The Epidemiological Studies On The Effect Of Early Use Of Glucocorticoids On The Hand,Foot And Mouth Disease

Objectives To study the effect of early using of glucocorticoids (GCs) on the hand,foot and mouth disease (HFMD) including development of severe HFMD while tounderstand the condition of early using of GCs to therapy HFMD including for fever andthe cognitive present situation of HFMD cases’ family and medical staff on HFMDtreatment using of the GCs.Those aims were in order to provide scientific evidence forprevention and treatment of HFMD.Methods Descriptive epidemiological methods were be used to collect theinpatient children with HFMD who fit the standard of research objects admitted to a3Agrade hospital in Shenzhen in2011.Inpatients’datas were collected though formulating aunified questionnaire from patient records.The method of retrospective cohort study wasused to collect the inpatient children with HFMD who meet the study inclusion andexclusion standard and admitted to this hospital from January2011to June2012.Conditionscoring method was for evaluting changes in the patient’s condition.The survey not onlycontained HFMD cases basic information but also comprehended indicators that used toscore the illness degree of HFMD cases.Accompanying relatives of HFMD inpatientsenrolled in the cohort study who were selected by a simple random sampling method wereinterviewed by telephone while all the doctors for diagnosis and treatment HFMD in thishospital were surveyed through questionnaire.Epidata3.0and SPSS17.0software were used for data entering and analysis.Nonparametric test was used to analyzed measurement dataand ranked data while Chi-square test was used to analyzed enumeration data.Results There were totally348HFMD inpatients and most of whom were youngerthan3years old. Males was about0.90times higher than female and90.5%(315/348) caseswere scattered children.Onest time of HFMD was mainly in May-August. Severe casesaccounted for49.71(173/348) while severe cases with using of GCs was more than thosewho did not use GCs (χ2=24.37,P=0.00).There were21mild cases development to severecases after using of GCs.93.39%(325/348) inpatients were fever. There had131patientswho used GCs early(≤3d) while89patients who used GCs lately(>3d).There was asignificant difference (χ2=24.89,P=0.00) in children who early using of GCs accompaniedby clinical symptoms and who lately using of GCs.Severe cases of cohort study accounted for49.55%(218/440) and the proportion ofexposure group were significantly higher than the non-exposed group(χ2=32.73,P=0.00).14.62%(38/260) developed severe cases after the use of GCs in the twogroup.21cases developed severe cases who received early GCs treatment(≤3d).The riskration of development severe cases who used GCs early (≤3d) was4.6times (95%CI=2.29-9.23) of unused GCs while3.42-fold (95%CI=1.92-6.09) of lately used GCs (>3d)or unused GCs. There has22.73%(50/220) was sicker after using of GCs in the exposuregroup while74%(37/50) was distributed in those who used GCs early. For mild cases andsevere cases, condition score change and hospitalization expenses and hospitalization daysbetween the exposure group and non-exposed group were significantly different,whilecondition score change between early started using GCs (≤3d) and lately started using GCs(>3d) or unused GCs was significantly different too. For mild cases, the hospitalizationexpenses and days of cases who early started using GCs (≤3d) were more than who latelystarted using GCs (>3d) or unused GCs.There was a positive correlation between the degreeof exacerbations and GCs dose and the number of using days in the exposure group.28%(56/200) of familialities of HFMD inpatients had known the GCs while17familymembers think that GCs could be used for fever in the telephone interview. Mental activityand performance of the two groups of relatives when they brought children to go to see a doctor were no significant difference.There was92.31%(12/13) of doctors had used GCs intreatment of HFMD cases and13doctors used guidelines recommended as the basis forselection GCs to treat HFMD,in which four people at the same time choosed experience inmedicine and one at the same time selected the same occupation suggestion. There has90.91%(10/11) doctor who selected≧39.0℃as the temperature value of using GCs forfever of HFMD. Condition requires accounted the reason of using GCs61.54%(8/13)while the reasons that should not choose GCs for fever were masking patient’scondition,exsiting controversy, having adverse effects and they accounted30.77%(4/13),30.77%(4/13),23.08%(3/13) in turn.Conclusions The phenomenon of HFMD treatment with GCs was commonwhile use of GCs,especially the early use of GCs,therapy for HFMD increased the risk forsevere disease and made some patients sicker.The knowledge of family members of HFMDpatients about GCs was relatively scarce. The doctors generally thought that use of GCswas helpful to improve HFMD patients’disease while they still had qualified opinion ofusing GCs for fever.