258例手足口病中枢神经系统并发症的临床特征及预后分析  

Analysis of clinical features and prognosis in 258 patients with CNSC of HFMD

作　　者：李建明[1] 刘映霞[1] 林益敏[1] 何颜霞[2] 陈莉[1] 袁静[1] 

机构地区：[1]深圳市第三人民医院,518112 [2]深圳市儿童医院

出　　处：《中华实验和临床病毒学杂志》2014年第4期241-244,共4页Chinese Journal of Experimental and Clinical Virology

基　　金：深圳市科技计划项目（CXB201104250061A）;深圳市新发传染病重点专科基金

摘　　要：目的 探讨手足口病中枢神经系统并发症的临床特征及预后.方法 回顾分析了2008-2012年258例有中枢神经系统并发症的手足口病住院患儿的临床特征,将可能影响预后的因素“Age、DOF、BG、SIC、NPE、LMSO”进行Logistic分析.结果 ①手足口病不同神经系统并发症在Age、DOF、LS、CRP、CFPro、CFWBC、EV71阳性率差异均无统计学意义;但脑干脑炎组有更高的PWBC、BG、CFP,且差异有统计学意义;②SIC、NPE在脑干脑炎组发生率最高,分别有52.63％、57.89％,而对于无菌性脑膜炎、急性弛缓性麻痹组则为零;③MRI检查对于无菌性脑膜炎阳性率低,仅5.91％;而对于脑炎、脑干脑炎、急性弛缓性麻痹阳性率较高,分别有81.81％、100％、100％;④对于无菌性脑膜炎、急性弛缓性麻痹EEG检查均正常,而对于脑炎、脑干脑炎EEG阳性率分别为80.00％、66.7％;⑤脑干脑炎死亡率（36.8.％）最高,其余三组均无死亡病例;其后遗症发生率（21.05％）也高于急性弛缓性麻痹组（15.38％）、脑炎组（4.5％）、无菌性脑膜炎组（0）.⑥影响手足口病中枢神经系统并发症预后的主要因素是NPE（OR为0.099,P=0.008）、LMSO和SIC,NPE具有最大相对危险度,Logistic线性预测因子Z=12.68-2.314（NPE）-3.089（LMSO）-3.491（SIC）,三者阳性（预后差）预告准确率达70.6％,阴性（预后好）预告准确率达97.5％.结论 患者一旦出现NPE、SIC、LMSO、脑干脑炎,早期采取积极干预措施,有助改善预后.Objective To investigate the clinical features and prognosis in the patients with central nervous system complications （CNSC） of hand,foot,and mouth disease （HFMD）.Methods The clinical data of 258 hospitalized children with CNSC of HFMD during 2008-2012 were reviewed.The possible factors of the prognosis were analyzed by the Logistic regression,which included age,duration of fever（DOF）,blood glucose （BG）,severe impaired consciousness （SIC）,neurogenic pulmonary edema （NPE） and limb muscle strength obstacles（LMSO）.Results ①There was no significant difference of Age,DOF,LS,CRP,CFPro,CFWBC or positive rate of EV71 among patients with different CNSC of HFMD.Peripheral blood WBC,BG and CFP of the brain stem encephalitis group were at levels higher than those of the other groups,and the significant differences were observed.② The incidences of SIC,NPE （respectively 52.63%,57.89%） in brain stem encephalitis group were detected to be the highest,but was zero for aseptic meningitis and acute flaccid paralysis.③ Positive rate of imaging MRI was low （only 5.91%） for aseptic meningitis,but was much higher for encephalitis,brainstem encephalitis and acute flaccid paralysis （81.81%,100% and 100% respectively）.④ EEG test results were normal for aseptic meningitis and acute flaccid paralysis,but positive rates of EEG were 80.00%,66.7% for encephalitis,brainstem encephalitis respectively.⑤ Rate of mortality was the highest （up to 36.8%） for brainstem encephalitis,but was zero for the other three groups.The incidence of sequelae for brainstem encephalitis （up to 21.05%） was higher than those for the other three groups,i.e.for acute flaccid paralysis （15.38%）,encephalitis （4.5%） and aseptic meningitis （0）.⑥ NPE,LMSO and SIC were the three significant high-risk factors for prognosis of neurological outcome in patients with CNSC of HFMD,and NPE was the most significant one of the three.（odds ratio 0.099,P =0.008）.The linear predictor in the model was Z =12.68-

关 键 词：手足口病 中枢神经系统/并发症 临床特征 预后 

分 类 号：R725.1[医药卫生—儿科]