重症病毒性脑炎患儿脑损伤与NSE的相关性及MPPT对脑损伤修复的影响

Relationship between cerebral damage in children with severe viral encephalitis and neuron-specific enolase and the effect of methylpredniolone on the repair of cerebral damage

目的 探讨重症病毒性脑炎患儿脑损伤与 NSE的相关性 ,以及甲基强的松龙 (MPPT)对脑损伤修复的影响。方法 将 5 4例重症病毒性脑炎昏迷患儿随机分为 A、B两组 ,对照组为脑脊液常规正常的非昏迷患儿。患儿均给予抗病毒药物或足量抗生素、脱水剂、营养支持等治疗 ,A组加用 MPPT10～ 2 0 mg/ kg,B组加用地塞米松(DXM) 0 .5～ 1mg/ kg,均每日 1次 ,连用 5天。以改良的 Glasgow昏迷量表评分、双抗体夹心酶标免疫法测定的脑脊液神经元特异性烯醇化酶 (NSE)含量作指标并比较。结果 A、B组治疗前 NSE含量及 Glasgow评分与对照组比较有显著性差异 (P<0 .0 1) ,NSE含量与 Glasgow分值呈负相关 (r=- 0 .92 85 ,P<0 .0 1)。A、 B组治疗前 Glasgow评分及 NSE含量无明显差异 (P>0 .0 5 ) ,治疗后 1天差异有显著性 (P<0 .0 1) ,2周后 Glasgow评分比较差异有显著性 (P<0 .0 1)。不良反应无明显差异 (P>0 .0 5 )。结论 NSE含量变化是判定重症病毒性脑炎患儿脑损伤程度及修复的客观、敏感指标 ;MPPT是其治疗的安全有效措施 ,可避免或减轻神经系统后遗症的发生。

Objective To study the relationship between cerebral damage in children with severe viral encephalitis and neuron specific enolase(NSE)and the effect of methylpredniolone(MPPT)on the repair of cerebral damage Methods 54 children with severe viral encephalitis were randomly divided into group A and group B Patients in the control group were children with normal CSF routine and without coma All cases were administered with anti virus medicine or sufficient antibiotics, dehydration and nutrition support Group A was also treated with MPPT 10～20mg/kg, while group Btreated with dexamethasone(DXM)0 5～1mg/kg once a day for 5 successive days Evaluation with revised Glasgow Coma scale and NSE concentration in cerebrospinal fluid determined with ELISA were used as indexes for comparison Results There were significant differences in NSE concentration and Glasgow evaluation points between the treatment groups and the control group before treatment (P<0 01) NSE concentration was negatively related to the Glasgow points (r=-0 9285,P<0 01) There was no difference in Glasgow evaluation points or NSE concentration between group A and group B before treatment (P>0 05) There was significant difference in NSE concentration one day after treatment, and in Glasgow evaluation points one day and 2 weeks after treatment between the two group(P<0 01) There was no difference in the side effects between the two groups Conclusion The change of NSE concentration might be taken as an objective and sensitive index in the judgement of cerebral damage and repair in children with severe intracranial infection MPPT is a safe and effective measurement and it is able to avoid or reduce the occurrence of neural sequelae