手足口病合并急性弛缓性瘫痪2年临床随访研究  

A Two-Year Follow-up Study of Hand-Foot-and-Mouth Disease Cases Complicated with Acute Flaccid Paralysis

作　　者：张璐[1] 王玉光[1] 王旭[2] 程华[3] 张伟[1] 倪量[1] 杨洪玲[1] 宋蕊[1] 顾燕[1] 李兴旺[1] 

机构地区：[1]首都医科大学附属北京地坛医院感染中心,北京市100015 [2]首都医科大学附属北京儿童医院神经内科与康复中心 [3]首都医科大学附属北京儿童医院放射科

出　　处：《中国全科医学》2011年第20期2260-2263,共4页Chinese General Practice

基　　金：北京市中医管理局手足口病合并中枢神经系统感染的中医药证治研究(JJT2010-18);国家科技部"十一五"传染病重大专项:流感新型疫苗及中和抗体等研究(200909ZX10004-016)

摘　　要：目的对2008年北京地坛医院收治的20例手足口病合并急性弛缓性瘫痪（AFP）患儿进行2年随访,观察AFP后遗症的特点、影像学表现及预后,探讨有效的康复方案。方法对20例〔男16例,女4例,平均年龄（23±18）个月,年龄中位数16个月〕手足口病合并AFP患儿在急性期进行神经专科查体、脑脊液检查、颅脑和脊髓MR I检查,并在2年内随访比较患儿瘫痪肢体的康复情况、颅脑和脊髓MR I变化,对患儿采取的康复措施进行回顾性调查分析。结果 20例患者中11例痊愈,9例遗留不同程度的AFP后遗症。在急性期,年龄在半岁以内、呈单侧下肢损害、肌力在Ⅲ级或以上、脊髓胸腰段病变长度在1~2个脊髓节段以内的患儿基本痊愈。AFP后遗症表现为不同程度的踝关节主动、协同背屈功能障碍,足下垂,髋关节内收受限;部分患者出现肌萎缩（以股四头肌萎缩为主）,个别出现胫前及胫后肌群萎缩,严重者出现膝关节反张。急性期颅脑MR I提示中脑、脑桥或延髓背侧长T1长T2信号区,2年随访时上述区域病变基本消失,仅T2W遗留小范围轻度异常信号。2年随访,脊髓MR I表现为颈2~7和（或）胸12~腰1的脊髓前角病变区面积变小,T2W I异常信号较前明显减弱。结论手足口病合并AFP患儿,半数可以康复,但部分患儿遗留不同程度AFP后遗症,其中急性期出现双侧下肢、上肢、四肢瘫痪的病例后遗症状重,可伴有肌萎缩、关节变形。急性期MR I对评估病情意义大,脊髓胸腰段病变在3个或3个以上者预后不良。在神经内科、康复科专家指导下进行早期康复治疗,可以最大限度减少AFP后遗症的发生。Objective To investigate the clinical characteristics,magnetic resonance imaging（MRI） manifestations,and prognosis in cases of sequela from HFMD（hand-foot-and-mouth disease） complicated with AFP（Acute Flaccid Paralysis） in seek of effective rehabilitation procedure.Methods Twenty patients（male：16,female：4;aged（22±18） months,median：16 months） underwent neurological examination,CSF（cerebrospinal fluid） examination,and MRI examination of both the brain and the spinal cord during the acute stage.Rehabilitation status of the limbs and MRI.changes in both the brain and the spinal cord were collected via follow-up within the next 2 years,with the rehabilitation measures reviewed retrospectively.Results Of the 20 patients,11（55%） recovered completely and 9（45%）were left with sequelae of different severity.Recoveries from acute stage are more to take place among those who were under the age of six months,who got impaired unilaterally,who showed a muscular tone of no less than 3 points in terms of grading,and who showed a lesion restricted to 1~2 segments of the spinal cord.Mostly the sequelae were represented by impaired dorsiflexion of talocrural joint,,slight deformity of the joint,and muscular atrophy in severe cases.MRI findings at follow-up revealed that lesions used to be found in the brain stem and/or in the anterior horn of spinal cord during the acute stage mostly turned to be unreadable.Conclusion Almost half of the patients can be left with AFP sequelae.MRI findings from the acute stage can be helpful in the prognosis prediction.Early rehabilitative treatment under the guidance of experts can minimize the risk of AFP sequelae.

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 

分 类 号：R512.57[医药卫生—内科学]