热毒宁、甘草酸苷联合治疗对第2期手足口病及其免疫细胞、炎性细胞因子的影响

Combination Therapy of Reduning and Glycyrrhizin for the Second Stage of Hand, Foot and Mouth Disease and Its Immune Cells, and Inflammatory Cytokines

摘要: 目的：探讨热毒宁、甘草酸苷联合治疗对第2期手足口病患儿的治疗效果、免疫细胞及炎性细胞因子的影响。方法：286例第2期手足口病患儿随机分成实验1组(66例)、实验2组(73例)、实验3组(72例)及实验4组(75例)，同期63例健康体检儿童作为对照组。治疗5 d后，观察HFMD患儿的临床疗效。应用流式细胞术检测研究对象外周血T淋巴细胞、Th细胞、Tc细胞、NK细胞和B淋巴细胞所占淋巴细胞的百分比。酶联免疫吸附法测定炎性细胞因子IL-6、IL-10.、TNF-ɑ水平，分析各组间上述指标的差异。结果：1) 较实验1组，实验2组、实验3组及实验4组的退热时间、皮疹消退时间、精神状态恢复情况或惊颤消失时间及危重型病例转化率明显降低，治疗效率显著升高，差异有统计学意义(P < 0.05)，实验4组的正常体温恢复时间、皮疹消退时间、精神状态恢复情况或惊颤消失时间明显高于实验2组及实验3组(P < 0.05)；2) 第2期手足口病患儿T淋巴细胞、Th细胞、Th/Tc细胞比值较对照组显著降低，而B淋巴细胞百分比、IL-6、IL-10和TNF-ɑ水平明显升高，差异有统计学意义(P < 0.05)；3) 较实验1组，实验2组、实验3组及实验4组的T淋巴细胞、Th细胞、Th/Tc比值显著升高，B淋巴细胞及IL-6、IL-10.、TNF-ɑ的水平明显降低(P皆 < 0.05)；且实验2组与实验4组的Th细胞、B淋巴细胞、Th/Tc比值、IL-6、IL-10.、TNF-ɑ间的差异有统计学意义(P < 0.05)。结论：较单用热毒宁，热毒宁及甘草酸苷联合治疗能显著地改善第2期手足口患儿的临床症状和免疫功能紊乱，但热毒宁联合甘草酸苷改善免疫功能的作用较单独用药是否有叠加作用需进一步研究。

Abstract: Objective: To investigate the effect of Reduning combined with glycyrrhizin on immune cells and inflammatory cytokines in children with hand-foot-mouth disease (HFMD). Methods: 286 children with Stage II HFMD were randomly divided into the routine group (66 cases), the Reduning group (73 cases), the glycyrrhizin group (72 cases) and the combined group (75 cases), and 63 healthy children as the control group. After 5 days of treatment, the clinical therapeutic effect of HFMD children was observed. The percentage of T lymphocyte, Th cells, Tc cells, NK cells, and B lymphocyte in the lymphocyte of all subjects’ peripheral blood was measured by flow cytometry. Inflammatory cytokines IL-6, IL-10 and TNF-ɑ were measured by ELISA, to analyze the differences of the above indicators among the groups. Results: 1) Compared with the conventional treatment group, the time of antipyretic, the time of rash subside, the time of mental state recovery or the time of quiver subside and the conversion rate of critical cases were significantly decreased and the treatment efficiency was significantly increased (P < 0.05). The recovery time of normal body temperature, the time of rash subside, the time of mental state recovery or the time of the shiver subsided in the combination group were significantly higher than those in the Reduning group and the glycyrrhizin group (P < 0.05); 2) The ratio of T lymphocyte cells, Th cells and Th/Tc cells were significantly lower than those of the control group, but the percentage of B lymphocyte, IL-6, IL-10 and TNF-ɑ levels were significantly higher than those of the control group (P < 0.05); 3) Compared with the conventional medication group, the T lymphocytes, Th cells, and Th/Tc ratios of the Reduning group, the glycyrrhizin group and the combined medication group were significantly increased, and the B lymphocytes and the level of IL-6, IL-10 and TNF-ɑ were significantly reduced (P < 0.05); there were significant differences in Th cells, B lymphocytes, th/TC ratio, IL-6, IL-10 and TNF-α between the Reduning group and the combination group. Conclusion: Compared with the treatment of Reduning, Reduning and glycyrrhizin combined treatment can significantly alleviate the immune dysfunction in children with Stage II hand-foot-mouth disease; however, the effect of Reduning combined with glycyrrhizin on improving immune function should be further studied.