手足口病致急性迟缓性麻痹的临床特点研究

Clinical Analysis of Acute Flaccid Paralysis in Infants and Young Children with Hand-foot-mouth Disease

目的探讨手足口病致急性迟缓性麻痹的临床特点。方法对28例手足口病伴急性迟缓性麻痹患儿进行临床观察,行病原学检查、颅脑和脊髓磁共振检查及脑脊液检查,行心肌酶、神经-肌电图检查。给予免疫球蛋白、地塞米松、鼠神经生长因子、弥可保等治疗。随访2个月观察预后。结果手足口病所致急性迟缓性麻痹多见于2岁以下儿童(22/28);麻痹前期均有典型手足口病的皮疹。81.5%(20/28)的患儿合并病毒性脑炎。81.5%(20/28)的患儿脑脊液压力或常规异常。咽拭子EVPCR和血清免疫学检查均显示有9例患儿肠道病毒71型(EV71)阳性。患儿瘫痪肢体1周后开始恢复,75.0%(21/28)患儿急性期(2周)后肌力基本恢复。随访2个月89.3%(25/28)患儿肌力基本恢复。结论手足口病易合并中枢系统病变,EV71是引起急性迟缓性麻痹的主要肠道病毒,其对脊髓前角细胞具有一定嗜组织性。经积极治疗后患儿肌力恢复迅速,预后较好。

Objective To analyze the clinical features of acute flaccid paralysis（AFP） in infants and young children with hand-foot-mouth disease（HFMD）.Methods Twenty-eight HFMD cases with AFP were enrolled.The etiology,cerebrospinal fluid（CSF）,myocardial enzymes,spinal cord magnetic resonance imaging（MRI） findings were collected.Patients were treated with immunoglobulin,dexamethasone,mecobalamin,and rat nerve growth factor.They were followed up for two months.Results AFP due to HFMD was confirmed in 22 patients.Typical skin rash was observed in the pre-paralysis phase in all patients.Twenty patients were accompanied with viral encephalitis.In addition,20 patients experienced abnormal CSF or routine examination findings.Throat swab and sero-immunological examinations showed positive enteric virus-71（EV71） in 9 patients.The muscle strength began to be improved in a week,and basically recovered two weeks after acute phase in 21 patients.The muscle strength was basically recovered in 25 patients during the 2-month follow-up.Conclusion HFMD patients have a high incidence of central nervous system involvement.EV71 is a major virus that can causes AFP by damaging anterior horn cells.The prognosis usually is good in infants and young children after active treatment.