CAJ | 학술논문

目的研究手足口病患儿中合并急性弛缓性瘫痪(AFP)的临床特征和影像学改变,探讨这类非脊髓灰质炎肠道病毒71型( EV71)相关性AFP的发生演变过程.方法对我院2011年5至8月收治手足口病患儿中合并AFP者进行临床观察和影像学检查及随访,进行早期强化康复治疗,评价疗效,根据早期强化康复后肌力是否恢复4级分为康复组和后遗症组,分析临床特征在两组间的差别,寻找影响预后的因素.应用SPSS10.0统计包对组间差异进行独立样本的t检验和x2检验.结果 16例AFP患儿7例最重的瘫痪肢体肌力达到0级,14例非0级瘫痪肢体合并出现踝阵挛,8例恢复满意(康复组),8例遗留后遗症(后遗症组),最初肌力是否0级(0例vs 7例,x2=12.4)、最初腱反射是否消失(2例vs 8例,x2=9.6),肌肉是否明显萎缩(0例vs 8例,x2=16)在两组间差异有统计学意义(P均＜0.01).起病1周内行磁共振成像(MRI)检查可见脊髓腹侧内和脑干背侧异常信号且有强化,1周后查则无强化改变,1个月后复查病灶更清晰.结论非脊髓灰质炎EV71感染所致的AFP常常同时合并上运动神经元损害,由于病初瘫痪程度和前角损害严重性的不同,完全恢复或残留后遗瘫痪.MRI的随访有助于了解AFP的病理过程.
목적 연구수족구병환인중합병급성이완성탄탄(AFP)적림상특정화영상학개변,탐토저류비척수회질염장도병독71형( EV71)상관성AFP적발생연변과정.방법 대아원2011년5지8월수치수족구병환인중합병AFP자진행림상관찰화영상학검사급수방,진행조기강화강복치료,평개료효,근거조기강화강복후기력시부회복4급분위강복조화후유증조,분석림상특정재량조간적차별,심조영향예후적인소.응용SPSS10.0통계포대조간차이진행독립양본적t검험화x2검험.결과 16례AFP환인7례최중적탄탄지체기력체도0급,14례비0급탄탄지체합병출현과진련,8례회복만의(강복조),8례유류후유증(후유증조),최초기력시부0급(0례vs 7례,x2=12.4)、최초건반사시부소실(2례vs 8례,x2=9.6),기육시부명현위축(0례vs 8례,x2=16)재량조간차이유통계학의의(P균＜0.01).기병1주내행자공진성상(MRI)검사가견척수복측내화뇌간배측이상신호차유강화,1주후사칙무강화개변,1개월후복사병조경청석.결론 비척수회질염EV71감염소치적AFP상상동시합병상운동신경원손해,유우병초탄탄정도화전각손해엄중성적불동,완전회복혹잔류후유탄탄.MRI적수방유조우료해AFP적병리과정.
Objective To explore the development and prognosis of the acute flaccid paralysis (AFP) associated with enterovirus 71 ( EV71 ) infection through clinical follow-up study for clinical and magnetic resonance imaging ( MRI ) features based on the research progress of virology and pathology.Method Sixteen children with HFMD associated with AFP in hospital from May 1,2011 to August 31,2011 were investigated and the patients received intensive rehabilitation training.The 16 cases were divided into two groups (the recovery or the sequela) by if the muscle strength recovered to level 4 after intensive rehabilitation.The MRI findings of 15 children were analyzed and among them,6 patients were reexamined after one month.The clinical markers were compared between groups including course of disease,WBC,WBC in cerebrospinal fluid (CSF),ventilator support,therapy,the worst muscle strength,the initial tendon reflex,the muscle atrophy,and multi-limb paralysis.The data were analyzed by t test and x2 test with SPSS10.0.Result All the 16 children were infected with enterovirus 71 ( EV71 ).The myodynamia of 7 children were level 0,4 children had serious upper limbs paralysis.The neck muscle in 3 cases and the brain stem motor nuckus in 4 cases were involved.The ankle clonus of non-completely paralyzed limbs in 14 cases occurred during rehabilitation. Eight children had the better prognosis,the other 8 children had sequela.0 level muscle strength (0 case vs.7cases,x2 =12.4),the initial tendon reflex (2 cases vs.8 cases,x2 =9.6),obvious muscle atrophy ( 0 case vs.8 cases,x2 =16),were significantly different in the children with the recovery when compared to the sequela (P ＜ 0.01 ).The severe upper limbs paralysis had the worse prognosis than the severe lower limbs paralysis.MR imaging showed signs of spinal nerve root inflammation and the bilateral hyperintense lesions,symmetrical in the posterior portions of the medulla,pons,and asymmetrical in the ventral horns of cervical spinal cord.Signal enhancement occurred only in the early MRI examination. Conclusion In the evolution of AFP due to EV71 infection,the upper motor neuron damage is common,the prognosis is related with the severity of early paralysis and neuron damage.MR imaging is helpful to understand the pathological mechanism of AFP.