CAJ | 학술논문

目的研究8例手足口病(hand-foot-and-mouth disease,HFMD)并发急性弛缓性麻痹(AFP)患儿的脊髓MRI特点并进行临床随访.方法观察8例于足口病并发急性弛缓性麻痹患儿临床特点,于起病2周行脊髓和头颅MRI检查,早期进行针对性功能锻炼、药物治疗,并儿随访3个月.结果 8例手足口病并发急性弛缓性麻痹病例中,2例四肢瘫痪,1例双下肢瘫痪,5例单侧下肢瘫痪.大部分患儿表现为轻瘫,以下肢麻痹为主.病程2周行脊髓MRI,示患儿脊髓病变集中于颈2～7和(或)胸12～腰1,表现为脊髓前角T1长T2信号.脊髓前角病变严重程度与临床表现、预后相关.下肢瘫痪恢复较快,四肢瘫痪者,恢复缓慢;并发脑炎者,恢复相对较慢.结论本组手足口病患儿合并急性弛缓性麻痹病例约占0.83%.AFP病变涉及颈2～7和(或)胸12～腰1脊髓前角区,引起所支配的上肢和(或)下肢肌群的急性弛缓性麻痹.随访结果显示,手足口病伴发AFP可能是可逆性病变,单侧下肢瘫痪恢复快,四肢瘫痪恢复慢.MRI可准确的显示脊髓病,变,对全面评估病情及预后有重要价值.
목적 연구8례수족구병(hand-foot-and-mouth disease,HFMD)병발급성이완성마비(AFP)환인적척수MRI특점병진행림상수방.방법 관찰8례우족구병병발급성이완성마비환인림상특점,우기병2주행척수화두로MRI검사,조기진행침대성공능단련、약물치료,병인수방3개월.결과 8례수족구병병발급성이완성마비병례중,2례사지탄탄,1례쌍하지탄탄,5례단측하지탄탄.대부분환인표현위경탄,이하지마비위주.병정2주행척수MRI,시환인척수병변집중우경2～7화(혹)흉12～요1,표현위척수전각T1장T2신호.척수전각병변엄중정도여림상표현、예후상관.하지탄탄회복교쾌,사지탄탄자,회복완만;병발뇌염자,회복상대교만.결론 본조수족구병환인합병급성이완성마비병례약점0.83%.AFP병변섭급경2～7화(혹)흉12～요1척수전각구,인기소지배적상지화(혹)하지기군적급성이완성마비.수방결과현시,수족구병반발AFP가능시가역성병변,단측하지탄탄회복쾌,사지탄탄회복만.MRI가준학적현시척수병,변,대전면평고병정급예후유중요개치.
Objective To understand the features of magnetic resonance imaging (MRI) findings and the results of clinical follow-up study in 8 infants and children with hand-foot-and-mouth disease (HFMD) complicated with acute flaccid paralysis (AFP) who were admitted to Beijing Ditan Hospital during the outbreak of HFMD in 2008. Methods The clinical characteristics of the 8 HFMD cases were investigated, and MRI findings were analyzed. The recovery of their impairment in limbs was followed up for three months. Results All the 8 cases showed poliomyelitis-like syndrome. MRI of spinal cord showed unilateral or bilateral hyperintense lesions which chiefly occurred in the anterior horn regions of the spinal cord (C2-C7 or T12-L1) on T1/T2-weighted images. Lesions of spinal cord chiefly occurred in T12-L1. Most of the cases showed mild paralysis, which occurred in more than haft of cases in single lower extremity. The patients who had acute paralysis of single lower extremity recovered faster than those with paralysis of four limbs. Conclusions In HFMD with AFP cases, MRI of spinal cord showed unilateral or bilateral lesions in the anterior horn regions of the spinal cord (C2-C7 or T12-L1 ) on T1/T2weighted images. AFP may be to some degree reversible in HFMD cases. MRI can directly and completely show the range and degree of changes associated with AFP in HFMD cases, thus provide instructive suggestions to its treatment. The acute paralysis of HFMD cases may be benefited from earlier treatment for AFP.