肠道病毒71型致手足口病合并脑炎81例临床分析

Clinical characteristics of 81 cases of handfootmouth disease complicated with encephalitis caused by Enterovirus 71

摘要:

目的研究肠道病毒71型（EV71）所致手足口病合并脑炎患儿的临床和实验室特点，以提高临床诊治水平。方法对外周血EV71 DNA聚合酶链反应(PCR)阳性的81例手足口病合并脑炎患儿的病历资料进行回顾性分析。结果81例患儿均有发热，48例抖动，45例惊跳，42例呕吐。实验室检查示外周血白细胞升高53例；血糖升高10例，降低20例；肌钙蛋白无异常；脑脊液白细胞升高73例。81例患儿均采用甘露醇减轻神经系统水肿，其中32例采用甲基强的松龙控制炎症，27例采用丙种球蛋白支持治疗；除1例发生左上肢迟缓性瘫痪，其余80例均临床治愈。结论EV71感染所致手足口病合并脑炎患儿均有发热、精神差表现，部分患儿合并抖动、惊跳、呕吐；治疗上应积极降颅内压，酌情联合肾上腺糖皮质激素及丙种球蛋白治疗。

Abstract:

ObjectiveTo study the clinical and laboratory characteristics of handfootmouth disease complicated with encephalitis caused by Enterovirus 71(EV71), so as to improve the quality of diagnosis and treatment .MethodsClinical data of 81 patients with handfootmouth disease complicated with encephalitis were analyzed retrospectively.ResultsOf 81 cases, all had fever, 48 had twitch, 45 startled, and 42 had vomiting. Fiftythree cases were with leukocytosis in peripheral blood； 10 with hyperglycemia, 20 with hypoglycemia ; none with abnormal troponin; 73 with leukocytosis in cerebrospinal fluid. All patients used mannitol to reduce intracranial pressure, 32 used methylprednisolone to inhibit inflammation, and 27 used gamma globulin for support treatment ; except 1 case developed flaccid paralysis of left upper limb,the other cases were clinically cured.ConclusionAll patients with handfootmouth disease complicating with encephalitis caused by EV71 had clinical symptoms of fever and poor spirit, some startled, twitched and vomiting, intracranial pressure should be reduced actively, combination therapy with gamma globulin and glucocorticoid should be chosen appropriately.