预测手足口病患儿发生VE方面的灵敏度、特异度较高，具有一定的参考价值。
Abstract:Objective To analyze the clinical efficacy，serum nuclear factor-κB (NF-κB) changes，and predictive value for viral encephalitis (VE) in children with hand，foot，and mouth disease (HFMD) treated with Wuwei Xiaodu Decoction.
Methods A total of 116 children with HFMD who visited Shanghai Childrens Medical Center were selected for a retrospective study from December 2020 to December 2022. According to the different treatment methods， they were divided into two groups, with 58 cases in each group. The control group received routine Western medicine treatment，while the observation group received Wuwei Xiaodu Decoction on the basis of control group. The clinical efficacy，clinical symptom disappearance time，serum NF-κB level，serum inflammatory factor indicators ［tumor necrosis factor-α (TNF-α)，interleukin-6 (IL-6)，C-reactive protein (CRP)］，total incidence of adverse reactions， and incidence of VE were compared between the two groups. After treatment，the children were divided into a VE group (n=11) and a non-VE group (n=105) according to whether they developed VE. The serum NF-κB levels within 24 h after admission in the two groups were compared，and the receiver operating characteristic curve (ROC) was plotted to analyze the predictive value of serum NF-κB for VE.
Results The total clinical efficiency of the observation group was higher than that of the control group (96.55% vs 77.59%, χ2=9.265, P＜0.01). The total incidence of adverse reactions in the observation group (5.17%) was not significantly different from that in the control group (8.62%)，but the incidence of VE in the observation group (1.72%) was lower than that in the control group (17.24%), and the difference was statistically significant (P＜0.05). The serum NF-κB level in the non-VE group within 24 hours after admission was lower than that in the VE group［(2.99±0.34) μg/mL vs (3.85±0.51) μg/mL， t=7.590， P＜0.01］. When the serum NF-κB cutoff value was 1.65 μg/mL，the best prediction for VE was obtained，with an area under ROC curve (AUC) of 0.826 (95%CI: 0.731-0.952)，a sensitivity of 94.28%, and a specificity of 90.06%.
Conclusion Wuwei Xiaodu Decoction can effectively alleviate the symptoms of children with HFMD such as rash and ulcers on hands and feet, decrease serum NF-κB level, reduce inflammation response and the incidence of VE, which is safe and effective. Moreover, serum NF-κB has high sensitivity and specificity in predicting the occurrence of VE in children with HFMD, which has certain reference value.
keywords: Wuwei Xiaodu Decoction Hand, foot, and mouth disease Serum nuclear factor- κB Viral encephalitis
文章编号： 中图分类号：R272 文献标志码：B
基金项目:上海市卫生健康委员会中医药传承和创新项目（ZYCC2019022）;上海市市级财政项目［ZY（2021-2023）〖KG-*2〗-0206-08）〖KG-*2〗］;西南医科大学附属中医医院联合项目（2020XYLH-042）
| Author Name | Affiliation |
| XU Lihua*, CHEN Jia, SHI Xiaoxiao, SUN Kexing, LIU Fang, WANG Junxia | *Dongfang Hospital Affiliated to Tongji University, Shanghai 200120, China |
引用文本：
徐丽华,陈佳,史晓晓,等.血清核因子-κB对手足口病儿童五味消毒饮疗效的评估价值及病毒性脑炎预测效能[J].中国临床研究,2024,37(4):585-590.
徐丽华,陈佳,史晓晓,等.血清核因子-κB对手足口病儿童五味消毒饮疗效的评估价值及病毒性脑炎预测效能[J].中国临床研究,2024,37(4):585-590.