中国实用儿科杂志

中国实用儿科杂志 ›› 2011, Vol. 26 ›› Issue (07): 527-.

• 论著 • 上一篇    下一篇

儿童单纯疱疹病毒性脑炎20例临床分析及随访研究?

  

  1. 复旦大学附属儿科医院神经科，上海　201102
  • 出版日期:2011-07-06 发布日期:2011-07-06

Clinical analysis and follow-up studies in 20 cases of herpes simplex virus encephalitis in children.　　

  1. Department of Neurology，Children’s Hospital of Fudan University，Shanghai 201102，China
  • Online:2011-07-06 Published:2011-07-06

摘要：

分析儿童单纯疱疹病毒性脑炎（HSE）临床特征和预后，探讨HSE早期诊断的重要性。方法　分析2005年1月至2010年5月复旦大学附属儿科医院神经科住院的20例HSE患儿，均经脑脊液（CSF）病毒病原学确诊，观察治疗效果及预后。结果　20例患儿中发热20例（100%）、意识障碍16例（80%）、抽搐19例（95%）、精神行为异常4例（20%）、肢体偏瘫7例（35%）。CSF常规或生化异常14例（70%），其中红细胞增多9例（64%）、CSF糖 < 2.2 mmol/L 3例（21%）。头颅影像学检查19例异常（95%），颅内出血11例（58%），其中合并丘脑出血5例（45%）；中脑梗塞1例（5%）。对12例进行6个月至5年的随访，完全康复1例、智力运动发育迟缓生活不能自理5例、智力发育迟缓3例、肢体运动障碍3例、合并癫痫7例。结论　HSE起病急，多为重症病情，但儿童患者临床特征可不典型。应进行细致临床观察，尽早行神经影像学检查，积极查找病原学，早期正规给予抗病毒治疗是早期诊断、改善预后的关键。

关键词: 单纯疱疹病毒, 脑炎, 儿童, 随访研究

Abstract:

To analyze the clinical feature and prognosis of HSE，and to discuss the importance of a careful clinical check-up in early dianosis of HSE in children. Methods　Twenty patients with Herpes simplex virus encephalitis（HSE） were traced in this study. Information was retrieved from medical records on age，sex，neurological signs and symptoms at admission，electroencephalogram（EEG），cerebral CT scan，and/or MRI results. Biological data were reviewed，including CSF leukocyte count，protein and glucose level，HSV DNA PCR，and HSV serological test results.12 of 22 patients were followed up from 6 months to 5 years for the assessment of the morbidity. Results　All the 20 patients（100%） had fever，and 16（80%） had the altered state of consciousness. Convulsion was seen in 19（95%） cases，psycho- behavior disorder in 4（20%） ，and hemiparesis in 7（35%）.Cerebrospinal fluid test was abnormal in 14 cases（70%）and red blood cells increased in 9 case（64%）.The glucose in the cerebrospinal fluid was lower than 2.2mmol/L in 3 cases（21%）.The cerebral CT scan and/ or MRI was done for 19 patients. Brain lesions were observed in 19（95%） patients . Intracranial hemorrhage was seen in 11 cases（58%），thalamic hemorrhage in 5 cases（45%），midbrain infarction in 1 case（5%）.In the followed-up patients，1 of 12 showed good recovery，mental and motor development retardment with self-care inability in 5 case，mental development retardation in 3，dyscinesia in 3，and 7 cases were combined with epilepsy. Conclusion　Generally，HSE is with acute onset and is a critical illness.The range of clinical features of HSE are wide and may be atypical in children.A careful clinical and neurological follow-up is required for early diagnosis and prognosis improvement.

Key words: Herpes simplex virus, encephalitis, child, follow-up studies