婴儿巨细胞病毒脑炎5例临床分析及文献回顾

Five cases of cytomegalovirus encephalitis and literature review

目的探讨婴儿巨细胞病毒(CMV)脑炎的临床特征与诊断治疗。方法对我院2005年1月至2008年10月经血和脑脊液CMV抗原及抗体检测确诊的5例CMV脑炎患儿的临床资料进行回顾分析。结果男2例,女3例;月龄2～9个月,平均4.8个月;病程2～55d,平均18.6d。除1例患儿无发热外,其余患儿均以中低热和不规则发热为主要表现,4例有反应差或嗜睡,3例合并发作性抽搐。2例运动和智力较同龄儿落后。无阳性体征。所有病例血清抗CMVIgM阳性,同时脑脊液抗CMVIgM阳性,其中3例血和脑脊液pp65抗原阳性,2例抗CMVIgG阳性。所有病例于2～4周复查血清和脑脊液抗CMVIgM阴性,抗CMVIgG阳性。2例CT示脑萎缩,1例MRI示双小脑、右颞叶出血灶。脑干测听除1例存在单耳明显异常、1例未做外,余均正常。脑脊液检查细胞数正常2例,2例细胞数升高[(130～150)×106/L],间隔1～2d复查细胞数正常。1例病程1个月时脑脊液细胞数为500×106/L,中性粒细胞占80%,多次脑脊液细胞数波动在(60～280)×106/L,以淋巴细胞分类为主。脑脊液均存在蛋白升高,2例糖水平偏低;脑电图明显异常2例,合并肝功能异常3例,1例尿培养曾发现屎肠球菌,均采用更昔洛韦治疗,10mg/(kg·d),分两次静点,连续治疗2周3例,4周2例,3例患儿停药前复查血清和脑脊液pp65由阳性转为阴性,4例临床明显好转。结论婴儿CMV症状性感染可表现为脑炎,对婴儿出现反应差、抽搐、脑脊液蛋白升高、合并肝功能异常及发育落后者,应注意进行血和脑脊液CMVpp65抗原及CMV抗体检查,应用更昔洛韦治疗,并进行长期随诊。

Objective To investigate clinical characteristics,diagnosis and treatment of human cytomegalovirus（CMV） encephalitis.Methods Five cases of CMV encephalitis diagnosed in Beijing Children＇s Hospital from January 2005 to October 2008 were retrospectively analyzed.All cases were confirmed by CMV pp65 antigen in leukocyte and specific antibody detection in both cerebral spinal fluid（CSF） and serum.Results Three cases were diagnosed as acquired encephalitis and the other two had congenital CMV infection but reactived CMV encephalitis or acquired encephalitis afterwards.All cases responsed very well to Ganciclovir treatment except one who developed internal hydrocephalus and finally gave up any further treatment.All cases were followed-up for one year and half.There were 2 cases with remarkble retardation compared to infants at same age.Conclusions CMV encephalitis can be found in infants as symptomatic infection.For infant cases with lethargy,convulsion,elavated protein level in CSF,abnormal liver function and development retardation,CMV specific antigen and antibody detection both in CSF and serum should be done.Ganciclovir is effective to CMV encephalitis.Followed up study is in need for these cases.