摘要
目的 评价影响儿童单纯疱疹病毒性脑炎（HSE）的预后因素,探讨儿童HSE预后差的病理生理机制.方法 纳入广州市妇女儿童医疗中心2012年1月至2013年10月确诊的儿童HSE 21例,除2例自动出院外,余19例纳入本研究,所有病例脑脊液单纯疱疹病毒（HSV） DNA-PCR检测均阳性.所有病例发病48 h内均未予阿昔洛韦抗病毒治疗,对所有病例进行临床和影像学分析随访,随访时间6个月以上,临床及检查数据包括脑电图（EEG）、改良Glasgow Coma Scale（GCS）评分、脑磁共振成像（MRI）的结果,所有患儿均在住院时和起病1个月后进行至少2次MRI的平扫和增强扫描,然后对分析结果进行合理分组,进行多因素和单因素预后分析,以Logistic回归和Fisher±39;s精确概率法统计分析,计算OR值.结果 本组病例年龄（2.03 ±2.23）岁,GCS评分（9.68±2.65）分,18例患儿存活,5例（27.8％）没有后遗症,3例（16.7％）轻度损害,这8例属于预后好.6例（33.3％）有中度神经系统损害,4例（22.2％）有严重的神经系统后遗症.8例预后好,11例预后差.多因素分析显示EEG、影像学病灶性质分布、年龄、GCS评分与预后相关（P＜0.05）.单因素分析显示年龄1～4岁（OR=30,95％ CI 2.066～366.510,P=0.002）,GCS评分≤10分（OR=27.518,95％ CI2.066～306.510,P=0.004）,MRI显示广泛坏死性异常（OR=12,95％ CI1.294 ～ 111.323,P=0.017）是预后差的高危因素.结论 年龄、GCS评分、MRI的病变性质和损害程度是儿童HSE预后的重要影响因素.儿童HSE容易累及广泛甚至深部核团或白质,坏死性损害为主,是儿童HSE预后差的重要病理基础.
Objective To evaluate the factors influencing prognosis and to explore the pathological mechanism in which herpes simplex virus encephalitis（HSE） was one of the severe types of acute viral encephalitis in children and had poor prognosis.Methods Twenty-one children with HSE were diagnosed by the clinical syndrome of focal encephalitis and HSV DNA-PCR positive in cerebrospinal fluid（CSF） from Jan.2012 to Oct.2013,among whom,19 patients were treated with intravenous Acyclovir,30 mg/（kg ·d） 48 hours after onset and were followed up for 6 to 24 months.Clinical data were collected including Glasgow Coma Score,the brain magnetic resonance imaging（MRI）,and electroencephalography（EEG）.All MRI examinations including plain scan and contrast enhancement were carried out at the beginning of admission and 1 month after the onset of symptoms.The clinical outcomes were divided into two levels accoming to the severity of the neurological deficit,then the data were analyzed by using Logistic regression and Fisher＇s exact probability method.The OR value was calculated.Results Eighteen children survived,of whom 5 cases had no neurological deficit（27.8%）,3 cases were left with mild impairment（16.7%）,and the above 8 cases were thought to have better outcome.Six cases had moderate impairment （33.3%） and 4 cases had severe impairment（22.2%） and 1 child died,and these 11 cases were thought to have worse outcome.Patients aged between 1 month and 10 years,average （2.03 ± 2.23） years old.The mean GCS score was （9.68 ± 2.65） scores,the GCS of the patients were more than 7except for one death child with 3 scores.The multiple factor analysis showed that EEG,age,GCS and the range and character in MRI were significantly correlative to the prognosis（P 〈 0.05）.The single factor analysis illustrated that age 1-4 years old（OR =30,95% CI 2.066-366.510,P =0.002）,GCS ≤ 10 scores（OR =27.518,95% C1 2.066-366.510,P =0.004）and the wide necrosis existence involving diffuse white matter or deep nuclei of MRI findings （OR =12,95 % CI 1.294-111.323,P =0.017） indicated the worse outcome.Conclusions Age,GCS score,nature and damage degree of MRI lesions are the main important factors affecting the prognosis of children＇s HSE.HSE in children is apt to involve the cortex such as frontal lobe,parietal lobe even diffuse white matter or deep nuclei,which indicates the poor prognosis.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2014年第19期1488-1491,共4页
Chinese Journal of Applied Clinical Pediatrics
关键词
单纯疱疹病毒性脑炎
儿童
预后
磁共振成像
随访研究
Herpes simplex encephalitis
Child
Prognosis
Magnetic resonance imaging
Follow-up study
