儿童伴胼胝体压部可逆性病变的轻微脑炎或脑病临床特征研究  

Clinical features of clinically mild encephalitis/encephalopathy with a reversible splenial lesion of corpus callosum in children

作　　者：高阳[1,2] 邹丽萍[1] 王建军[3] 王建文[1] 仇佳晶[1] 申文雯[1] 

机构地区：[1]中国人民解放军总医院儿童医学中心,北京100853 [2]川北医学院儿内科,四川南充637000 [3]川北医学院附属医院,四川南充637000

出　　处：《中国实用儿科杂志》2016年第1期56-59,共4页Chinese Journal of Practical Pediatrics

摘　　要：目的比较中国儿童伴胼胝体压部可逆性病变的轻微脑炎或脑病(MERS)的病因、临床特征,以及与日本、美国、比利时儿童MERS的异同点。方法对2013年1月至2014年12月中国人民解放军总医院儿童医学中心收治的2例儿童MERS临床特征及影像学特点进行总结;同时以2000年1月至2015年2月为限,通过检索中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、Pubmed及Web of science数据库,对检索到的儿童MERS临床资料进行对比分析。结果共纳入儿童病例115例,男女比例1.1∶1,发病年龄为6个月至14岁;多发生于感染性疾病过程中,58.3%的患儿感染病原体明确,其中以流感病毒、轮状病毒感染多见,其次为细菌感染及肺炎支原体感染;神经系统症状可表现为精神行为错乱(42.6%)、抽搐发作(37.4%)、意识下降(5.2%)或意识障碍(25.2%)、构音障碍(6.9%)等;实验室检查缺乏特异性,影像学显示为孤立性胼胝体压部或累及整个胼胝体及对称性周围白质病变;经抗感染及对症支持治疗后,症状消失,随访磁共振成像(MRI)病灶可完全消失,无任何严重神经系统后遗症。结论感染成为儿童MERS最常见的诱因,临床表现为脑炎或脑病症状,头颅MRI发现以胼胝体压部为主的可逆性病变有提示作用,无须特殊治疗,短期内可自行恢复,预后较好。Objective To compare the etiology and clinical characteristics of clinically mild encephalitis/encephalopathy with a reversible splenial lesion of corpus callosum in Chinese children with those cases from different countries. Methods The clinical and imaging features of two children with the diagnosis of MERS were analyzed and pediatric MERS cases were screened from ＂China National Knowledge Infrastructure＂, ＂China Biology Medicine＂, ＂PubMed ＂ and ＂Web of Science＂ databases for analysis between January,2000 and February,2015. Results A total of 115 cases were collected and the male to female ratio was 1.1 to 1, with onset age of 6 months to 14 years old. There was usually a certain infection before the onset. About 58.3% of infectious pathogens were detected, and influenza virus and rotavirus infection were very common pathogens, followed by bacterial infections and mycoplasma pneumoniae infection. The neurological symptoms manifested as mental and behavioral disorders （42.6%）, seizures （37.4%）, decreased consciousness （5.2%） or consciousness （25.2%） and dysarthria （6.9%）. The MR imaging （MRI） findings exhibited lesions in an isolated splenial or the white matter and entire corpus callosum, and completely disappeared at follow-up MRI. With anti-infection and symptomatic treatments, the clinical symptoms of most patients were relieved without leaving any serious neurological sequelae. Conclusion Infection is a prevalent predisposing factor of MERS in children, with nonspecific clinical characteristics. The MRI examination plays a role of implication for diagnosis. And all clinical symptoms of patients will disappear within a few days and the prognosis of patients is good.

关 键 词：儿童 伴胼胝体压部可逆性病变的轻微脑炎或脑病 

分 类 号：R72[医药卫生—儿科]