| Objective:To analyze the clinical characteristics of 2790 cases hand,foot and mouth mild disease and evaluate clinical efficacy and security with different therapy in treating hand,foot and mouth disease(HFMD) mild.Methods:Newly diagnosed 2790 cases of HFMD mild meeting the inclusion criteria in the outpatient and inpatient pediatriede partment of Anhui Province Traditional Chinese Medicine etc in total 21 hospitals from March 1, 2012 to March 31, 2012.A clinical epidemiological research method is conducted,to analyze the clinical characteristics of2790 cases HFMD mild.A cohort study is conducted,2790 cases of children of HFMD mild are classified into western medicine group(718cases),Traditional Chinese medicine(TCM) group(750cases) and integrative medicine group(1322cases) depending on the actual treatment.The symptomatic treatment is mainly taken in western medicine group. The prescription that can clearing heat and detoxificating,eliminating dampness or clearing qi and cold ying,detoxificating and melting dampness is mainly taken in TCM group depending on dialectical type,coordinating with Antiviral Oral Liquid and Reduning Injection.The treatment of integrative medicine group combines western medicine group with TCM group.The indicators such as the basic status(including gender,age, height,nation, place of residence,specific nucleic acid detection,close contact history a week before the onset of HFMD mild,drug allergies, etc),distribution of rash or herpes and accompanying symptoms at baseline,rate of rash or herpes symptoms disappeared after treatment at different visit time,rate of accompanying symptoms disappeared after treatment at different visit time,time of the temperature returned to normal,time of rash or herpes disappearance,severe conversion rate,treatment outcome and incidence of adverse events are observed in the threegroups.Statistical analyses is performed after observation.Results:1.Clinical epidemiological characteristics in children of HFMD mild.The male to female ratio is 1.67: 1 among 2790 cases of children of HFMD, incidence of male is higher than female.Children have a higher incidence in Han nationality than that in ethnic minority. Most of children of HFMD mild come from city(58.87%), followed by rural and township.The history of close contact with children of HFMD mild has a higher incidence than children without history of exposure within a week before the onset of HFMD mild in children has been tested intestinal virus-specific nucleic acid detection, the infection of EV71 and COXA16 account for majority,other intestinal virus rarely cause HFMD.2.Clinical characteristics in children of HFMD mild.The distribution of rash or herpes on hand and foot scattered in sparse and between sparse and dense clusters onset.The mainly symptom of oral mucosa is blister-like rash and mucous membrane rash.There has no or scattered rash or herpes in buttock,anus,chest and back and four limbs.The mainly accompanying symptoms are fever, blisters within the slurry,salivation, anorexia;runny nose, cough, expectoration, vomiting, diarrhea, constipation,irritability, lethargy and other associated symptoms are rare.3.The disappearance rate of rash or herpes symptoms at different visit time after treatment. In the third day of treatment,the disappearance rate of rash or herpes symptoms in hand of western medicine group is better than traditional Chinese medicine group and integrative medicine group(P<0.05);in the fifth and seventh day of treatment, TCM group and western medicine group are both better than integrative medicine group(P<0.05).In the third day of treatment,the disappearance rate of rash or herpes symptoms on foot,TCM group is better than western medicine group(P<0.05);in the fifth day of treatment,TCM group is better than western medicine group and integrative medicine group(P<0.05);in the seventh day of treatment,TCM group isbetter than western medicine group(P<0.05),western medicine group is better than integrative medicine group(P<0.05);In the seventh day of treatment,the disappearance rate of rash or herpes symptoms in the buttocks,TCM group is better than western medicine group and integrative medicine group(P<0.05),western medicine group is better than integrative medicine group(P<0.05).In the fifth day of treatment,the disappearance rate of rash or herpes symptoms in the oral mucosa,TCM group and western medicine group are both better than integrative medicine group(P<0.05);In the seventh day of treatment,TCM group is better than western medicine group(P<0.05),western medicine group is better than integrative medicine group(P<0.05).The results suggest that TCM group and western medicine group both can make rash or herpes symptoms of hand,foot,buttocks and oral in HFMD children disappear early and their overall effect is better than integrative medicine group.4.The disappearance rate of accompanying symptoms at different visit time after treatment.In the third and seventh day of treatment,the disappearance rate of fever has no difference among the three groups(P>0.05); in the fifth day of treatment,TCM group is better than integrative medicine group(P<0.05),western medicine group is better than TCM group(P<0.05).The results suggest that three treatment programs has no difference for fever control in the early and late treatment,but in the middle treatment,TCM group and western medicine group are both better than integrative medicine group in fever control.In the third day of treatment,the disappearance rate of blister slurry of western medicine group is better than TCM group and integrative medicine group(P<0.05),TCM group is better than integrative medicine group(P<0.05);in the fifth day of treatment,western medicine group is better than TCM group(P<0.05), however there are no difference between TCM group and integrative medicine group,western medicine group and integrative medicine group(P>0.05);in the seventh day of treatment,the disappearance rate of blister slurry has no difference among the three groups(P>0.05). The results suggest that western medicine group in promoting early serous blisters disappear superior efficacy of TCM group andintegrative medicine group,but there are no difference in terms of the efficacy of the blisters disappeared within the slurry.In the third day of treatment,the disappearance rate of salivation of western medicine group is better than TCM group(P<0.05),TCM group is better than integrative medicine group(P<0.05),there are no difference between western medicine group and integrative medicine group(P>0.05);in the fifth and seventh day of treatment the disappearance rate of salivation has no difference among the three groups(P>0.05).The results suggest that TCM group and western medicine group both can make salivation symptoms disappear early,their efficacy is better than integrative medicine group.In the third and seventh day of treatment,the disappearance rate of anorexia has no difference among the three groups(P>0.05);in the fifth day of treatment,the disappearance rate of anorexia of western medicine group is better than TCM group and integrative medicine group(P<0.05),there has no difference between TCM group and integrative medicine group(P>0.05).The results suggest that three treatment programs has no difference for anorexia in the early and late treatment,but in the middle treatment,western medicine group is better than TCM group and integrative medicine group in improving anorexia symptom.5.Time of temperature return to normal in children of HFMD mild.The median time of temperature returned to normal time of TCM group,western medicine group and integrative medicine group separately are 24 hours,48 hours(95% CI 48 to 70) and 24hours(95% CI 24 to 31),there are significant differences among the three groups(P<0.0001). Time of temperature return to normal of TCM group is close to integrative medicine group,and it is shorter than western medicine group.TCM group and integrative medicine group both can make children of HFMD mild reduce fever early,and its overall effect is better than western medicine group.6. Time of the rash or herpes disappearance in children of HFMD mild.The median time of all rash or herpes disappearance of TCM group,western medicine group and integrative medicine group separately are 132 hours,144 hours and 141 hours,there are significant differences among the three groups(P<0.0001).Time of all rash or herpesdisappearance of TCM group is the shorter and the speed of onset is faster than other two groups,western medicine group is close to integrative medicine group.The median time of rash or herpes disappearance in hand of TCM group,western medicine group and integrative medicine group separately are 96 hours,120 hours and 96 hours,there are difference among three groups(P<0.05).In the speed of rash or herpes early disappearance in hand, TCM group is faster than western medicine group and integrative medicine group(P<0.05),but in the speed of rash or herpes all disappearance,integrative medicine group is the best among three groups.The median time of rash or herpes disappearance on foot of TCM group,western medicine group and integrative medicine group separately are 96 hours,120 hours and 96 hours,there are difference among three groups(P<0.05).Time of the rash or herpes disappearance on foot of TCM group and integrative medicine group are both shorter than western medicine group,and integrative medicine group is better than TCM group.The median time of rash or herpes disappearance in oral mucosal of TCM group,western medicine group and integrative medicine group separately are 96 hours, 96 hours and 96 hours,there are significant differences among the three groups(P<0.0001).Time of the rash or herpes disappearance in oral mucosal of TCM group is shorter than western medicine group,and integrative medicine group.7.The outcome of treatment and the incidence of adverse events in children of HFMD mild.The clinical cure rate of TCM group,western medicine group and integrative medicine group separately are 92.40%, 85.52%, 90.54%;the invalid rate of three groups separately are 14.35%, 7.60%, 9.00%; the severe conversion rate of three groups separately are 0.00%, 0.14%, 0.45%;there are differences among the three groups(P<0.05).The treatment outcome of TCM group is the best among three groups.The incidence of adverse events of three groups separately are 0.00%, 0.42%,0.53%, there are no differences among the three groups(P<0.05).Conclusion:1.The incidence of HFMD mild in boys is higher than that in girls,in Han nationalityis higher than that in minority, in urban is higher than that in rural and townships.The majority of children infected with COXA16 and EV71. The history of close contact with HFMD is an important predisposing factors. The distribution of rash or herpes on hand and foot scattered in sparse and between sparse and dense clusters onset.The mainly symptom of oral mucosa is blister-like rash and mucous membrane rash.The mainly accompanying symptoms are fever, blisters within the slurry, salivation,anorexia.2.TCM and Western medicine are both to make the rash or herpes of HFMD mild early disappear and both of them have a higher overall effect than the treatment formula combined Traditional Chinese Medicine and Western medicine.3.TCM and Western medicine are both to improve the disappearance rate of fever symptom in fifth day,but the disappearance rate of fever symptoms has no difference among three regimen in third and seventh day.Western medicine can make blisters disappear early in third day,but the blister disappear slurry has no difference among three regimen. TCM and Western medicine can make salivation symptom disappear early in third day.Western medicine can improve efficiency of the disappearance rate of anorexia symptom in the fifth day,but there is no difference among three treatment programs in promoting anorexia symptom disappeared early and completely.4.TCM can reduce time of the temperature return to normal, make children of HFMD mild antipyretic in early stage. TCM has superiority than with than Western medicine.5.TCM can make rash or herpes in children with HFMD mild disappear quickly in a short time.6.TCM is a kind of safe and effective treatment formula in treating HFMD mild for its higher clinical cure rate,lower severe conversion rate,lower incidence of adverse events. |
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