271例手足口病合并脑炎患儿的临床特征

发布时间：2018-07-04 15:39

本文选题：EV71 + 脑炎　；参考：《大连医科大学》2012年硕士论文

【摘要】：背景:手足口病（Hand foot and mouth disease，HFMD）是一种常见的儿童传染病，，轻症表现为手足及口腔疱疹。但是，重症患者伴有神经系统并发症（如：无菌性脑膜炎，急性弛缓性瘫痪及脑炎等），或者伴有系统性疾病（如：休克、心功能障碍和肺水肿、肺出血）。HFMD的病原为肠道病毒(细小核糖核酸病毒家族的肠道病毒属)，如：柯萨奇A16（Coxsackie A16virus，CAV-16）和肠道病毒71型（Enterovirus71,EV71）,经粪口，密切接触和呼吸道飞沫传播。1969年，EV71首次在加州发现，其基因型为BrCr，急性感染EV71时易引起神经并发症。小于3岁儿童易出现严重并发症如脑膜炎、脑干脑炎、普通脑炎、急性弛缓性瘫痪及脑脊髓炎，并可致残或死亡。近十年来EV71HMFD在中国及其它亚洲流行。EV71HMFD已导致数万人感染和多例儿童死亡。自1995年以来中国大陆地区一直有散在的流行，但是2008年安徽阜阳地区高度集聚病快速致死的HFMD爆发是空前的。本文分析2010年大连地区HFMD流行期间并发脑炎的271例儿童的临床特征。材料与方法:2010年1月-12月因HFMD在大连市儿童医院住院患者593例中，根据271例患儿合并脑炎，诊断标准为卫生部发布的诊断标准。根据临床特点将脑干脑炎分级(I, II, III)。年龄为1月-13岁。收集并分析2010年大连市儿童医院因HFMD合并脑炎住院患儿271例的临床资料。结果：因HFMD住院患儿593例，271例合并脑炎，其中男181例，女90例，男女比为2：1。年龄1个月-13岁，中位数为2岁，小于3岁患儿为158（58%）。HFMD合并脑炎的季节为4-12月，高峰期7月份有72（26.5%）例患儿住院，8月58（26.5%）例，6月51例（18.8%）。入院前HFMD病程为1-7天，平均3.2天。HFMD发病至并发脑炎的时间为2小时-5天，平均1.5天。住院时间4-32天，平均9.8天。入院时体温最高达41℃，平均38.5℃，发热持续时间3.4天。HFMD合并脑炎的神经系统表现为肌阵挛122例，震颤88例，共济失调96例，头痛71例，呕吐92例，精神萎靡166例。30%患儿血白细胞增高，54%LDH升高。224例患儿脑脊液检查显示88%白细胞升高，高达870×106/L，54%蛋白质升高，最高达1200mg/L。用RT-PCR法检测粪便EV71核酸阳性155（57%）例。脑电图异常10例，表现为慢波、尖波或尖慢波。心电图异常2例。1例室性早搏，1例房室传导阻滞。头颅CT示鼻窦炎5例。脑干脑炎244（90%）例，脑炎和/或脑膜脑炎23(8.5%)例，脑脊髓炎4例。32例重患转入ICU治疗。Ⅰ、Ⅱ、Ⅲ级脑干脑炎分别为235例、4例及5例。其中5例Ⅲ级脑干脑炎患儿，3例死亡，1例恢复，1例有神经后遗症。3例死亡患者均为EV71感染。恢复期脑炎反复6例。男孩4例，小于3岁3例，平均脑炎反复时间为病程17天，2例复查腰穿提示白细胞增多，恢复期脑炎症状与首次症状相似。合并肺炎6例及支气管炎3例。结论：HFMD合并脑炎男孩易感，大连地区发病季节为春夏季，尤以夏季多发，高峰期为7月。发病年龄以小于3岁多见，；脑炎常累及脑干。血白细胞、LDH脑脊液白细胞及蛋白质可升高。大部分患者经治疗痊愈。部分患儿病情发展快，在诊断重症病例3天内可死亡。脑干脑炎III级预后差、死亡率高或致残。部分患儿在病程2周左右恢复期脑炎反复。除神经受累外可累及多脏器（心、干、及肺）。HFMD合并脑炎的主要病原为EV71。EV71是HFMD合并脑炎、神经后遗症及致死的病例增多的主要原因。
[Abstract]:Background: Hand foot and mouth disease (HFMD) is a common infectious disease of children. Light symptoms are hand and foot and oral herpes. However, severe patients are accompanied by nervous system complications (such as aseptic meningitis, acute flaccid paralysis and encephalitis), or with systemic diseases (such as shock, cardiac dysfunction, and pulmonary edema). The pathogen of.HFMD is the enterovirus (enterovirus of the parvovirus family), such as Coxsackie A16 (Coxsackie A16virus, CAV-16) and enterovirus 71 (Enterovirus71, EV71), which are transmitted through the mouth, close contact and respiratory droplet for.1969 years. EV71 is found in California for the first time, and its genotype is BrCr, and the acute infection is EV71. Children less than 3 years of age are prone to severe complications such as meningitis, brainstem encephalitis, common encephalitis, acute flaccid paralysis and encephalomyelitis, and can be deformity or death. In recent ten years, the prevalence of EV71HMFD in China and other Asian countries has led to tens of thousands of infections and many children died. Since 1995, the mainland of China There has been a spread in the area, but the rapid death of HFMD in Fuyang, Anhui, in 2008, is unprecedented. This paper analyses the clinical features of 271 children with encephalitis during the HFMD epidemic in Dalian in 2010.
Materials and methods: in 593 cases of hospitalized patients in Dalian children's Hospital of Dalian in January 2010, 271 cases were combined with encephalitis according to 271 cases of encephalitis. The diagnostic standard was issued by the Ministry of health. According to the clinical characteristics, the brain stem encephalitis was graded (I, II, III). The age was -13 years in January. In 2010, the children's hospital with HFMD combined with encephalitis was collected and analyzed. Clinical data of 271 cases of hospitalized children.
Results: there were 593 cases of hospitalized children in HFMD and 271 cases of encephalitis, including 181 males and 90 females. The ratio of male and female to 2:1. age was 1 months -13 years, the median was 2 years, the season of 158 (58%).HFMD with encephalitis was 4-12 months, 72 (26.5%) children were hospitalized in the peak period in July, August 58 (26.5%) cases, June cases. -7 days, an average of 3.2 days of.HFMD onset to encephalitis was 2 hours -5 days, an average of 1.5 days. The time of hospitalization was 4-32 days, an average of 9.8 days. The body temperature was up to 41, average 38.5, and 3.4 days of fever lasting for encephalitis with 122 cases of myoclonus, 88 cases of tremor, 96 cases of ataxia, 71 cases of headache, 92 cases of vomiting, and essence. The blood leucocyte increased in 166 children with.30%. The cerebrospinal fluid examination showed that 88% white blood cells were elevated in.224 cases, up to 870 x 106/L, 54% protein increased, and 155 (57%) cases of EV71 nucleic acid positive in feces were detected by 1200mg/L.. 10 cases of abnormal electroencephalogram were shown as slow wave, sharp or sharp slow wave. 2 cases of electrocardiogram were abnormal.1 case room. 1 cases of atrioventricular block, 1 cases of atrioventricular block, 5 cases of cranial CT sinusitis, 244 (90%) cases of brainstem encephalitis, 23 (8.5%) cases of encephalitis and / or meningoencephalitis, 4 cases of encephalomyelitis in.32, 235 cases, 4 and 5 cases respectively, of which 5 cases of grade III brainstem encephalitis, 3 death, 1 cases, and neurological sequelae,.3 All the patients were infected with EV71. Recurrent encephalitis was repeated in 6 cases. 4 cases in boys, less than 3 years old and 3 cases, the average time of encephalitis was 17 days, 2 cases were rechecked the increase of leukocyte, the symptoms of encephalitis were similar to that of the first symptom. 6 cases of pneumonia and 3 cases of bronchitis were combined.
Conclusion: HFMD combined with encephalitis is easy to feel in boys. The onset season in Dalian is spring and summer, especially in summer. The peak period is July. The onset age is less than 3 years old. Encephalitis often involves brain stem. Blood leukocytes, LDH cerebrospinal fluid leucocyte and protein can be elevated. Most patients are cured by treatment. Some children develop quickly in diagnosis of severe disease. Patients with brain stem encephalitis have poor prognosis in 3 days. The prognosis of brain stem encephalitis III is poor, mortality is high or disability. Some children have recurrent encephalitis in the recovery period of about 2 weeks. The main cause of.HFMD combined encephalitis except for nerve involvement (heart, stem, and lung) is EV71.EV71, the main cause of the increase of HFMD with encephalitis, neurosequelae and fatal cases.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.1

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