儿童水痘-带状疱疹病毒导致胰腺炎合并病毒性脑炎1例并文献复习

A Case of Pancreatitis Complicated by Viral Encephalitis Caused by Varicella-Aoster Virus in Children and Literature Review

目的分析儿童水痘-带状疱疹病毒(VZV)导致胰腺炎及病毒性脑炎的临床特征并复习相关文献,以提高对该疾病的认识。方法回顾性分析1例儿童VZV感染引起胰腺炎及病毒性脑炎患儿的临床特点、实验室检查等资料,复习VZV及胰腺炎的相关文献报道。结果患水痘1周后出现头痛、呕吐,检查血尿淀粉酶均正常,腹部CT提示胰腺形态、大小及密度未见明显异常。脑脊液有核细胞计数28×10^(6)个/L。给予抗感染、降颅压等治疗后未再头痛,但呕吐剧烈、唾液分泌增多。水痘16d后出现腹痛,复查胰腺炎检查:淀粉酶310μ/L,脂肪酶2310μ/L。给予抗感染、生长抑素及血液滤过等综合治疗后,淀粉酶、脂肪酶逐渐恢复正常,未再呕吐及腹痛。结论免疫功能正常儿童VZV感染引起胰腺炎合并病毒性脑炎罕见。引起胰腺炎时主要症状可表现为腹痛、剧烈呕吐,病初胰酶可正常,随着病情进展,胰酶逐渐升高。做到早诊断、早治疗,避免误诊和漏诊,可防止病情进一步恶化从而降低死亡率。

Objective Analyze the clinical characteristics of pancreatitis and viral encephalitis caused by varicella-zoster virus(VZV)in children and review relevant literature to improve the understanding of the disease.Methods To retrospectively analyze the clinical characteristics,laboratory examinations and other data of one child patient with pancreatitis and viral encephalitis caused by varicella-zoster virus,and review relevant literature on varicella-zoster virus and pancreatitis.Results One week after suffering from chickenpox,headache and vomiting occurred.Both blood and urine amylase tests were normal.Abdominal CT showed no obvious abnormalities in the shape,size and density of the pancreas.The count of nucleated cells in cerebrospinal fluid was 28×10^(6)·L^(-1).After anti-infection,lowering of intracranial pressure and other treatments,the headache relieved,but severe vomiting and increased saliva secretion were observed.Abdominal pain occurred 16 days after the onset of chickenpox.Reexamination of pancreatitis showed serum amylase 310μ·L^(-1) and lipase 2310μ·L^(-1).After comprehensive treatments such as anti-infection,somatostatin and hemofiltration,serum amylase and lipase gradually returned to normal without vomiting and abdominal pain.Conclusion It is rare for VZV infection in children with normal immune function to cause pancreatitis complicated with viral encephalitis.The main symptoms of pancreatitis were abdominal pain and severe vomiting.At the beginning of the disease,the pancreatin can be normal,and it gradually increases with the progress of the disease.Achieve early diagnosis and treatment,avoid misdiagnosis and missed diagnosis,prevent further deterioration of the disease and reduce mortality.