儿童急性脊髓炎临床特征与早期激素治疗疗效分析  

Clinical characteristics and therapeutic efficacy of early steroids treatment in childhood acute myelitis

作　　者：陆燕芬[1] 陆勤[1] 黄建军[1] 陈丽琴[1] 

机构地区：[1]上海交通大学附属儿童医院神经内科,上海200040

出　　处：《临床儿科杂志》2007年第2期91-93,共3页Journal of Clinical Pediatrics

摘　　要：目的探讨小儿急性脊髓炎临床特点,激素及静脉丙种球蛋白治疗效果与预后。方法同顾性分析自1995年以来收住院的19例急性脊髓炎患儿的临床表现、实验室检查及治疗结果,在部分随访病例的基础上进行分析。结果19例患儿的主要临床表现为:89．47％有双下肢运动功能障碍;84．21％有括约肌功能障碍; 47．37％有感觉平面障碍;仅35．71％脑脊液检查白细胞增高(10～85)×106／L;75％脊髓影像学检查异常,病变部位以胸髓居多,占55．55％。全部病例均使用肾上腺皮质激素,疗程4-8周,9例同时应用静脉丙种球蛋白; 19例患儿治愈9例,好转6例,未愈4例。结论儿童急性脊髓炎早期激素合并丙种球蛋白治疗效果好,其预后取决于病变的范围和程度及有无并发症。Objectives To explore clinical characteristics of, therapeutic efficacy of steroids and intravenous gamma globulin on, and prognoses of childhood acute myelitis. Methods The clinical characteristics, laboratory examination and therapeutic efficacy of 19 children with acute myelitis were retrospectively analyzed. Results in 19 patients 17 （89.47 % ） presented with paralysis in two legs, 16/19 （84.21% ） with sphincter functional disturbance, 9/19 （47.37 %） with sensory defect, 15/19 （78.95 %） suffered from spinal shock in earlier course of the disease. Five （5） of 14 （35.71%） patients were found increased white blood cells （10 - 85） ×10^6/L in cerebral spinal fluids. Abnormal spinal MRI was observed in 75 % patients, of which more than half （55.55 %） of the injured part are in thorax-spinal areas. All of the 19 cases were treated with steroids for 4 - 8 weeks and 9 of them were also given gamma globulin intra-venously. Prognosis showed 9 cases cured, 6 cases improved and 4 cases failed. Conclusions The therapeutic efficacy of steroids combined with intra-venous gamma globulin in earlier period is good. The prognosis depends on the areas affected and degree of the lesion and complications.

关 键 词：脊髓炎 儿童 治疗 预后 

分 类 号：R744.3[医药卫生—神经病学与精神病学]