埃可病毒18型儿童病毒性脑炎和脑膜炎临床特征分析

Analysis of clinical features of viral encephalitis and viral meningitis in children with Echo 18enterovirus infection

目的了解埃可病毒18型(echovirus 18,E-18)所致儿童病毒性脑炎及脑膜炎的临床特点。方法对2013年11月-2015年9月河北省儿童医院收治的儿童病毒性脑炎和脑膜炎患者进行肠道病毒检测及型别鉴定,并对其临床症状、实验室检查、病情与转归等资料进行回顾性比较研究。结果本研究共收集151份患儿的脑脊液样本,其中123份(81.5%,123/151)检出肠道病毒,主要为E-18(50.4%,62/123)、E-6(15.4%,19/123)和E-30(19.5%,24/123)。E-18、E-6和E-30感染患者的临床表现以轻症为主,发热(98.1%,103/105)、头痛(90.5%,95/105)多见,E-18感染发生喷射性呕吐的概率(85.5%)明显高于E-6(10.5%)和E-30(62.5%)感染(χ^2=37.2,P<0.01)。E-18、E-30感染患儿脑脊液、脑电图及头颅影像学检查结果差异无统计学意义。E-18和E-30感染患儿治愈率(分别为98.4%、70.8%)明显高于E-6感染患儿(31.6%),差异有统计学意义(χ^2=42.2,P<0.01)。结论E-18感染所致儿童病毒性脑炎和脑膜炎的临床表现与E-6和E-30相似,以轻症为主,治愈率高。

Objective To understand the clinical characteristics of viral encephalitis and meningitis in children caused by echovirus 18(E-18).Methods Children with viral encephalitis and viral meningitis admitted to Hebei Children′s Hospital from April to September 2015were studied.According to the results of enterovirus detection and typing,they were divided into E-18,E-6and E-30enterovirus encephalitis and meningitis.Retrospective comparative analysis of clinical symptoms,laboratory tests,treatment and outcomes were performed.Results A total of 151cerebrospinal fluid samples were collected in this study,and 123(81.5%,123/151)were identified as enterovirus infections,with Echo 18(50.4%,62/123),Echo 6(15.4%,19/123),and Echo 30(19.5%,24/123)infections being the main ones.Fever(98.1%,103/105)and headache(90.5%,95/105)were the main manifestations of Echo 18,Echo 6and Echo 30infections.The positive rate of Echo 18infection with jet vomiting was 85.5%(53/62),significantly higher than that of Echo 6(10.5%,2/19)and Echo 30(62.5%,15/24)(χ^2=37.2,P<0.01).The differences of the results of laboratory tests,electroencephalogram and brain magnetic resonance imaging among patiences with three enterovirus infections were not significant.The cure rates of Echo 18(98.4%),and Echo 30(70.8%)infected patients were significantly higher than that of Echo 6infection(31.6%)(χ^2=42.2,P<0.01).Conclusions The clinical manifestations of children with Echo 18enterovirus encephalitis and meningitis are similar to that caused by Echo 6and Echo 30enterovirus.