手足口病致下肢急性弛缓性麻痹的临床分析

Clinical analysis of acute flaccid paralysis in infants and young children with hand-foot-mouth disease

目的分析探讨手足口病致下肢迟缓性麻痹的临床特点。方法回顾性分析42例手足口病所致下肢急性迟缓性麻痹患儿的临床资料,所有患儿均给予丙种球蛋白、利巴韦林、神经生长因子及弥可保等治疗,观察其临床表现,并行病原学检查、头颅和脊髓磁共振检查、脑脊液检查、脑电图、肌电图、神经电图等检查及心肌酶检测。结果手足口病所致下肢急性弛缓性麻痹患儿,麻痹前期均有典型手足口病的皮疹症状,瘫痪前驱期多伴有单峰热;76.2%(32/42)的患儿脑脊液压力、生化或细胞数异常;咽拭子EVPCR和血清免疫学检查均显示有17例患儿肠道病毒EV71阳性;88.1%的患儿在病程的3～8d患肢肌力开始恢复,病程2个月时,69.0%(29例)的患儿达到痊愈标准。结论手足口病致下肢急性弛缓性麻痹主要由EV71感染所致,经积极治疗后患儿肌力恢复较快,预后良好。

Objective To analyze the clinical features of acute flaccid paralysis （AFP） in infants and young children with hand- foot- mouth disease （HFMD）. Methods Clinical data of 42 HFMD cases with AFP were retrospective analyzed. All the patients were given gamma globulin, ribavirin, nerve growth factor and methylcobalamin,and they were followed up for two months.The clinical manifestations were observed,the etiology,cerebrospinal fluid （CSF）,spinal cord magnetic resonance miaging （MRI）, electroencephalogram,electromyograph,nerve electrogram and myocardial enzymes findings were collected. Results Typical skin rash was observed in the pre-paralysis phase in all patients and in the prodromal period of paralysis most patients were associated with single-peak hot.76.2% （32/42） patients experienced abnormal CSF or routine examination findings. Throat swab and sero-mimunological examinations showed positive enteric virus-71in 17 patients. 88.1% children began to recover in the course of 3~8 d, after two months follow-up, 69.0% （29 cases） children reached recovery standard.Conclusion Acute flaccid paralysis （AFP） in young children with hand- foot- mouth disease is mainly caused by virus-71, after active treatment, patients,muscle function recovers fast and with good prognosis.