Analysis Of The Efficacy Of Glucocorticoids And Intravenous Immunoglobulin In The Treatment Of Children With Severe Hand, Foot And Mouth Disease

Objective:To describe and analyze the situation and efficacy of Glucocorticoids(GCs)and IntravenousImmunoglobulin(IVIG)in children with severe HFMD based on real clinical data through observational studies.To provide scientific and evidence-based evidence for children with severe hand-foot-and-mouth disease to achieve the goal of improving the cure rate,reducing the mortality rate,and reducing the social and family economic burden.Methods:A follow-up study was conducted to collect information on the diagnosis and treatment of children with severe hand,foot and mouth disease during a year from 2016.04.01-2017.3.31 using a questionnaire survey.The survey included basic information,demographics and onset of illness before admission to the hospital.Situation and medical treatment after admission,laboratory examination,use of GCs and IVIG,etc.According to the actual use of GCs and IVIG,the children were divided into conventional therapy group,Glucocorticoids group and Combined group.Conventional therapy group:1.General treatment;2.Control of intracranial hypertension;3.Symptomatic treatment;4.Close observationofchangesinconditionsandclosemonitoring;Glucocorticoids group:Glucocorticoids(Methylprednisolone)was used?2 days to treat children with intravenous drip in a dose of 2 mg/(kg·d)on the basis of the conventional therapy group;Combined group:On the basis of the conventional therapy group,Methylprednisolone and Intravenous Immunoglobulinin combined therapy were used.The dosage of Methylprednisolone was the same as Glucocorticoids group,and the total amount of IVIG was 1-2 g/kg(given in 2-5days).Observe and compare the changes in the patients'condition,the incidence of outcome events(cure,sequelae,death),skin rash duration,fever days,nervous system involvement time,hospitalization days,and adverse reactions.Objectively evaluate the effectiveness of GCs and IVIG.Use spss22.0 software for statistical analysis of data.Measured data were expressed as mean±standard deviation(`X±S).Comparisons between groups were analyzed by analysis of variance,and comparisons were made between two groups.Those with variance were treated with LSD method;those with non-uniform variance were treated with Tamhane's-t~2 method;count data were analyzed withX~2 test,P<0.05 was considered statistically significant.Results:A total of 469 hospitalized cases of severe hand,foot and mouth disease were collected in one year,including 446 valid questionnaires,23 invalid questionnaires(effective rate:95.1%).446children with severe hand-foot-mouth disease including 284 males(63.7%)and 162 females(36.3%).The conventional therapy group consisted of 81 patients,302 patients in the Glucocorticoids group and 61patients in the combined group,and two death.Clinical efficacy indicators:1.Rash duration:conventional therapy group(5.51±1.21)days;Glucocorticoids group(5.59±1.25)days;combined group(6.44±2.05)days;2.Fever days:the conventional therapy group(0.89±0.72 days;Glucocorticoids group was(1.33±1.11)days;Combined group was(1.97±1.42)days;3.Nervous system involvement time:conventional therapy group(1.83±0.75)days;Glucocorticoids group(2.06±1.06)days;The combined group was(3.16±1.33)days;4.Hospitalization days:(5.04±1.25)days in the conventional therapy group;(5.30±1.23)days in the Glucocorticoids group;(7.66±2.63)days in the combined group.The above four efficacy indicators among the three groups were statistically significant(P<0.05).5.On the incidence of adverse reactions,there were 4 cases(4.94%)in conventional therapy group;10 cases(3.31%)in Glucocorticoids group;1case(1.64%)in combined group.There was no significant difference in the incidence of adverse reactions between groups.(P>0.05).All children in three groups were cured and discharged without any sequelae.Two cases of deaths did not improve after the combination of GCs and IVIG and eventually died due to circulatory and respiratory failure.Conclusion:Inthetreatmentofchildrenwithsevere hand-foot-mouthdisease,GlucocorticoidsandIntravenous Immunoglobulin should be used with caution in children with mild and moderate conditions(fever and neurological involvement);for children with severe conditions,Glucocorticoids and Intravenous Immunoglobulin could be used to improve systemic disorders and reduce mortality.