腺病毒性脑炎患儿23例的临床分析

Clinical features of twenty-three cases of adenoviral encephalitis in children

目的探讨腺病毒性脑炎患儿的临床特点,为临床诊治腺病毒性脑炎提供参考。方法收集2012年1月至2020年12月因怀疑中枢神经系统感染而入住汕头大学医学院第二附属医院患儿的1185份脑脊液标本,针对22种常见呼吸道病原体和脑炎常见病原体进行聚合酶链反应检测,收集腺病毒核酸检测阳性病例的临床表现、实验室检查和影像学结果并进行分析。结果1185份脑脊液标本中,病毒核酸阳性242份,阳性检出率为20.4%,其中腺病毒阳性标本23份,阳性检出率为1.9%。23例腺病毒性脑炎患儿中,男18例,女5例;发病年龄为(44.8±35.9)个月,范围为2个月19 d至10岁。23例患儿中,发热21例(91.3%),抽搐16例(69.6%),头痛4例(17.4%),呕吐11例(47.8%),意识改变11例(47.8%),情绪改变3例(13.0%)。23例患儿中,8例白细胞计数为(6~<10)×10^(9)/L,10例白细胞计数为(10~20)×10^(9)/L,且白细胞分类以中性粒细胞为主(21例,91.3%);20例(87.0%)患儿C反应蛋白在正常范围;脑脊液检查示,20例(87.0%)白细胞计数<15×10^(6)/L,3例白细胞计数≥15×10^(6)/L,最高达500×10^(6)/L,19例患儿的蛋白质处于正常范围,15例患儿的葡萄糖处于正常范围,19例患儿的氯化物在正常范围内。16例患儿接受头颅磁共振成像检查,8例未见明显异常,6例出现局部脑膜线状强化,1例出现颅内小软化灶,1例出现颅内广泛病变。13例患儿接受脑电图检查,7例呈正常脑电图或边缘状态,4例可见广泛中高幅慢波,1例可见棘波或棘慢波,1例同时具备上述2种改变。23例患儿中,22例治疗后病情好转出院,其中1例患儿出现继发性癫痫;另有1例患儿遗留严重大脑功能障碍,出院时无法吸吮,留置胃管,并发继发性癫痫。结论腺病毒性脑炎患儿的临床表现及辅助检查无明显特异性,大部分腺病毒性脑炎患儿预后较好,但少部分可遗留严重后遗症。

Objective To investigate the clinical features of adenoviral encephalitis(AE),and to provide reference for clinical diagnosis and treatment of adenoviral encephalitis.Methods From January 2012 to December 2020,1185 cerebrospinal fluid(CSF)samples of hospitalized children with suspected central nervous system infection in the Second Affiliated Hospital of Shantou University Medical College were collected for the detection of 22 common respiratory pathogens and common pathogens for encephalitis by polymerase chain reaction.Records of patients with adenovirus positive in CSF were reviewed and relevant clinical manifestations,laboratory tests and imaging examination results were collected for analysis.Results Among 1185 CSF samples,242 samples were positive for viral nucleic acid,with detection rate of 20.4%,including 1.9%(23/1185)of adenovirus.As for 23 children diagnosed with AE,18 were male,five were female,with the age of(44.8±35.9)months,ranging from two months and 19 days to 10 years.Of 23 children,21(91.3%)presented with fever,followed by convulsions(16 cases,69.6%),headache(four cases,17.4%),vomiting(11 cases,47.8%),consciousness change(11 cases,47.8%)and emotion disturbance(three cases,13.0%).Among 23 children,eight cases had white blood cell counts(WBC)of(6 to<10)×10^(9)/L,10 cases had WBC of(10 to 20)×10^(9)/L and the white blood cell classification was mainly neutrophils(21 cases,91.3%),and C reactive protein of 20 cases(87.0%)was in the normal range.Cerebrospinal fluid examination showed that WBC were less than 15×10^(6)/L in 20 cases(87.0%),and WBC≥15×10^(6)/L in three cases,which were up to 500×10^(6)/L;the protein of 19 cases was in the normal range,the glucose of 15 cases was in the normal range,and the chloride of 19 cases was in the normal range.Among 16 cases with brain magnetic resonance imaging examination,eight cases did not show abnormality,six cases with local meningeal linear enhancement,one case with small intracranial malacia,and one case with extensive intracranial lesions.For 13 cases who received electroencephalogram(EEG)test,seven cases showed normal EEG or marginal state,four cases showed extensive medium and high amplitude slow wave,one case showed spike wave or spike slow wave and one case had both of the above two changes.Among 23 children,22 cases recovered including one case had secondary epilepsy,and the remaining one case had severe brain dysfunction and was unable to suck when discharged,with an indwelling gastric tube and accompanied by secondary epilepsy.Conclusions The clinical manifestations and auxiliary examinations of children with AE have no obvious specificity.Most children with AE have a good prognosis,but a small number of them may have serious sequelae.