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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。
Objective To explore TCM syndromes and core pathogenesis of hand, foot and mouth disease complicated by central nervous system infection. Methods A prospective clinical study was conducted in 327 inpatients with hand-foot-mouth disease complicated by central nervous system infection. Dynamic observation was conducted according to a unified TCM syndrome observation table. The syndromes were classified into Damp-heat Syndrome, Syndrome, damp-heat syndrome is divided into wet weight in heat syndrome, dampness in wet syndrome, by two attending physicians based on clinical data to determine the type of TCM syndromes and core pathogenesis. Results The classification of syndromes in 327 children was: wet weight was 208 (63.8%) in the heat syndrome, 79 (24.2%) were in the heat syndrome and 40 (12.2%) were in the heat syndrome, (P <0.01). The duration of wet weight before heat injection was longer than that of heat weight wet (P <0.05). The wet weight was higher than that of heat test The days of hospitalization tended to be longer than those of the warmer card (P = 0.083); the results showed that the color of the rash was stronger than that of the wet card, and the ratio of oral rashes was higher than that of the heat card and warmer card (P <0.05) Lethargy and neck stiffness ratio is higher than the wet weight in the heat and heat to dampness syndrome (P <0.05); wet weight in the heat syndrome and the heat dampness in the wet evidence appear more likely to be frightened than warm card (P < 0.05). There was no difference in the etiology of different syndromes. Conclusion HFMD complicated with central nervous system infection is mainly caused by damp-heat epidemic poison. The main diseases are spleen, heart, liver and core pathogenesis of damp-heat. Wet weight in the heat and heat on the wet weight is easy to see easily shock and other dynamic performance, wet weight on the heat syndrome is not obvious, the heat is not good, the disease develops more slowly, lingering refractory; More red and oral rashes more common; warm card is easy to see neck stiffness, lethargy performance.