肠道病毒71型手足口病合并脑干脑炎患儿的远期随访

The long-term follow-up of children with hand-foot-mouth disease complicated with brainstem encephalitis caused by enterovirus 71

目的：研究肠道病毒71（EV71）型手足口病（HFMD）合并脑干脑炎患儿的远期预后。方法对2010年1月至2012年12月在深圳市儿童医院住院的82例EV71型HFMD合并脑干脑炎患儿进行随访。随访包括电话问卷调查、神经系统查体、智力测试和头颅磁共振成像（MRI）复查。结果1.电话随访82例患儿中,遗留后遗症者14例（17%,14/82例）,包括肢体无力5例、性格改变3例、肢体抖动1例、癫1例、抽搐1例、睡眠呼吸障碍并吞咽障碍1例、发声低弱并吞咽障碍1例、中枢性低通气并吞咽障碍1例,且临床严重程度越重的患儿遗留后遗症概率越大,差异有统计学意义（χ2=27.273,P〈0.001）。2.完成智力测试者27例,父母文化程度越高的患儿全量表智商（ FIQ）及言语智商（ VIQ）分数越高,差异有统计学意义（父：t=4.761、4.376,P均〈0.05；母：t=4.079、3.473,P均〈0.05）；临床严重程度越重、发病年龄越小的患儿FIQ及VIQ分数越低,但差异无统计学意义（P〉0.05）。3.头颅MRI复查28例,MRI仍显示脑干异常信号6例,包括原病灶吸收变小、软化、胶质增生等。6例MRI异常患儿中,遗留后遗症者占83%（5/6例）。结论 EV71型HFMD合并脑干脑炎患儿后遗症主要为肢体运动及脑神经障碍,其后遗症概率与临床严重程度呈正比。大多数患儿的认知功能预后良好,远期头颅MRI仍显示脑干病灶者,存在神经系统后遗症或边缘智力概率较大。

Objective To study the long-term prognosis of hand-foot-mouth disease（ HFMD） complicated with brainstem encephalitis caused by enterovirus 71（EV71） . Methods Long-term follow-up of 82 cases of EV71 HFMD complicated with brainstem encephalitis were conducted,who were hospitalized in Shenzhen Children′s Hospital from January to December of 2012. Follow-up methods included telephone interview,neurological examination,intelli-gence tests and brain magnetic resonance imaging （MRI） study. Results （1）Telephone interview and physical exam results indicated that 14 of 82 cases （17%） had sequelae,including limb weakness in 5 cases,personality changes in 3 cases,limb shaking in 1 case, epilepsy in 1 case,seizures in 1 case,sleep-disordered breathing and swallowing disorder in 1 case,low voice and swallowing disorder in 1 case,central hypoventilation and swallowing disorder in 1 case. The se-quelae ratio increased as the clinical symptoms worsening,and there was a statistical significance （χ2=27. 273,P〈0. 001）. （2）Twenty-seven children completed intelligence tests and the findings showed that they had higher full-scale intelligence quotient（ FIQ） and verbal intelligence quotient（ VIQ） scores as their parents reached a higher level of edu-cation;there was a statistical significance （father：t=4. 761,4. 376,all P〈0. 05; mother：t= 4. 079,3. 473, all P〈0. 05）;FIQ and VIQ scores were negatively correlated with clinical severity and onset age,but there was no statistical sig-nificance （P〉0. 05）. （3）Twenty-two out of 28 cases had normal brain MRI,and the other 6 cases had abnormalities including narrowed lesions, malacia formatted, gliosis and so on,and 5 of these 6 cases （83%） with MRI-positive had sequelae. Conclusions The major sequelae of EV71 HFMD with brainstem encephalitis complication are limb motor impairment and cranial nerve disorders. The sequelae ratio increases as the clinical symptoms worsening. Most of them had normal long-term cognition. However, those with MRI positive are more vulnerable to have neurological sequelae or margin intellectual scores.