CAJ | 학술논문

目的评价影响儿童单纯疱疹病毒性脑炎(HSE)的预后因素,探讨儿童HSE预后差的病理生理机制.方法纳入广州市妇女儿童医疗中心2012年1月至2013年10月确诊的儿童HSE 21例,除2例自动出院外,余19例纳入本研究,所有病例脑脊液单纯疱疹病毒(HSV) DNA-PCR检测均阳性.所有病例发病48 h内均未予阿昔洛韦抗病毒治疗,对所有病例进行临床和影像学分析随访,随访时间6个月以上,临床及检查数据包括脑电图(EEG)、改良Glasgow Coma Scale(GCS)评分、脑磁共振成像(MRI)的结果,所有患儿均在住院时和起病1个月后进行至少2次MRI的平扫和增强扫描,然后对分析结果进行合理分组,进行多因素和单因素预后分析,以Logistic回归和Fisher's精确概率法统计分析,计算OR值.结果本组病例年龄(2.03 ±2.23)岁,GCS评分(9.68±2.65)分,18例患儿存活,5例(27.8％)没有后遗症,3例(16.7％)轻度损害,这8例属于预后好.6例(33.3％)有中度神经系统损害,4例(22.2％)有严重的神经系统后遗症.8例预后好,11例预后差.多因素分析显示EEG、影像学病灶性质分布、年龄、GCS评分与预后相关(P＜0.05).单因素分析显示年龄1～4岁(OR=30,95％ CI 2.066～366.510,P=0.002),GCS评分≤10分(OR=27.518,95％ CI2.066～306.510,P=0.004),MRI显示广泛坏死性异常(OR=12,95％ CI1.294 ～ 111.323,P=0.017)是预后差的高危因素.结论年龄、GCS评分、MRI的病变性质和损害程度是儿童HSE预后的重要影响因素.儿童HSE容易累及广泛甚至深部核团或白质,坏死性损害为主,是儿童HSE预后差的重要病理基础.
목적 평개영향인동단순포진병독성뇌염(HSE)적예후인소,탐토인동HSE예후차적병리생리궤제.방법 납입엄주시부녀인동의료중심2012년1월지2013년10월학진적인동HSE 21례,제2례자동출원외,여19례납입본연구,소유병례뇌척액단순포진병독(HSV) DNA-PCR검측균양성.소유병례발병48 h내균미여아석락위항병독치료,대소유병례진행림상화영상학분석수방,수방시간6개월이상,림상급검사수거포괄뇌전도(EEG)、개량Glasgow Coma Scale(GCS)평분、뇌자공진성상(MRI)적결과,소유환인균재주원시화기병1개월후진행지소2차MRI적평소화증강소묘,연후대분석결과진행합리분조,진행다인소화단인소예후분석,이Logistic회귀화Fisher's정학개솔법통계분석,계산OR치.결과 본조병례년령(2.03 ±2.23)세,GCS평분(9.68±2.65)분,18례환인존활,5례(27.8％)몰유후유증,3례(16.7％)경도손해,저8례속우예후호.6례(33.3％)유중도신경계통손해,4례(22.2％)유엄중적신경계통후유증.8례예후호,11례예후차.다인소분석현시EEG、영상학병조성질분포、년령、GCS평분여예후상관(P＜0.05).단인소분석현시년령1～4세(OR=30,95％ CI 2.066～366.510,P=0.002),GCS평분≤10분(OR=27.518,95％ CI2.066～306.510,P=0.004),MRI현시엄범배사성이상(OR=12,95％ CI1.294 ～ 111.323,P=0.017)시예후차적고위인소.결론 년령、GCS평분、MRI적병변성질화손해정도시인동HSE예후적중요영향인소.인동HSE용역루급엄범심지심부핵단혹백질,배사성손해위주,시인동HSE예후차적중요병리기출.
Objective To evaluate the factors influencing prognosis and to explore the pathological mechanism in which herpes simplex virus encephalitis(HSE) was one of the severe types of acute viral encephalitis in children and had poor prognosis.Methods Twenty-one children with HSE were diagnosed by the clinical syndrome of focal encephalitis and HSV DNA-PCR positive in cerebrospinal fluid(CSF) from Jan.2012 to Oct.2013,among whom,19 patients were treated with intravenous Acyclovir,30 mg/(kg · d) 48 hours after onset and were followed up for 6 to 24 months.Clinical data were collected including Glasgow Coma Score,the brain magnetic resonance imaging(MRI),and electroencephalography(EEG).All MRI examinations including plain scan and contrast enhancement were carried out at the beginning of admission and 1 month after the onset of symptoms.The clinical outcomes were divided into two levels accoming to the severity of the neurological deficit,then the data were analyzed by using Logistic regression and Fisher's exact probability method.The OR value was calculated.Results Eighteen children survived,of whom 5 cases had no neurological deficit(27.8％),3 cases were left with mild impairment(16.7％),and the above 8 cases were thought to have better outcome.Six cases had moderate impairment (33.3％) and 4 cases had severe impairment(22.2％) and 1 child died,and these 11 cases were thought to have worse outcome.Patients aged between 1 month and 10 years,average (2.03 ± 2.23) years old.The mean GCS score was (9.68 ± 2.65) scores,the GCS of the patients were more than 7except for one death child with 3 scores.The multiple factor analysis showed that EEG,age,GCS and the range and character in MRI were significantly correlative to the prognosis(P ＜ 0.05).The single factor analysis illustrated that age 1-4 years old(OR =30,95％ CI 2.066-366.510,P =0.002),GCS ≤ 10 scores(OR =27.518,95％ C1 2.066-366.510,P =0.004)and the wide necrosis existence involving diffuse white matter or deep nuclei of MRI findings (OR =12,95 ％ CI 1.294-111.323,P =0.017) indicated the worse outcome.Conclusions Age,GCS score,nature and damage degree of MRI lesions are the main important factors affecting the prognosis of children's HSE.HSE in children is apt to involve the cortex such as frontal lobe,parietal lobe even diffuse white matter or deep nuclei,which indicates the poor prognosis.