589例儿童病毒性脑炎的临床分析

发布时间：2018-03-07 07:49

本文选题：病毒性脑炎　切入点：儿童　出处：《重庆医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：回顾性分析病毒性脑炎（Viral encephalitis，VE）儿童的临床特点，以期指导临床医师更好地认识不同地区的病毒性脑炎，达到满意治疗目的。方法：对2011年1月至2012年12月在重医大附属儿童医院出院确诊病毒性脑炎的589例患儿的病历资料进行回顾性总结分析。结果： 1.589例病毒性脑炎患儿年龄分布于7月~15岁以内，平均5.60±3.37岁，中位数年龄5.00岁，其中男孩348人，占59.1%，女孩241人，占40.9%，男女比例1.44:1。 2.重庆地区422人，占71.6%；云贵川地区160人，占27.2%；其它地区7人，占1.2%。城镇患儿269人，占45.7%；农村患儿320人，占54.3%。 3.本组病例全年均有发病，但在7月份左右有集中趋势（P＜0.01）。 4.最多见的临床表现为发热（78.6%）、呕吐（68.3%）、头痛（52.8%）、意识障碍（38.7%）、咳嗽（38.4%）和惊厥（36.0%）。 5.所有患儿均作血清学病毒IgM抗体检测，318例（54.0%）异常，其中CV感染率最高，为58.5%，其次为HSV（32.4%）、AV（22.6%）、EBV（11.0%）、MEV（4.7%）、MV（4.1%）、RV（2.5%）、CMV（2.2%）。 6.567例做了脑脊液病毒IgM抗体检测，143例（25.2%）异常，其中CV感染率最高，为50.3%，其次为HSV（28.7%）、AV（28.7%）、EBV（11.2%）、MEV（7.7%）、MV（4.9%）、RV（3.5%）、CMV（2.1%）。 7.本研究头痛（60.2%VS47.0%，P＜0.05）多见于肠道病毒相关的VE（EVAE组），共济失调（1.1%VS6.1%，P＜0.05）和脑膜刺激征（11.8%VS22.0%，，P＜0.05）多见于其他病毒相关的VE（OVAE组）。 8.269例做了头颅CT检查，59例（21.9%）异常；332例做了头颅MRI检查，102例（30.7%）异常；MRI优于CT（P＜0.05）；565例做了脑电图检查，407例（72.0%）异常。 9.354例临床治愈，230例临床好转，5例死亡；36例遗留不同程度后遗症。结论：本研究CV感染率（58.5%）最高；头痛多见于EVAE组，而共济失调和脑膜刺激征多见于OVAE组；血清学病毒IgM抗体检测较脑脊液检测阳性率高；头颅CT和MRI有助评价病情和病灶定位，MRI优于CT；脑电图检查异常率高，可用于早期诊断及监测病情变化；所有VE患儿出院后都应该随访至少6个月到1年。
[Abstract]:Objective:. The clinical characteristics of children with viral encephalitis were analyzed retrospectively in order to guide clinicians to better understand viral encephalitis in different areas and to achieve satisfactory treatment. Methods:. The medical records of 589 children with viral encephalitis were retrospectively analyzed from January 2011 to December 2012. Results:. In July, the age of children with viral encephalitis was less than 15 years (mean 5.60 卤3.37 years). The median age was 5.00 years old. There were 348 boys (59.1%) and 241 girls (40.9%). The ratio of male to female was 1.44: 1. 2. There are 422 children in Chongqing, accounting for 71.6; 160 in Yungui River, accounting for 27.22; 7 in other areas, accounting for 1.2. 269 children in cities and towns, 45.7 percent in rural areas, 320 children in rural areas, accounting for 54.3 percent. 3. There was an annual incidence in this group, but there was a tendency of concentration in July (P < 0.01). 4. The most common clinical manifestations were fever (78.6), vomiting (68.3), headache (52.8), disturbance of consciousness (38.7), cough (38.4) and convulsion (36.0). 5. all the children were tested for serological virus IgM antibody in 318 cases (54.0). The CV infection rate was the highest (58.5%), and the second was HSV 32.4% (22.6V) 11.0%. 6.567 cases were tested for cerebrospinal fluid virus (IgM) antibody and 143 cases were found to be abnormal. Among them, the infection rate of CV was the highest (50.3%), followed by 28.77.7AV (28.7AV) and 11.2mv (7.7mV3.5V). 7. In this study, VS47.0 (P < 0.05) was more common in the VE(EVAE group, the ataxia was 1.1 VS6.1 (P < 0.05) and the meningeal stimulation sign was 11.8VS22.0T (P < 0.05). 8.269 cases were examined with CT scan of the head, 59 cases (21. 9)) and 332 cases with abnormal cranial MRI.) abnormal MRI was superior to that of CT(P < 0. 05% in 565 cases. Electroencephalogram (EEG) was performed in 407 cases (72.0%). 9.354 cases were cured and 230 cases were cured. 5 cases died and 36 cases left different degree sequelae. Conclusion: the CV infection rate is the highest in this study, headache is more common in EVAE group, while ataxia and meningeal irritation sign are more common in OVAE group, the positive rate of IgM antibody detection of serological virus is higher than that of cerebrospinal fluid (CSF). Cranial CT and MRI were helpful to evaluate the state of disease and location of lesions. MRI was superior to CT.The abnormal rate of EEG examination was high and could be used for early diagnosis and monitoring of disease changes. All children with VE should be followed up for at least 6 months to 1 year after discharge from hospital.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R512.3

【参考文献】