儿童急性播散性脑脊髓炎13例回顾性剖析.docVIP

儿童急性播散性脑脊髓炎13例回顾性剖析 　　摘要：目的探讨儿童急性播散性脑脊髓炎的临床特点、诊断、治疗及预后。方法对13例患儿的临床资料（包括临床表现、辅助检查及治疗）进行回顾性分析。结果 13例患儿平均发病年龄（8±4.22）岁，12例具有前期感染史或疫苗接种史，急性或亚急性起病。临床表现多样。9例脑脊液检查异常，8例脑电图检查异常。头颅MRI均表现为T2相多发、斑片状高信号病灶。全部病例均予糖皮质激素治疗，其中10例联合丙种球蛋白冲击治疗，均显著好转。6个月~2年随访，1例复发,1例留下神经系统后遗症。结论儿童急性播散性脑脊髓炎临床表现多样，早期诊断、及时规范治疗预后良好。 　　关键词：急性播散性脑脊髓炎；儿童；回顾性分析 　　Retrospective Analysis on 13 Children with Acute Disseminated Encephalomyelitis 　　HUANG Xian-gui,PENG Jiang-feng,WEI Dong-xiu 　　(Department of Pediatrics, The People’s Hospital of Liuzhou City,Liuzhou 545006,Guangxi,China) 　　Abstract：ObjectiveTo investigate the clinical characteristics, diagnosis, treatment and prognosis of children with acute disseminated encephalomyelitis(ADEM).MethodsAll clinical data were analyzed retrospectively in 13 children with ADEM,including clinical manifestation, auxiliary examination and treatment.Results: Mean age of onset was（8±4.22）years old in 13 cases, Acute or subacute onset.12 patients with previous history of infection or vaccination history. The clinical manifestations were diverse. Results Cereospinal fluid examination were abnormal In 9 cases, and electroencephalogram was abnormal in 8 cases. On magnetic resonance imaging(MRI)，all cases showed long T2 signal.All patients were treated with corticosteroid and 10 who received additional intravenous immunoglobulin had a better result.All cases were followed-up from 6 months to 2 years, 1 case recurrenced and 1 case leaved the sequelae of nervous system.ConclusionADEM was a disease with multiple neurological signs. Good prognosis can be obtained with early diagnosis and standard treatment. 　　Key words：ADEM; Children; Retrospective analysis 　　 急性播散性脑脊髓炎（ADEM）是以中枢神经系统急性炎症脱髓鞘病变为特征的自身免疫性疾病。儿童及青壮年多发，临床表现多样，总体预后良好，但有部分患儿可能遗留后遗症甚至死亡。早期诊断，及时治疗至关重要。现回顾我院儿科收治的13例ADEM临床资料，分析该病临床特点、诊断、治疗及预后。 　　1资料和方法 　　1.1一般资料选取我院儿科收治的住院患儿，均有完整病史及辅助检查资料。入选标准：①起病前有感染史或疫苗接种史；②急性或亚急性起病，神经系统临床表现多样；③MRI检查可见颅内或脊髓以白质为主的多发异常信号；④排除病原体直接感染或由其他慢性、进行性疾病所致的颅内病变。住院时间为8~21d，平均15d。男7例，女6例。年龄2岁2月~13岁。