小儿肠道病毒中枢神经系统感染的临床特点

CLINICAL FEATURES OF CHILDREN WITH ENTEROVIRAL CENTRAL NERVOUS SYSTEM INFECTION

目的探讨小儿肠道病毒（EV）中枢神经系统感染的临床特点。方法采用逆转录聚合酶链反应和病毒基因序列分析方法,对87例无菌性中枢神经系统感染病儿的脑脊液标本进行检测,并对其中61例EV中枢神经系统感染病儿的临床特点和预后进行回顾分析。结果无菌性中枢神经系统感染病儿中EV感染的发生率是70.10%,其中脑膜炎40例（65.57%）,脑炎21例（34.43%）。21例脑炎病儿的脑脊液标本经分型引物检测,17例（80.95%）阳性,其中埃柯病毒12型9例,柯萨奇病毒B3型5例,埃柯病毒7型1例,柯萨奇病毒B5型1例,柯萨奇病毒A9型1例。61例EV中枢神经系统感染均为急性起病,5—10月份高发（85.25%）,发病年龄高峰在3~5岁（44.26%）。EV脑膜炎的主要特征是脑膜刺激症状和脑脊液细胞数增加,主要临床表现为发热、头痛、呕吐,较大儿童可诉有乏力、畏光、肌痛,婴幼儿常伴有腹泻和皮疹。EV脑炎根据主要症状临床分型为昏迷型（3/21）、癫痫型（3/21）、精神障碍型（1/21）、小脑炎型（1/21）、脑干脑炎型（2/21）和混合型（11/21）。常规治疗后脑膜炎和大部分脑炎病儿完全恢复。4例重型柯萨奇病毒B3型脑炎病儿GLASGOW昏迷评分均〈7分,其中1例完全康复;1例运动障碍,经1年康复治疗后生活自理;1例癫痫、1例精神障碍伴癫痫,均可被药物完全控制。结论 EV是小儿中枢神经系统感染最常见的病原体之一;脑膜炎临床症状一般较轻,预后良好;大部分脑炎症状较轻,预后良好,重症脑炎可留有程度不同的后遗症。

Objective To investigate the clinical characteristics of children with enteroviral（EV） infection in central nervous system（CNS）. Methods By using reverse transcription polymerase chain reaction（RT-PCR） and gene sequencing,the cerebrospinal fluid（CSF） of 87 sick children with aseptic CNS infection was detected,of whom,61 with enterovirus infection was reviewed and analyzed retrospectively. Results EV infection rate in aseptic CNS infection was 70.10%,in which,meningitis 40 cases（65.57%）,and encephalitis 21（34.43%）.By using consensus primer amplification,CSF in 17 of 21 kids with encephalitis was positive,in which nine were echoviruses 12;five were coxsackie B3;and coxsackie A7,coxsackie B5,and coxsackie A9 were one case,respectively.The main clinical manifestation was acute onset,the high-incidence months were May-October（85.25%）,with peak age of onset being 3-5 years（44.26%）.The main features of EV meningitis were meningeal irritation signs and CSF cell count increased,the main clinical manifestations included fever,headache,vomiting,and,in older children,fatigue,photophobia,and myalgia might be their complaints;in infants,diarrhea and rash might be accompanied.Based on major symptoms,the disease was classified as coma-type（3/21）,epilepsy type（3/21）,mental-disorder type（1/21）,cerebellitis type（1/21）,brainstem encephalitis type（2/21） and mixed type（11/21）.After conventional treatment,all sick kids with meningitis and most with encephalitis were completely recovered.Of four with severe encephalitis infected with Coxsackievirus B3,Glasgow coma scale 7 points,one fully recovered,one with motor disorder was able to be self-cared after one-year rehabilitation management,one with epilepsy and one with both mental disorder and epilepsy were completely controlled with medication. ConclusionEV is one of the most common causes of central nervous system infection in children.The clinical symptoms of meningitis and most of encephalitis are mild with good prognosis;for severe encephalitis,various extents of sequela may occur.