儿童轻型非典型病毒性脑炎的诊断和治疗

Diagnosis and Treatment of Mild Atypia Viral Encephalitis in Children

目的探讨轻型非典型病毒性脑炎(VE)的诊断和治疗方法。方法选择符合轻型非典型VE诊断标准的患儿40例。分为拟诊VE组24例,腮腺炎组16例。病例均行血常规、小便常规、大便常规检查,心、肝、肾功能检查,电解质等生化检查。6例行血尿淀粉酶、肥达试验。7例行脑脊液常规、生化检查及心电图、胸片、肝胆脾B超。19例单独行头颅CT检查,2例单独行头颅MRI检查,二者均查2例。40例患儿行脑电图(EEG)检查,并对其中的慢波(δ、θ)异常按相应年龄予定量和分级。对二组患儿临床主要症状、阳性体征出现率,EEG弥散性慢波异常程度及出现率、治愈率进行对比分析,最后对所有病例的最后诊断与入院前诊断进行对比分析。采用SPSS10.0软件进行统计分析。结果拟诊VE组和腮腺炎组患儿临床主要症状出现率无显著性差异(χ2=8.2225 P>0.05);EEG弥散性慢波异常程度及出现率比较无显著性差异(轻度异常比较:χ2=0.0043 P>0.05;中度异常比较:χ2=0.0052 P>0.05)。拟诊VE组脑脊液常规、生化正常3例,异常4例。拟诊VE组患儿均治愈;腮腺炎组治愈15例,明显好转1例,二组治愈率差异无显著性(χ2=0.0196 P>0.05)。二组最后(出院)诊断率(100%)和入院前(外院)诊断率(30%)有显著性差异(χ2=47.08 P<0.005),诊断准确率增加70%。结论采用轻型非典型VE诊断依据可显著提高其诊断准确率,具有重要的实用价值;EEG检查在VE中敏感性高的特点能有效弥补非典型病例诊断上的不足。

Objective To explore the convenient and pragmatic diagnostic method of mild atypia viral encephalitis （ VE ）. Methods The diagnostic model in reference was regarded as diagnosis evidence. Forty cases correspond to the diagnostic criteria were selected and di- vided into 2 groups： 24 cases in VE group and 16 cases in parotiditis group which were definited parotiditis. Chemical and biological inspections of all cases were examined including blood rokutine, routine bowel, heart, liver and kidney function ,elestrolytes and so on. Six cases were examined with a test of blood urine amylase and fertilizer. Seven cases were examined with CSF routine examination, biological and chemical examination, electrocardiogram, chest film, liver gallbladder spleen type - B ultrasonic examination. Nineteen cases were examined with routine head CT,2 cases were examined with skull routine MRI,2 cases were examined CT and MRI. Electroencephalogram （EEG） inspection was made and the abnormal slow waves （δ, θ） quantitated and classified according to ages. The main clinical symptoms, the posi- tive sign rate, the abnormal level of EEG diffusion and frequency and the cure rate were compared and analyzed. At last, the final diagnosis and the pre - hospital diagnosis of all patients were compared and analyzed. The statistics were analyzed by SPSS 10.0 software. Results Appearance rate of main symptom and positive sign, degree and appearance rate of diffuse abnormal slow wave on EEG and curative rate between 2 groups had no significant differences. The CSF routine and chemical and biological examination of 3 cases were normal in VE group, and 4 cases were abnormal. All cases in VE group were cured. There were 15 cases were cured in the parotiditis group, and condition of 1 case was improved. There was no significant difference of the cure rate between the 2 groups （ Χ^2 = 0.019 6 P 〉 0.05 ） ; and there were significant diffe-rences between the final diagnosis and pre - hospitalized diagnosis in all patients with VE （Χ^2 = 47.08 P 〈 0. 005 ）. The clinical diagnostic rate of VE increased 70%. Conclusions Applying these diagnosis evidence of mild atypia viral encephalitis can improve the clinical diagnostic accurate rate of VE significantly. EEG can remedy efficiently the shortage in diagosis of atypia viral encephalitis case.