Hand, Foot And Mouth Disease With Central Nervous System Infections Tcm Syndrome Characteristics And Core Disease Mechanisms

BackgroundHand, foot, and mouth disease (HFMD) is an emerging infectious disease caused by about 20 intestinal viruses, especially EV-71 which would lead to higher rate of incidence of severe symptoms and mortality. In 1998, there was an outbreak in Taiwan affecting more than 12 million people, of which more than 400 children suffer the severe complications such as encephalitis, aseptic meningitis, pulmonary edema and pulmonary hemorrhage and of which 78 died. In 2008, an outbreak beginning in March in Fuyang, Anhui Province lead to 6188 infections, of which 52 severe conditions and 22 deaths by May 10. Similar outbreaks were also reported in Hainan, Guangdong, Hebei and other provinces. Severe hand, foot and mouth disease, particularly foot and mouth disease with central nervous system infections and severe complications has changed people's understanding of HFMD. The mechanism and treatment haven't been explained clearly. In view of foot and mouth disease epidemic in recent years has become one of the most serious infectious diseases, Ministry of Health has listed HFMD as one of C diseases. It's essential to increase the awareness of HFMD and improve the treatment quality and to explore effective Chinese medicine treatment and to lower the mortality and rate of disabilities.ObjectiveCarry out multi-focus, prospective, randomized-control clinical study to explore the syndrome characteristics and the core mechanism of the HFMD complicated with central nervous system infection and to evaluate the TCM clinical efficacy and safety.Subjects and methodsThe inpatients of HFMD complicated with central nervous system infection from 7 Research Center (2 in Beijing,1 in Hebei,3 in Shangdong,1 in Sichuang) all were infants who had central nervous system infection in two days. Formulated a unified form of TCM syndromes observed, the HFMD was divided into three syndromes of damp overbalancing heat syndrome, heat overbalancing damp syndrome and warn-heat syndrome. The attending physician, graduate students and project groups observed the clinical features of Chinese and Western Medicine of the cases in accordance with the requirements of dynamic. Then summarized the clinical data of Chinese and Western Medicine, and drew to identify syndromes and pathogenesis of the cases by expert panel. result(1) Among 327 patients, there are 208 of damp overbalancing heat syndrome(63.8%),79 of heat overbalancing damp syndrome(24.2%) and 40 of warn-heat syndrome (12.2%)。(2) The maximum temperature of the three groups was statistically significant different, the maximum temperature of the heat overbalancing damp syndrome group and the warn-heat syndrome group was significantly higher than the damp overbalancing heat syndrome group (P<0.01). The temperature of the heat overbalancing damp syndrome group and the warn-heat syndrome has no significant difference (P>0.05); After onset, the course of disease of the damp overbalancing heat syndrome group was longer than heat overbalancing damp syndrome group, and there were significant differences between them(P<0.05). Also, the damp overbalancing heat syndrome group tended to be longer than the warn-heat syndrome group(P is close to 0.05)。(3) Rash color,somnolence,hyperarousal,neck stiffness and oral rash had the statistical difference between the three certificates. Heat overbalancing damp syndrome group's rash was more red than the other two (P<0.05).More somnolence patients in warn-heat syndrome group than the other two (P<0.05). damp overbalancing heat syndrome group and heat overbalancing damp syndrome were more hyperarousal than warn-heat syndrome group (P<0.05). Neck stiffness happened in warn-heat syndrome group more than the other two (P<0.05). The heat overbalancing damp syndrome group had oral rash more than the other two. (P<0.05)。Conclusion(1) Severe HFMD belongs to epidemic, whose etiology is pathogen. It is dominated by warm dampness. The Disease locations mainly are heart, liver, spleen and the core of mechanism is dampness-heat violating the wind.(2) The Clinical syndrome of the HFMD complicated with central nervous system infection is mainly damp overbalancing heat syndrome. Among the three syndromes, The maximum duration of temperature of warn-heat syndrome and heat overbalancing damp syndrome are higher than damp overbalancing heat syndrome. Warn-heat syndrome group is more likely to have somnolence and neck stiffness. Damp overbalancing heat syndrome group and heat overbalancing damp syndrome group are more hyperarousal than the other group, and the oral rash is more likely to happen in heat overbalancing damp syndrome group.