
Clinical effect of carvedilol in treatment of children with severe hand-foot-mouth disease caused by enterovirus 71 infection
GONG Xiao-Yan, LI Bing-Fei
Chinese Journal of Contemporary Pediatrics ›› 2019, Vol. 21 ›› Issue (8) : 796-800.
Clinical effect of carvedilol in treatment of children with severe hand-foot-mouth disease caused by enterovirus 71 infection
Objective To study the clinical effect of carvedilol in the treatment of children with severe hand-foot-mouth disease (HFMD) caused by enterovirus 71 (EV71) infection. Methods A retrospective analysis was performed for the clinical data of 86 children with severe HFMD caused by EV71 infection who were admitted to the hospital from April 2016 to August 2017. According to whether carvedilol was used, the children were divided into conventional treatment group with 51 children and carvedilol treatment group with 35 children. A total of 56 healthy children who underwent physical examination at the outpatient service during the same period were enrolled as the control group. The two treatment groups were compared in terms of clinical features and levels of catecholamines (norepinephrine, adrenaline and dopamine), and the levels of catecholamines were compared between these two treatment groups and the control group. Results Before treatment, the conventional treatment group and the carvedilol treatment group had significantly higher levels of norepinephrine and adrenaline than the control group (P < 0.05). After treatment, both the conventional treatment group and the carvedilol treatment group had significant reductions in norepinephrine, adrenaline, blood glucose, systolic pressure, diastolic pressure, heart rate, body temperature and leukocyte count (P < 0.05). Compared with the conventional treatment group, the carvedilol treatment group had significantly lower dopamine level, blood glucose, heart rate and respiratory rate after treatment (P < 0.05). Conclusions Changes in norepinephrine and adrenaline might be involved in the pathogenesis of severe HFMD caused by EV71 infection. Carvedilol, in addition to the conventional treatment, can improve respiration, heart rate and blood glucose in children with severe HFMD caused by EV71 infection.
Hand-foot-mouth disease / Carvedilol / Catecholamine / Clinical effect / Child
[1] 费晓, 方凯, 李兴旺, 等. EV71感染者儿茶酚胺水平的研究[J]. 中华实验和临床感染病杂志(电子版), 2013, 7(2):187-192.
[2] 钱素云, 李兴旺. 我国手足口病流行及诊治进展十年回首[J]. 中华儿科杂志, 2018, 56(5):321-323.
[3] Sun BD, Liu HM, Nie SN. S100B protein in serum is elevated after global cerebral ischemic injury[J]. Word J Emerg Med, 2013, 4(3):165-168.
[4] Sedý J, Zicha J, Kunes J, et al. Mechanisms of neurogenic pulmonary edema development[J]. Physiol Res, 2008, 57(4):499-506.
[5] Zhang Y, Liu H, Wang L, et al. Comparative study of the cytokine/chemokine response in children with differing disease severity in enterovirus 71-induced hand, foot, and mouth disease[J]. PLoS One, 2013, 8(6):e67430.
[6] 钟涛, 郑伟华, 李雄. 肠道病毒71型致神经源性肺水肿机制研究进展[J]. 医学综述, 2015, 21(7):1178-1180.
[7] 朱磊, 朱俊岭, 盛利平, 等. 危重型手足口病患儿水通道蛋白4的表达及临床意义[J]. 中华实用儿科临床杂志, 2018, 33(22):1716-1719.
[8] Su VY, Chang YS, Hu YW, et al. Carvedilol, bisoprolol, and metoprolol use in patients with coexistent heart failure and chronic obstructive pulmonary disease[J]. Medicine (Baltimore), 2016, 95(5):e2427.
[9] Guzeloglu M, Ertuna E, Arun MZ, et al. Effects of carvedilol on vascular reactivity in human left internal mammary artery[J]. Eur Rev Med Pharmacol Sci, 2017, 21(21):4983-4988.
[10] 中华人民共和国国家卫生健康委员会. 手足口病诊疗指南(2018年版)[J].中华临床感染病杂志, 2018, 11(3):161-166.
[11] 卫生部手足口病临床专家组. 肠道病毒71型(EV71)感染重症病例临床救治专家共识[J]. 中华儿科杂志, 2011, 49(9):675-678.
[12] 许红梅, 潘招军. 肠道病毒71型感染所致儿童手足口病与天然免疫细胞的研究进展[J].中华实用儿科临床杂志, 2018, 33(22):1681-1686.
[13] 赵倩, 张少丹, 高艳霞, 等. 重症手足口病患儿血清去甲肾上腺素水平变化及其他相关因素分析[J].实用儿科临床杂志, 2012, 27(18):1418-1420.
[14] 孙立波, 朱友荣, 金丹群, 等. 重症手足口病患儿血浆儿茶酚胺水平的研究[J]. 中国小儿急救医学, 2018, 25(5):382-385.
[15] Inamasu J, Sugimoto K, Yamada Y, et al. The role of catecholamines in the pathogenesis of neurogenic pulmonary edema associated with subarachnoid hemorrhage[J]. Acta Neurochir, 2012, 154(12):2179-2185.
[16] Fu YC, Chi CS, Chiu YT, et al. Cardiac complications of enterovirus rhombencephalitis[J]. Arch Dis Child, 2004, 89(4):368-373.
[17] 于春梅, 梁向荣, 刘勇, 等. 小儿手足口病63例儿茶酚胺测定及其临床意义[J]. 中国实用儿科杂志, 2014, 29(1):58-59.
[18] 叶志荣, 林勇军, 洪娜娇, 等. 卡维地洛片治疗慢性收缩性心力衰竭的临床研究[J]. 中国临床药理学杂志, 2018, 34(14):1592-1594.
[19] 张育才, 王荃, 钱素云, 等. 手足口病的临床分期、分型与重症手足口病的早期识别[J].中国临床医生杂志, 2018, 46(7):757-759.
[20] Chakraborty R, Iturriza-Gómara M, Musoke R, et al. An epidemic of enterovirus 71 infection among HIV-1-infected orphans in Nairobi[J]. AIDS, 2004, 18(14):1968-1970.