重症手足口病恢复期和随访MRI表现及临床意义

Severe Hand, Foot and Mouth Disease Recovery and Follow-up MRI Manifestations and Clinical Signifi cance

目的探讨重症手足口病中枢神经系统损害的MRI表现及与临床转归的相关性。方法对我院2010年5月-2013年5月42例重症手足口病患儿恢复期和随访期中枢神经MR影像及临床资料进行回顾性分析,根据恢复期影像学结果分成阳性组和阴性组,比较两组病例临床转归情况,以及观察随访期中枢神经病灶恢复情况。结果42例患儿MRI检查结果为阳性18例,阴性24例,阳性率为42.9%(18/42)。阳性病例MRI显示全部有脑干损害,合并脊髓损害6例,小脑齿状核损害1例。出院时,阳性组临床治愈9例,遗留神经功能障碍8例,无法脱离呼吸机而转院1例;阴性组临床治愈21例,遗留神经功能障碍3例;阳性组的临床治愈率为50%(9/18),阴性组的临床治愈率为87.5%(21/24),两者治愈率的差异具有统计学意义(p<0.05)。阳性组中的15例进行了1年的随访,MRI显示病灶完全消失9例,病灶缩小6例。结论经过积极治疗大部分重症手足口病中枢神经损害及其后遗症是可恢复的,MRI检查结果是临床判断病情的一个手段,但不能预测患者远期预后。

Objective To explore the correlation of MRI image and clinical outcome on damage of the central nervous system in severe hand-foot-and-mouth disease. MethodsRetrospectively analyzed 42 cases of the central nervous MRI images and clinical datas of the recovery and follow-up of severe hand-foot-and-mouth patients during May 2010 and May 2013, divided these patients into positive group and negative group according to the results of the recovery image, and then compared the clinical outcomes and recover condition of the follow-up in central nerve damage of these two groups. Results Results There are 18 positive cases and 24 negative cases in the 42 cases MRI images; All the positive cases showed brain stem damage, in which 6 cases combined with spinal cord injury and 1 cases combined with cerebellar dentate nuclear damage. In the positive group, there were 9 cases that are clinical cure and 8 cases with nerve dysfunction, and 1 case that cannot be separated from breathing machine and transfered. In the negative group, there were 21 cases that are clinical cure and 3 cases with nerve dysfunction. The clinical cure rate of positive group was 50%（9/18）, and the clinical cure rate of negative groups was 87.5%（21/24）, The cure rate differences between positive group and negative group has statistically significant（P〈0.05）. We made the follow-up of 15 cases of positive group for 1 year, and found that there were 9 cases with lesions disappeared and 6 cases with narrowed lesions in MRI images. Conclusion After active treatment, most central nerve damage and its sequela of severe hand-foot-mouth disease were recoverable. MRI examination can be an approach for clinical judgment, but cannot predict long-term prognosis of the patients.