CAJ | 학술논문

目的：分析一例疑似疫苗相关麻痹型脊髓灰质炎（ VAPP ）的急性弛缓性麻痹（ AFP ）病例，评估病例与接种疫苗的关系。方法由预防接种异常反应调查诊断专家组根据病例临床表现、实验室和影像学检查结果，结合循证医学证据进行分析论证。结果患儿首次服脊髓灰质炎减毒活疫苗后第14天接种首针b型流感嗜血杆菌结合疫苗，第21天出现发热、肢体乏力，体查：四肢肌力0级，肌张力低，颈部以下皮肤痛觉缺失。麻痹第5天大便标本分离到脊髓灰质炎Ⅲ型病毒疫苗株，实验室检查未发现其他病原体感染，核磁共振检查显示延髓、颈段、下胸段脊髓多发病变，胸11椎体水平以下脊神经前根强化较显著。上述结果符合急性播散性脑脊髓炎的临床表现。结论本病例诊断为脊髓灰质炎疫苗相关ADEM病例，属于疫苗接种异常反应，疾病预防控制人员应注意此类异常反应的发生。
목적：분석일례의사역묘상관마비형척수회질염（ VAPP ）적급성이완성마비（ AFP ）병례，평고병례여접충역묘적관계。방법유예방접충이상반응조사진단전가조근거병례림상표현、실험실화영상학검사결과，결합순증의학증거진행분석론증。결과환인수차복척수회질염감독활역묘후제14천접충수침b형류감기혈간균결합역묘，제21천출현발열、지체핍력，체사：사지기력0급，기장력저，경부이하피부통각결실。마비제5천대편표본분리도척수회질염Ⅲ형병독역묘주，실험실검사미발현기타병원체감염，핵자공진검사현시연수、경단、하흉단척수다발병변，흉11추체수평이하척신경전근강화교현저。상술결과부합급성파산성뇌척수염적림상표현。결론본병례진단위척수회질염역묘상관ADEM병례，속우역묘접충이상반응，질병예방공제인원응주의차류이상반응적발생。
Objective To analyze and evaluate whether acute flaccid paralysis ( AFP ) of vaccine-assoociated paralytic pol-iomyelitis ( VAPP ) , a suspected case, is assoaciated with oral poliovirus vaccine ( OPV) vaccination.Methods The di-agnosis made by the experts of investigation and diagnosis for adverse events following immunization ( AEFI) was based on clinical manifestation, laboratory and imaging examination, in combination with the analysis on the principle of evidence-based medicine.Results The infant received the first dose of Hemophilus influenzae type b vaccine(Hib) on the 14th day following the first dose of oral poliovirus vaccine( OPV) .The infant developed symptoms of fever and muscle weakness on the 21st day following the first dose of OPV.Physical examination showed a zero level of limb muscle strength, hypomyoto-mia, analgesia of the skin under neck.The stool specimen was positive for polio vaccine virus typeШon the 5th day follow-ing paralysis.Other pathogen infection was not found in labrotory examnation.The MRI showed multiple lesions of medul-la, cervical and lower thoracic spinal cords, and an obvious enhancement in the anterior roots of spinal cord below the 11 thoracolumbar vertebral arch.The results are in line with the clinical manifestation of acute disseminated encephalomyelitis ( ADEM) .Conclusions The case was diagnosed as ADEM associated with OPV, determined as AEFI.Public health workers should pay attention to adverse events of this type.