手足口病致急性弛缓性麻痹的临床分析

The clinical characters of acute flaccid paralysis in children’s hand-foot-mouth-disease

目的探讨手足口病致急性弛缓性麻痹的临床特点。方法对15例手足口病伴急性弛缓性麻痹患儿进行临床观察,行头颅和脊髓磁共振检查及脑脊液、心肌酶检测。结果手足口病所致急性弛缓性麻痹多见于2岁以下儿童,麻痹前期可有皮疹,多呈单峰热,约86.67%的患者合并中枢神经系统受累(脑炎、脑膜炎、脑膜脑炎)。患儿瘫痪1周后,患肢运动功能开始恢复,住院期间可见到明显改善,轻症者1～2个月后恢复。结论手足口病合并中枢神经系统病变(86.67%),如脑炎、脑膜炎、脑膜脑炎等,较脊髓灰质炎更为常见。皮疹、心肌损害比例高于脊髓灰质炎,可能由于非脊髓灰质炎肠道病毒侵犯范围更广(包括皮肤、黏膜)有关。大部分手足口病患儿恢复早,预后好于脊髓灰质炎,可能是由于病理上组织炎症重于神经毒性所致。

Objective To analyze the clinical characteristics of AFP caused by HFMD,and try to explain those characteristics from the pathogenesis and pathology. Methods Fifteen HFMD cases （eleven male, four female） with AFP were enrolled. The clinical manifestations were observed, meanwhile the cerebrospinal fluid,myocardial enzyme,spinal cord MRI finding were collected. The recoveries of their impairment in limb extremities were followed up for at least two months. Results Acute paralysis cases caused by HFMD was particularly prevalent in children less than 2 years old, all of whom had skin rash and single-stage fever. About 86.67% AFP cases in HFMD complicated with Central Nervous System （CNS） involvement （encephalitis,meningitis or meningoencephalitis）. Muscle power was initially improved in a week. AFP in HFMD cases got obvious recovery in hospital and mild paralysis could recover in 1 or 2 months. Conclusions HFMD cases have high incidence （86.67%） of CNS involvement compared with that of polimyelitis. Skin rashs and myocardial damage are more common in HFMD cases than in poliomyelitis. It may be the reason that NPEV invades more organs than poliovirus. The acute paralysis of HFMD recovered faster and better than poliomyelitis. Based on the pathological findings inflammatory reaction seems to be more remarkable than neurotoxic effects which may help to explain this phenomena.