小儿单纯疱疹病毒脑炎的临床分析

Clinical Analysis of Herpes Simplex Virus Infection of the Central Nervous System in Children

目的:通过分子生物学方法了解小儿中枢神经系统单纯疱疹病毒(HSV)感染情况,分析其临床特点。方法:收集 150例住院的中枢神经系统病毒感染患儿的脑脊液标本,用套式PCR检测脑脊液中HSV DNA用酶联免疫吸附法检测脑脊液中特异性HSV IgM抗体。结果:150例中有6例脑脊液HSV1 DNA(+),另1例HSV1 IgM(+);病例呈散发性起病,无明显季节、年龄、性别分布特点。与其他病毒感染相比,惊厥持续状态、精神症状发生率高(P<0．01),意识障碍、病死率无显著差异。结论:单纯疱疹病毒感染占儿童中枢神经系统感染的4．67％。儿童中枢神经系统单纯疱疹病毒感染多为HSV1的原发感染,可导致脑炎、脑干脑炎、急性播散性脊髓膜炎;起病较危重,出现精神症状较多,及时有效的抗病毒治疗能明显改善病情,降低病死率。

Objective：To investigate the prevalence and clinical characteristic of herpes simplex virus infection of the central nervous system in children. Methods： Collected cerebrospinal fluid（CSF） from 150 acute viral infection of the central nervous system who were hospitalized during June 2001-June 2002, Polymerse chain reacton（PCR） techniques （nested- PCR） was used to detect herpes simplex virus（HSV）specific DNA in CSF,enzyme linked immunosorbert assays was applied to detect HSV- specific IgM and IgG antibody in CSF and serum specimens. Results： HSV1 PCR were positive in CSF of six patients,only one case whose CSF was HSV1 IgM positive in those children who were PCR negative in CSF; the rate of HSV infection in patients of acute viral infection of the central nervous system was 4. 67%. HSV infection of the central nervous system were sporadic without obvious difference in distribution of season,age and gender. Status convulsious and mental systems were higher in HSE（P〈0. 01 ）. There were no signifient difference in disturbance of consciousness and case fatality rate between HSV and other acute virus infection. Conclusion： HSV infections of CNS in children were HSV type 1 in the period, most of infections were caused by primary infections. The onset of HSE was more severe with higher rate of mental symptoms. Effective antival therapy could improve recovery and decrease case fatality rate.