手足口病合并急性弛缓性瘫痪15例临床分析  

Clinical study of 15 children with hand foot and month disease and acute flaccid paralysis

作　　者：王玉光[1] 张璐[1] 卢联合[1] 冯亮[1] 王凌航[1] 徐艳利[1] 任娜[1] 庞琳[1] 李兴旺[1] 陈志海[1] 

机构地区：[1]北京地坛医院感染中心,北京100015

出　　处：《中华急诊医学杂志》2009年第7期723-727,共5页Chinese Journal of Emergency Medicine

基　　金：首都医学发展基金资助项目（2005-1011）

摘　　要：目的探讨北京地坛医院2008年收治的15例手足口病合并急性弛缓性瘫痪（AFP）患儿的临床特征及预后。方法对15例手足口病合并AFP患儿的流行病学、临床表现、脑脊液、磁共振影像（MRI）及预后进行回顾性分析，并对患儿瘫痪肢体功能恢复情况进行了4周的随访。结果本组病例的年龄为5-72（22．47±20．68）个月，患儿在发热后的（3．47±1．68）d出现急性弛缓性瘫痪表现，在1～2d内发展至高峰。所有患儿均出现类脊髓灰质炎表现。15例患儿中，10例为单下肢瘫痪，2例为双下肢瘫痪，1例为单上肢，2例四肢瘫痪。肌力从0～4级不等，6例患儿肢体肌力降至0级。13／15例有脑炎、脑膜炎、共济失调等表现。3例患儿出现一过性尿潴留。8例患儿行脑脊髓MRI检查，结果显示8例患儿脊髓前角出现T2WI高信号改变，上肢瘫痪者病变在脊髓颈2～7（C2～C7），下肢瘫痪者病变在脊髓胸12～腰1（T12-L1），均表现为患侧脊髓前角长T1长T2信号。其中4例合并脑炎表现患者，MRI检查见中脑、桥脑或延髓长T1长T2信号。11例下肢瘫痪患儿在AFP发生的第4～8天开始恢复，其他4例在第2～3周开始恢复。瘫痪恢复顺序为由远端向近端恢复。结论手足口病合并AFP多发生于2岁以下患儿；瘫痪发生在手足口病初期，1～2d发展至高峰。多数患儿以单侧下肢瘫痪轻瘫为主，恢复较快，四肢瘫痪及单上肢瘫痪者恢复缓慢。MRI检查灵敏、准确，对确诊及预后判断有重要价值。Objective To discuss the clinical characteristics and prognosis of 15 children with hand foot and mouth disease （HFMD） and acute flaccid paralysis （AFP） who were adinitted to Beijing Ditan Hospital during the outbreak of HFMD in 2008. Method The epidemiology, clinical manifestations, cerebmspinal fluid （CSF）, magnetic resonance imaging and prognosis of 15 children with HFMD and AFP were retrospectively reviewed. The recovery of the patients＇ affected extremities were monitored for 4 weeks. Results The mean age of these patients was （22.47± 20,68） months （range： 5- 72 months）. Acute paralysis developed （3.47± 1.68） days after the onset of fever and progressed to maximum severity within （ 1 - 2） days. Poliomyelitis-like syndrome was observed in all cases. Of the 15 eases, 10 had monoplegia of lower limbs, two had paraplegia, one had monoplegia of upper limbs and two had quadriplegia. In these cases, the muscle power varied from level 0 to level 4, and six even showed no muscle power in their affected extremities. Thirteen cases developed neurologic complications （encephalitis, meningitis or ataxia） and three had transient urinary retention. Cerebrospinal MRI examination in eight cases showed hyperintense lesions on T2-weighted images, predominantly in the impaired anterior horn regions of the spinal cord （C2 - C7 for cases with upper extremity impairments and T12 - L1 for cases with lower extremity impairments）, and displayed long T1 signals and long T2 signals. In addition, the midbrain, brain-stem or medulla was also involved in four cases who also contracted encephalitis or meningitis. The muscle strength in 11 patients with single lower extremity impairment showed improvements in the distal limb muscles within 4 - 8 days, and the other cases showed recovery 2 - 3 weeks later. Conclusions HFMD in combination with AFP most commonly occurs in children aged less than 2 years old. Acute paralysis develops during the early stage of infection and progresses to a maximum severi

关 键 词：急性弛缓性瘫痪 手足口病 脑脊髓炎 非脊髓灰质炎肠道病毒 肠道病毒71型 

分 类 号：R725.1[医药卫生—儿科]