病毒性脑炎患儿脑脊液病毒核酸检测及临床分析

Virus nucleic acid testing and clinical analysis of cerebrospinal fluid in children with viral encephalitis

目的了解合肥地区儿童病毒性脑炎的病原构成及不同年龄组患儿临床表现差异。方法将53例病毒性脑炎患儿根据年龄分为A组(<3岁)、B组(3岁～6岁)及C组(>6岁)3组。(1)采用PCR法检测脑脊液常见病毒核酸,包括肠道病毒(EV)、单纯疱疹病毒(HSV)、水痘-带状疱疹病毒(VZV)和人巨细胞病毒(HCMV)。(2)分析不同年龄组临床表现特点。结果(1)32例核酸检测阳性(60.38%),其中EV 23例(43.40%),HSV 8例(15.09%),HCMV 1例(1.89%),未检出VZV。(2)A、B两组中有惊厥者明显多于C组(P<0.01),C组以头痛为早期症状者23例(85.19%),而A、B两组分别只有1例和4例(P<0.01)。HSV脑炎惊厥发生明显多于其他病毒性脑炎。结论证实合肥地区儿童病毒性脑炎病原以EV和HSV为主,HSV脑炎临床症状较严重,提示临床应加强病毒性脑炎病原检测工作,而PCFR检测患儿脑脊液中特异性病毒核酸片段符合临床快速、特异诊断要求。

Objective To comprehend the possible constitution of pathogens and disparity in clinical manifestation in children with viral encephalitis. Methods （1）The DNA or RNA of EV, HSV, VZV and HCMV were detected by PCR in the cerebrospinal fluid （CSF）. （2）The clinical manifestations were analyzed among groups of different ages. Results （1） The positive culture appeared in 32 of 53 cases （60.38%）. Among them, EV was discovered in 23 cases （43.40%）, HSV in 8 cases （15.09%） and HCMV in 1 case （1.89%）. VZV was not detected. （2）The convulsion in groups A and B was signifi- cantly greater than in group C （P 〈 0.01 ）. Group C with the early symptoms of headache was 23 cases （85.19%）, while A and B groups were only 4 cases and 1 case （P〈0.01）. HSE was more than other viral encephalitis. Conclusions EV and HSV might play an important role in etiological constitution of viral pathogens in children with viral encephalitis. The clinical symptoms of HSE were more serious. It is suggested pathogen detection be enhanced regarding viral encephalitis, and PCR testing in the cerebrospinal fluid in children with specific virus nucleic acid fragment meet the requirement of rapid, specific diagnosis clinically.