本文選題：EV71 + 腦炎　； 參考：《大連醫(yī)科大學(xué)》2012年碩士論文

【摘要】：背景:手足口�。℉and foot and mouth disease，HFMD）是一種常見的兒童傳染病，，輕癥表現(xiàn)為手足及口腔皰疹。但是，重癥患者伴有神經(jīng)系統(tǒng)并發(fā)癥（如：無菌性腦膜炎，急性弛緩性癱瘓及腦炎等），或者伴有系統(tǒng)性疾�。ㄈ纾盒菘恕⑿墓δ苷系K和肺水腫、肺出血）。HFMD的病原為腸道病毒(細小核糖核酸病毒家族的腸道病毒屬)，如：柯薩奇A16（Coxsackie A16virus，CAV-16）和腸道病毒71型（Enterovirus71,EV71）,經(jīng)糞口，密切接觸和呼吸道飛沫傳播。1969年，EV71首次在加州發(fā)現(xiàn)，其基因型為BrCr，急性感染EV71時易引起神經(jīng)并發(fā)癥。小于3歲兒童易出現(xiàn)嚴重并發(fā)癥如腦膜炎、腦干腦炎、普通腦炎、急性弛緩性癱瘓及腦脊髓炎，并可致殘或死亡。近十年來EV71HMFD在中國及其它亞洲流行。EV71HMFD已導(dǎo)致數(shù)萬人感染和多例兒童死亡。自1995年以來中國大陸地區(qū)一直有散在的流行，但是2008年安徽阜陽地區(qū)高度集聚病快速致死的HFMD爆發(fā)是空前的。本文分析2010年大連地區(qū)HFMD流行期間并發(fā)腦炎的271例兒童的臨床特征。 材料與方法:2010年1月-12月因HFMD在大連市兒童醫(yī)院住院患者593例中，根據(jù)271例患兒合并腦炎，診斷標(biāo)準(zhǔn)為衛(wèi)生部發(fā)布的診斷標(biāo)準(zhǔn)。根據(jù)臨床特點將腦干腦炎分級(I, II, III)。年齡為1月-13歲。收集并分析2010年大連市兒童醫(yī)院因HFMD合并腦炎住院患兒271例的臨床資料。 結(jié)果：因HFMD住院患兒593例，271例合并腦炎，其中男181例，女90例，男女比為2：1。年齡1個月-13歲，中位數(shù)為2歲，小于3歲患兒為158（58%）。HFMD合并腦炎的季節(jié)為4-12月，高峰期7月份有72（26.5%）例患兒住院，8月58（26.5%）例，6月51例（18.8%）。入院前HFMD病程為1-7天，平均3.2天。HFMD發(fā)病至并發(fā)腦炎的時間為2小時-5天，平均1.5天。住院時間4-32天，平均9.8天。入院時體溫最高達41℃，平均38.5℃，發(fā)熱持續(xù)時間3.4天。HFMD合并腦炎的神經(jīng)系統(tǒng)表現(xiàn)為肌陣攣122例，震顫88例，共濟失調(diào)96例，頭痛71例，嘔吐92例，精神萎靡166例。30%患兒血白細胞增高，54%LDH升高。224例患兒腦脊液檢查顯示88%白細胞升高，高達870×106/L，54%蛋白質(zhì)升高，最高達1200mg/L。用RT-PCR法檢測糞便EV71核酸陽性155（57%）例。腦電圖異常10例，表現(xiàn)為慢波、尖波或尖慢波。心電圖異常2例。1例室性早搏，1例房室傳導(dǎo)阻滯。頭顱CT示鼻竇炎5例。腦干腦炎244（90%）例，腦炎和/或腦膜腦炎23(8.5%)例，腦脊髓炎4例。32例重患轉(zhuǎn)入ICU治療。Ⅰ、Ⅱ、Ⅲ級腦干腦炎分別為235例、4例及5例。其中5例Ⅲ級腦干腦炎患兒，3例死亡，1例恢復(fù)，1例有神經(jīng)后遺癥。3例死亡患者均為EV71感染�；謴�(fù)期腦炎反復(fù)6例。男孩4例，小于3歲3例，平均腦炎反復(fù)時間為病程17天，2例復(fù)查腰穿提示白細胞增多，恢復(fù)期腦炎癥狀與首次癥狀相似。合并肺炎6例及支氣管炎3例。 結(jié)論：HFMD合并腦炎男孩易感，大連地區(qū)發(fā)病季節(jié)為春夏季，尤以夏季多發(fā)，高峰期為7月。發(fā)病年齡以小于3歲多見，；腦炎常累及腦干。血白細胞、LDH腦脊液白細胞及蛋白質(zhì)可升高。大部分患者經(jīng)治療痊愈。部分患兒病情發(fā)展快，在診斷重癥病例3天內(nèi)可死亡。腦干腦炎III級預(yù)后差、死亡率高或致殘。部分患兒在病程2周左右恢復(fù)期腦炎反復(fù)。除神經(jīng)受累外可累及多臟器（心、干、及肺）。HFMD合并腦炎的主要病原為EV71。EV71是HFMD合并腦炎、神經(jīng)后遺癥及致死的病例增多的主要原因。
[Abstract]:Background: Hand foot and mouth disease (HFMD) is a common infectious disease of children. Light symptoms are hand and foot and oral herpes. However, severe patients are accompanied by nervous system complications (such as aseptic meningitis, acute flaccid paralysis and encephalitis), or with systemic diseases (such as shock, cardiac dysfunction, and pulmonary edema). The pathogen of.HFMD is the enterovirus (enterovirus of the parvovirus family), such as Coxsackie A16 (Coxsackie A16virus, CAV-16) and enterovirus 71 (Enterovirus71, EV71), which are transmitted through the mouth, close contact and respiratory droplet for.1969 years. EV71 is found in California for the first time, and its genotype is BrCr, and the acute infection is EV71. Children less than 3 years of age are prone to severe complications such as meningitis, brainstem encephalitis, common encephalitis, acute flaccid paralysis and encephalomyelitis, and can be deformity or death. In recent ten years, the prevalence of EV71HMFD in China and other Asian countries has led to tens of thousands of infections and many children died. Since 1995, the mainland of China There has been a spread in the area, but the rapid death of HFMD in Fuyang, Anhui, in 2008, is unprecedented. This paper analyses the clinical features of 271 children with encephalitis during the HFMD epidemic in Dalian in 2010.
Materials and methods: in 593 cases of hospitalized patients in Dalian children's Hospital of Dalian in January 2010, 271 cases were combined with encephalitis according to 271 cases of encephalitis. The diagnostic standard was issued by the Ministry of health. According to the clinical characteristics, the brain stem encephalitis was graded (I, II, III). The age was -13 years in January. In 2010, the children's hospital with HFMD combined with encephalitis was collected and analyzed. Clinical data of 271 cases of hospitalized children.
Results: there were 593 cases of hospitalized children in HFMD and 271 cases of encephalitis, including 181 males and 90 females. The ratio of male and female to 2:1. age was 1 months -13 years, the median was 2 years, the season of 158 (58%).HFMD with encephalitis was 4-12 months, 72 (26.5%) children were hospitalized in the peak period in July, August 58 (26.5%) cases, June cases. -7 days, an average of 3.2 days of.HFMD onset to encephalitis was 2 hours -5 days, an average of 1.5 days. The time of hospitalization was 4-32 days, an average of 9.8 days. The body temperature was up to 41, average 38.5, and 3.4 days of fever lasting for encephalitis with 122 cases of myoclonus, 88 cases of tremor, 96 cases of ataxia, 71 cases of headache, 92 cases of vomiting, and essence. The blood leucocyte increased in 166 children with.30%. The cerebrospinal fluid examination showed that 88% white blood cells were elevated in.224 cases, up to 870 x 106/L, 54% protein increased, and 155 (57%) cases of EV71 nucleic acid positive in feces were detected by 1200mg/L.. 10 cases of abnormal electroencephalogram were shown as slow wave, sharp or sharp slow wave. 2 cases of electrocardiogram were abnormal.1 case room. 1 cases of atrioventricular block, 1 cases of atrioventricular block, 5 cases of cranial CT sinusitis, 244 (90%) cases of brainstem encephalitis, 23 (8.5%) cases of encephalitis and / or meningoencephalitis, 4 cases of encephalomyelitis in.32, 235 cases, 4 and 5 cases respectively, of which 5 cases of grade III brainstem encephalitis, 3 death, 1 cases, and neurological sequelae,.3 All the patients were infected with EV71. Recurrent encephalitis was repeated in 6 cases. 4 cases in boys, less than 3 years old and 3 cases, the average time of encephalitis was 17 days, 2 cases were rechecked the increase of leukocyte, the symptoms of encephalitis were similar to that of the first symptom. 6 cases of pneumonia and 3 cases of bronchitis were combined.
Conclusion: HFMD combined with encephalitis is easy to feel in boys. The onset season in Dalian is spring and summer, especially in summer. The peak period is July. The onset age is less than 3 years old. Encephalitis often involves brain stem. Blood leukocytes, LDH cerebrospinal fluid leucocyte and protein can be elevated. Most patients are cured by treatment. Some children develop quickly in diagnosis of severe disease. Patients with brain stem encephalitis have poor prognosis in 3 days. The prognosis of brain stem encephalitis III is poor, mortality is high or disability. Some children have recurrent encephalitis in the recovery period of about 2 weeks. The main cause of.HFMD combined encephalitis except for nerve involvement (heart, stem, and lung) is EV71.EV71, the main cause of the increase of HFMD with encephalitis, neurosequelae and fatal cases.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R725.1

【參考文獻】

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1 劉曉軍;李偉;張玉琴;劉亞敏;劉麗珍;;腸道病毒71型感染致重癥腦干腦炎的臨床特征和治療[J];中國當(dāng)代兒科雜志;2009年12期

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