小儿单纯疱疹病毒脑炎22例临床分析

Clinical analysis of herpes simplex encephalitis in 22 children

目的 :探讨小儿单纯疱疹病毒脑炎 (herpessimplexencephalitis,HSE)的临床特点、检测手段及治疗。方法 :对 2 2例经酶免疫斑点技术确诊为HSE的小儿的临床资料进行分析 ,所有病例均给予更昔洛韦 (ganciclovir,GCV)治疗。 结果 :小儿HSE多见于 5岁以上农村患儿 ,临床表现以发热、呕吐、抽搐、瘫痪、意识障碍和锥体束征为主 ,头颅影像学检查多见额叶和颞叶损害 ,治愈 7例 ,好转 1 4例 ,未愈 1例。结论 :小儿HSE临床表现不典型 ,血清中出现特异性单纯疱疹病毒IgM抗体是HSE的实验室诊断依据 ,头颅影像学表现为额颞叶损害时高度提示HSE 。

Objective:To explore the clinical characteristics of herpes simplex encephalitis(HSE) of children and to investigate the detective method and treatment.Methods:The clinical data of 22 cases of HSE,which were confirmed by detection of serum herpes simplex viruses(HSV) IgM antibody using enzyme immunodot technique were analyzed.All the patients were treated with ganciclovir(GCV).Results:HSE developed predominantly in children over 5 years of age.The most common clinical presentations of HSE were fever,vomiting,convulsion,paralysis,conscious disturbance and presentation of pyramidal sign.The lesions of frontal and temporal lobes of brain were common in the neuroimaging findings of the patients.Seven cases were cured,14 cases improved and 1 case did not respond.Conclusions:Clinical manifestations of HSE of children are not typical.The presence of serum specific HSV IgM antibody is a laboratory diagnostic evidence.HSE should be highly suspected if lesions of frontal and temporal lobes are present in the neuroimaging findings.GCV is the choice of therapy for HSE.