儿童单纯疱疹病毒性脑炎41例临床特点及预后探究.docVIP

儿童单纯疱疹病毒性脑炎41例临床特点及预后探究 　【摘要】 目的 探讨儿童单纯疱疹病毒性脑炎(HSE)的临床特征、早期诊断的依据及影响预后的因素。方法 回顾性分析41例单纯疱疹病毒性脑炎患儿的临床资料与随访结果。结果 41例HSE病例发热41例(100%);惊厥29例(70.7%);头痛27例(65.8%);呕吐21例(51.2%);意识障碍25例(60.9%)，其中昏迷10例;精神异常15例(36.6%);运动失常12例(29.3%);幻视11例(26.8%)，合并脑神经症状12例(29.2%);头颅CT/MRI异常28例，病变主要累及颞叶和额叶，其中脑实质及蛛网膜下腔出血9例;脑电图异常36例。转归：5例放弃，1例死亡，对32例进行1~3年随访：痊愈19例，轻度致残5例、中度致残3例、重度致残5例，合并癫痫7例。结论 早期出现意识障碍及精神症状是单纯疱疹病毒性脑炎的临床表现特征，头颅CT不能作为早期诊断的依据，治疗时的病程、脑损害程度可影响预后。 【关键词】 单纯疱疹病毒Ⅰ型;脑炎;儿童 　　[Abstract] Objective Herpes simplex virus(HSV)is an important etiologic agent of acute childhood encephalitis.Herpes simplex virus encephalitis(HSE)has a high mortality and disable ratio.If acyclovir is given earlier，the outcome of patients will be improved.This study aimed at analyzing the clinical characteristics and the basis of early diagnose of HSE in childhood and discuss the factors influencing the prognosis.Methods 41 inpatients with HSE were enrolled in this study.The ages ranged from 6 months to 14 years，including 23 males and 18 females.These cases were diagnosed as having positive specific immunoglobulin M antibodies(94%)of herpes simples virus types 1(HSV-1)in cerebrospinal fluid(CSF)and/or a minimum 4-fold increase of anti-HSV antibody titers(36%)in CSF at the recovery phases.32 cases were followed-up from 1 years to 3 years for evaluation of sequelae，assessment of intellectual faculties and reexamination with CT and/or MRI of brain were performed.Results The clinical manifestation included fever 41(100%);seizure 29(70.7%);headache 27(65.8%);vomit 21(51.2%);altered consciousness 25(60.9%)and including coma 10;mental dysfunction 15(36.6%);ataxia 12(29.2%)，cranial nerve paresis 12(29.2%);visual hallucination 11(26.8%).CT of brain revealed abnormalities in 23 cases of 41 patients and 5 cases with MRI of brain revealed abnormalities.The temporal and frontal lobe were involved in the most cases.Cerebral hemorrhage changes were seen in 9 cases.In followed-up patients，19 of 32 showed recovery，5 cases mildly disa