摘要
目的 分析儿童单纯疱疹病毒性脑炎 (HSE)的临床特征 ,探讨其诊断依据及影响预后的因素。方法 对 2 2例经脑脊液病毒病原学确诊的HSE患儿的临床特征进行分析 ,并对治疗效果进行观察和随访。结果 发热 2 2例 (10 0 % ) ,意识障碍 18例 (81% ) ,其中昏迷 12例 [采用GlasgowComaScale(GCS)评分、GCS≤ 4分 3例、5～ 7分 5例、8～ 9分 4例 ],嗜睡 6例。惊厥 16例 (72 % ) ,呕吐 13例(5 9% ) ,头痛 10例 (4 5 % ) ,精神症状 8例 (36 % )。合并颅神经麻痹 10例 (4 5 % ) ,肢体瘫痪 7例 (31% )。应用酶联免疫吸附方法测定脑脊液 (CSF )HSV IgM阳性者 13例、特异性IgG抗体局部产生指数 :血清/CSF比值≤ 2 0者 7例、双份CSF标本恢复期特异性HSV IgG 4倍以上升高者 4例 ;或采用聚合酶链反应 (PCR)技术测定脑脊液HSV DNA阳性者 3例。头颅CT和 (或 )MRI提示异常者 19例 ,病变部位以额、颞叶为主 12例 ,7例伴颅内出血。对 15例患儿进行 6个月～ 6年的随访 ,完全康复 5例 ,轻度残疾 3例 ,中度残疾 5例 ,重度残疾 2例 ,合并癫者 7例。结论 HSE临床可分轻重两型 ,早期意识障碍及精神症状是本病特征。脑脊液病毒学检测阳性为确诊依据。起始治疗时的病程、意识状态、及脑内病变程度是影响预后的重要因素。
Objective Herpes simplex virus encephalitis(HSE)is one of the severe types of acute viral encephalitis in children, and has high mortality and morbidity. If aciclovir is given earlier, the outcome of patients will be improved. This study aimed to analyze the clinical characteristics of HSE in children and discuss the factors influencing the prognosis. Method Twenty-two inpatients with HSE including 14 males and 8 females were enrolled in this study. The age was between 3 months to 13 years (average 5.5 years). Eighteen of 22 patients were treated with aciclovir, 15 mg/(kg·d) for 14 days. Fifteen of 22 patients were followed-up from 6 months to 6 years for the evaluation of the morbidity, assessment of intellectual ability and the reexamination with CT were performed. The verification of HSE was based on one of the following indexes, the positive HSV-IgM in the CSF, a fourfold increase of anti-HSV antibody titers in CSF at the recovery phases, the HSV antibody ratio of serum to CSF≤20 by enzyme-linked immunosorbent assay (ELISA), or the detection of HSV DNA in CSF by polymerase chain reaction (PCR). Results All the 22 patients (100%) had fever, 18(81%)had the altered consciousness, and 12 had coma, of whom 3 cases had ≤4 scores of the Glasgows Coma Scale, 5 cases had 5-7 scores, and 4 cases had 8-9 scores. Seizures were seen in 16 (72%) cases, vomiting in 13 (59%), headache in 10 (45%), personality changes in 8 (36%), cranial nerve paresis in 10 (45%), and hemiparesis in 7 (31%). CT and/or MRI of the brain revealed abnormalities in 19 of 22 patients. The temporal and frontal lobe were involved in 12 patients. Haemorrhagic changes were seen in 7 cases. In the followed-up patients, 5 of 15 showed recovery, 3 mildly disabled, 5 moderately disabled, and 2 severely disabled. Conclusions HSE may be classified as mild and severe types. The early alteration of the consciousness and the personality changes are the clinical characteristics of HSE. The definite diagnosis of HSE will rely on the positive results by the virological tests in CSF. The duration of illness prior to the treatment, the Glasgow Coma Scale score and the lesions of the brain showed to be the important factors for the prognosis.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2001年第7期432-434,共3页
Chinese Journal of Pediatrics
关键词
疱疹病毒2型
脑炎
儿童
随访研究
HSE
Herpes virus 2, human
Encephalitis, viral
Child
Follow-up studies
