德宏傣族儿童流行性乙型脑炎临床特点

Clinical Features of Epidemic Encephalitis B of Dai Children in Dehong

目的分析该地傣族儿童流行性乙型脑炎(乙脑)的流行、诊断及防治情况,提高救治水平,防止乙脑流行,保护易感人群。方法回顾性分析2011年6月—2015年9月该院儿科收治的46例乙脑患儿的临床资料,观察患儿的民族、年龄、临床表现、疫苗接种情况、诊断检查以及血清、脑积液特异性IgM抗体等。结果 46例患儿分别为傣族28例(60.87%),均来自农村,6例接种过乙脑疫苗,2例傣族;6例未接种过乙脑疫苗,傣族3例,34例乙脑疫苗接种史不详;均有蚊虫叮咬史,傣族自家或周围有养(禽、猪、牛)场所、有大量凤尾竹及鱼塘;发病时间在7~9月,7月为高峰,发病年龄1月~13岁,持续性高热,体温在39~41℃,头痛,抽搐,意识障碍为主要表现;外周血白细胞总数升高(89.13%),中性分类增高(84.78%);血C反应蛋白增高(85.71%);44例脑脊液检查,白细胞增高(31.81%),早期中性增高,8例蛋白轻度增高。血清特异性IgM抗体阳性(65.22%),脑脊液特异性IgM抗体阳性(86.96%),血清、脑积液特异性IgM抗体均阳性(54.35%);脑电图检查阳性(87.00%);影像学检查:39例行头颅CT检查:25例正常,14例异常。经过积极治疗,治愈18例(41.30%),近期后遗症28例(68.87%),其傣族20例(71.44%),3个月后随访28例均有智力倒退、学习困难(100.00%),14例伴运动功能障碍(50.00%),无死亡病例。最终总结出46例乙脑患儿符合儿童乙脑的一般特征,但发病率傣族最高(60.87%),近期后遗症28例,傣族20例(71.43%),未接种过乙脑疫苗和乙脑疫苗接种史不详者以傣族最高(60.87%),近期后遗症28例,傣族20例(71.43%)。结论乙脑临床上起病急、发展快、病情重、致残率高,乙脑的预防比临床治疗更重要,对13岁以下儿童的预防接种乙脑疫苗是保护易感人群的主要措施,应引起足够的重视,尤其加大力度做好傣族社区、村落宣传工作。

Objective To analyze the diagnosis and control Situation of epidemic encephalitis B of dai children in De- hong, improve the emergency level, prevent the spreading of encephalitis B and protect the susceptible population. Methods The clinical data of 46 eases of children with encephalitis B admitted and treated in our department from June 2011 to September 2015 were retrospectively analyzed and the nationality, age, clinical manifestation, vaccination situation, diagnosis examination, serum, specificity of hydrocephalus and IgM antibody of the children were observed. Results In the 46 cases of children, there were 28 dai patients, accounting for 60.87%, and all came from rural area, 6 cases were vaccinated with vaccinum encephalitidis epidemicae, including 2 dai patients, 6 cases were not vaccinated with vaccinum encephalitidis epidemicae, including 3 dai patients, the vaccinum encephalitidis epidemicae vaccination history of 34 eases was not in detail, and there were a large number of f^rrns, fernleaf hedge bamboos and fishponds in their own home or surroundings of dai people, the disease time was between July and September, July was the peak, and the disease age was between 1 month and 13 years with continuous high-fever, and the body temperature was be- tween 39 and 41~C, and the major manifestations were headache, clonic convulsion and disorder of consciousness, the total number of peripheral white blood cells increased, accounting for 89.13%, neutral classification increased, account- ing for 84.78%, blood c-reactive protein increased, accounting for 85.71%, the examination of 44 cases with cere- brospinal fluid showed that leukocytosis accounted for 31.81%, protein elevation was in 8 cases, the positive rate of specific IgM in acute phase serum was 65.22%, the positive rate of specific IgM in cerebrospinal fluid was 86.96%, and the positive rate of specific IgM in acute phase serum and cerebrospinal fluid was 54.35%, the positive rate of electrocardiogram was 87%, the head CT examination of 39 cases showed that 25 cases were .normal and 14 cases were abnor- mal, after the active treatment, 18 cases were cured, accounting for 4L30%, 28 cases were with short-term sequelae, accounting for 68.87%, including 20 cases of dai patients, accounting for 71.437%, and 3-month follow-up showed that 28 cases were with mental decline and learning difficulty, accounting for 100%, 14 cases were with dyskinesia, ac- counting for 50% and no death cases, and finally we conclude that 46 cases of children with encephalitis B met the general features, but the morbidity rate of Dai patients was the highest, accounting for 60＇.87%, 28 cases with short- term sequelae and 20 dai cases, accounting for 71.43%. Conclusion In clinic; the encephalitis B has the features of a- cute onset, rapid development, severe disease and high disability rate and the prevention is more important than the clinical treatment, and for children aged below 13, the prevention and vaccination of vaccinum encephalitidis epidemi- cae is a major measure of protecting the susceptible population, and-we should pay enough attention and especially do a good job in the publicity work in Dai community and rural area.