CAJ | 학술논문

目的：研究肠道病毒71(EV71)型手足口病(HFMD)合并脑干脑炎患儿的远期预后。方法对2010年1月至2012年12月在深圳市儿童医院住院的82例EV71型HFMD合并脑干脑炎患儿进行随访。随访包括电话问卷调查、神经系统查体、智力测试和头颅磁共振成像(MRI)复查。结果1.电话随访82例患儿中,遗留后遗症者14例(17%,14/82例),包括肢体无力5例、性格改变3例、肢体抖动1例、癫1例、抽搐1例、睡眠呼吸障碍并吞咽障碍1例、发声低弱并吞咽障碍1例、中枢性低通气并吞咽障碍1例,且临床严重程度越重的患儿遗留后遗症概率越大,差异有统计学意义(χ2=27.273,P<0.001)。2.完成智力测试者27例,父母文化程度越高的患儿全量表智商( FIQ)及言语智商( VIQ)分数越高,差异有统计学意义(父：t=4.761、4.376,P均<0.05；母：t=4.079、3.473,P均<0.05)；临床严重程度越重、发病年龄越小的患儿FIQ及VIQ分数越低,但差异无统计学意义(P>0.05)。3.头颅MRI复查28例,MRI仍显示脑干异常信号6例,包括原病灶吸收变小、软化、胶质增生等。6例MRI异常患儿中,遗留后遗症者占83%(5/6例)。结论 EV71型HFMD合并脑干脑炎患儿后遗症主要为肢体运动及脑神经障碍,其后遗症概率与临床严重程度呈正比。大多数患儿的认知功能预后良好,远期头颅MRI仍显示脑干病灶者,存在神经系统后遗症或边缘智力概率较大。
목적：연구장도병독71(EV71)형수족구병(HFMD)합병뇌간뇌염환인적원기예후。방법대2010년1월지2012년12월재심수시인동의원주원적82례EV71형HFMD합병뇌간뇌염환인진행수방。수방포괄전화문권조사、신경계통사체、지력측시화두로자공진성상(MRI)복사。결과1.전화수방82례환인중,유류후유증자14례(17%,14/82례),포괄지체무력5례、성격개변3례、지체두동1례、전1례、추휵1례、수면호흡장애병탄인장애1례、발성저약병탄인장애1례、중추성저통기병탄인장애1례,차림상엄중정도월중적환인유류후유증개솔월대,차이유통계학의의(χ2=27.273,P<0.001)。2.완성지력측시자27례,부모문화정도월고적환인전량표지상( FIQ)급언어지상( VIQ)분수월고,차이유통계학의의(부：t=4.761、4.376,P균<0.05；모：t=4.079、3.473,P균<0.05)；림상엄중정도월중、발병년령월소적환인FIQ급VIQ분수월저,단차이무통계학의의(P>0.05)。3.두로MRI복사28례,MRI잉현시뇌간이상신호6례,포괄원병조흡수변소、연화、효질증생등。6례MRI이상환인중,유류후유증자점83%(5/6례)。결론 EV71형HFMD합병뇌간뇌염환인후유증주요위지체운동급뇌신경장애,기후유증개솔여림상엄중정도정정비。대다수환인적인지공능예후량호,원기두로MRI잉현시뇌간병조자,존재신경계통후유증혹변연지력개솔교대。
Objective To study the long-term prognosis of hand-foot-mouth disease( HFMD) complicated with brainstem encephalitis caused by enterovirus 71(EV71) . Methods Long-term follow-up of 82 cases of EV71 HFMD complicated with brainstem encephalitis were conducted,who were hospitalized in Shenzhen Children′s Hospital from January to December of 2012. Follow-up methods included telephone interview,neurological examination,intelli-gence tests and brain magnetic resonance imaging (MRI) study. Results (1)Telephone interview and physical exam results indicated that 14 of 82 cases (17%) had sequelae,including limb weakness in 5 cases,personality changes in 3 cases,limb shaking in 1 case, epilepsy in 1 case,seizures in 1 case,sleep-disordered breathing and swallowing disorder in 1 case,low voice and swallowing disorder in 1 case,central hypoventilation and swallowing disorder in 1 case. The se-quelae ratio increased as the clinical symptoms worsening,and there was a statistical significance (χ2=27. 273,P<0. 001). (2)Twenty-seven children completed intelligence tests and the findings showed that they had higher full-scale intelligence quotient( FIQ) and verbal intelligence quotient( VIQ) scores as their parents reached a higher level of edu-cation;there was a statistical significance (father:t=4. 761,4. 376,all P<0. 05; mother:t= 4. 079,3. 473, all P<0. 05);FIQ and VIQ scores were negatively correlated with clinical severity and onset age,but there was no statistical sig-nificance (P>0. 05). (3)Twenty-two out of 28 cases had normal brain MRI,and the other 6 cases had abnormalities including narrowed lesions, malacia formatted, gliosis and so on,and 5 of these 6 cases (83%) with MRI-positive had sequelae. Conclusions The major sequelae of EV71 HFMD with brainstem encephalitis complication are limb motor impairment and cranial nerve disorders. The sequelae ratio increases as the clinical symptoms worsening. Most of them had normal long-term cognition. However, those with MRI positive are more vulnerable to have neurological sequelae or margin intellectual scores.