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目的:探讨大剂量促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)对EV71感染的手足口病危重患儿合并肾上腺功能障碍的临床治疗效果。方法:选择2010年10月~2011年10月收治的EV71感染的合并肾上腺功能障碍的手足口病危重患儿100例作为研究对象,随机将其分为对照组和观察组,每组50例。对照组患儿采取抗病毒、降颅压、激素消炎、退热及支持疗法等常规治疗;观察组患儿在常规治疗基础上加用静脉注射大剂量ACTH(250μg/1.7 m2)进行治疗。对两组患儿疗效进行评价,并比较肾功能指标。结果:两组患儿治疗效果比较,观察组总有效率为98.0%,对照组总有效率为72.0%,两组有效率差异具有统计学意义(χ2=13.254,P=0.031);对照组的皮质醇增值(△max)值(3.8±2.1)μg/dl,观察组的(△max值)为(7.1±1.8)μg/dl,差异具有统计学意义(t=10.184,P=0.008)。结论:大剂量ACTH能够显著增加EV71感染的手足口病危重患儿肾上腺功能障碍的治疗效果,改善肾上腺功能,升高血液中的皮质醇浓度,减轻肾组织损伤或功能障碍,具有重要的临床应用价值。
Objective: To investigate the clinical effect of high dose adrenocorticotropic hormone (ACTH) on children with severe hand, foot and mouth disease (EV71) infection complicated with adrenal dysfunction. Methods: A total of 100 critically ill children with hand-foot-mouth disease complicated with adrenal dysfunction who were infected with EV71 from October 2010 to October 2011 were enrolled in this study. They were randomly divided into control group and observation group, 50 cases in each group. Children in the control group were treated with anti-virus, intracranial pressure reduction, hormone anti-inflammatory, antipyretic and supportive therapy. The treatment group was treated with intravenous high dose ACTH (250μg / 1.7 m2) on the basis of routine treatment. Efficacy of two groups of children were evaluated, and compared renal function. Results: The total effective rate was 98.0% in the observation group and 72.0% in the control group, the difference between the two groups was statistically significant (χ2 = 13.254, P = 0.031); in the control group Cortisol value (△ max) was (3.8 ± 2.1) μg / dl, and the value of △ max in observation group was (7.1 ± 1.8) μg / dl, the difference was statistically significant (t = 10.184, P = 0.008). Conclusion: High-dose ACTH can significantly increase the therapeutic effect of adrenal dysfunction in critically ill children with hand-foot-mouth disease (EV71) infection, improve adrenal function, increase the concentration of cortisol in the blood and reduce the damage or dysfunction of renal tissue, which has important clinical application value.