儿童病毒性脑炎的临床特征研究

Study of clinical features in children with enterovirus encephalitis

目的总结儿童病毒性脑炎的临床特征、实验室检查和辅助检查的特点,探讨儿童病毒性脑炎的早期诊断方法及治疗方法。方法回顾性分析我院神经科2012-01—2013-06收治的30例病毒性脑炎患儿的临床资料、实验室检查及辅助检查结果。结果 30例患儿以发热、意识障碍、头痛、呕吐为主要临床表现,其中发热27例（90.0%）,意识障碍22例（73.3%）,昏迷1例,头痛22例（73.3%）,呕吐21例（70.0%）;阳性12例（40.0%）,颈抵抗可疑阳性5例（16.7%）;双侧巴宾斯基征阳性12例（40.0%）,单侧巴宾斯基征阳性3例（10.0%）;布鲁津斯征均为阴性;2例（6.7%）凯尔尼格征阳性;血液肠道病毒学检查（柯萨奇、埃科病毒及EB病毒抗体IgM、IgG）,抗体[IgM和（或）IgG]均为阳性,但脑脊液病毒学抗原检查仅7例阳性;脑电图（EEG）和磁共振成像（MRI）检查,7例（23.3%）EEG异常,2例（6.7%）MRI异常。经抗病毒、降颅压等治疗,随访6~12个月,1例昏迷,1例小脑共济失调,余28例完全康复,未见后遗症。结论儿童病毒性脑炎多数发病较急,临床表现多样,以发热、意识障碍、头痛、呕吐为主,血液中病毒抗体阳性率高,但脑脊液病原学阳性率较低。对症治疗后大部分预后良好。

Objective To summarize the characteristics of clinical features,and the results of laboratory test and auxiliay examinations in children with enterovirus encephalitis,and to investigate the method of diagnosis and treatment of enterovirus encephalitis. Methods The clinical data of 30 cases in neurology ward of our hospital from January 2012 to June 2013 with en- terovirus encephalitis were collected and analyzed. Results The main clinical manifestations of 30 cases were fever （27 cases, 90.0M） ,disturbance of consciousness （22 cases,73.3%）,headache （22 cases,73.30//00） and vomit （21 cases,70.0%）. There were 12 cases （40.0 %） of positive cervical resistance, 5 cases （16.5 %） of suspicious positive cervical resistance. There were 12 cases （40.0%） of positive bilateral Babinski＇s sign and 3 cases （10.0%） of positive unilateral Babinski＇s sign. The Brudzinski＇s sing were all negative. 2 cases （6.7%） of Klinefelter＇s sign were positive. The antibodies （IgM and/or IgG） of 30 cases were all positive in intestinal virological examination of blood （IgM,IgG of antibody of Coxsackie virus,Eeko virus and Epstein-Barr virus）. But in 30 cases,only 7 cases of antibodies were positive in eerebro-spinal fluid （CSF） virological examination. The electroencephalogram （EEG） and magnetic resonance imaging （MRI） were examined in all of the patients which 7 cases （23.3%） of EEG and 2 cases （6.7 % ） of MRI were abnormalities. Following up for 6-12 months, 28 cases were fully recovered. Conclusion Most of enterovirus encephalitis in children is acute, and the main clinical manifestations are fever, disturbance of consciousness, headache and vomit. The positive rate of virus in blood is higher,but it is lower in CSF. The most prognosis is better.