新生儿单纯疱疹病毒性脑炎临床特征和预后分析  

Clinical features and prognosis of neonatal herpes simplex encephalitis

作　　者：马叶 彭小明[1] 张榕[1] 贺芬萍[1] Ma Ye;Peng Xiaoming;Zhang Rong;He Fenping(Department of Neonatology,Hunan Children′s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院新生儿科,长沙410007

出　　处：《中华新生儿科杂志（中英文）》2020年第5期331-335,共5页Chinese Journal of Neonatology

基　　金：科技厅临床医疗技术创新引导计划(2018SK50405)。

摘　　要：目的探讨新生儿单纯疱疹病毒性脑炎(neonatal herpes simplex encephalitis,NHSE)的临床特征及预后。方法选择2015年1月至2019年6月湖南省儿童医院新生儿科收治的NHSE患儿进行回顾性研究,根据患儿预后分为预后好组和预后差组,分析患儿临床特点及预后不良影响因素。结果共纳入13例NHSE患儿,失访2例,预后好组3例,预后差组8例。13例患儿中,惊厥9例,发热8例,有呼吸系统症状6例,皮肤疱疹3例;脑脊液白细胞>20×106/L 7例,单核细胞占比70%~90%;脑脊液单纯疱疹病毒(herpes simplex virus,HSV)DNA均阳性,其中6例HSV1型,7例HSV2型。颅脑彩超提示脑室周围白质回声增强(periventricular echoenhance,PVE)Ⅰ°4例,PVEⅡ°3例,PVEⅢ°6例;振幅整合脑电图(amplitude-integrated electroencephalography,aEEG)正常5例,轻度异常1例,重度异常7例;根据头颅MRI定性损伤量表进行分级,1级2例,2级2例,3级1例,4级8例。两组患儿颅脑彩超(P=0.035)、aEEG(P=0.014)、头颅MRI(P=0.004)结果比较差异有统计学意义;抽搐、发热、呼吸困难、疱疹发生率、脑脊液检查结果比较差异均无统计学意义(P>0.05)。结论NHSE临床表现不典型,惊厥、发热多见;可结合临床症状、脑脊液HSV-DNA、颅脑彩超、aEEG和头颅MRI对NHSE进行诊断和预后评估。Objective To study the clinical features and prognosis of neonatal herpes simplex encephalitis(NHSE).Method From January 2015 to June 2019,data from infants diagnosed with NHSE and admitted to the neonatal ward of our hospital were retrospectively reviewed.According to their outcomes,the infants were assigned into good or poor outcome group.The clinical characteristics were compared between the two groups and the factors for poor outcome group were analyzed.Result A total of 13 infants diagnosed with NHSE were included in our study.2 cases were lost during follow-up and excluded.3 cases were in the good outcome group and 8 cases in the poor outcome group.Among the 13 cases,9 had convulsions,8 had fever,6 had respiratory symptoms and 3 had skin herpes.In cerebrospinal fluid(CSF)examination,7 cases had>20×106/L leukocytes and monocytes accounted for 70%~90%.All cases had positive HSV-DNA in the CSF,including 6 cases of HSV1 and 7 cases of HSV2.Cranial ultrasound showed 4 cases of periventricular echo enhancement(PVE)Ⅰ°,3 cases of PVEⅡ°and 6 cases of PVEⅢ°.For amplitude-integrated electroencephalography(aEEG),5 cases were normal,1 case mildly abnormal and 7 cases severely abnormal.According to brain MRI qualitative injury scale,2 cases were grade 1,2 cases were grade 2,1 case was grade 3 and 8 cases were grade 4.Statistically significant differences existed between the two groups in cranial ultrasound(P=0.035),aEEG(P=0.014)and cranial MRI(P=0.004).No differences between the two groups in the incidences of convulsions,fever,dyspnea,HSV type and CSF test results.Conclusion The clinical manifestations of NHSE are atypical.Convulsion and fever are common.The diagnosis and prognostic evaluation of NHSE can be made according to the clinical features,CSF HSV-DNA,cranial ultrasound,aEEG and brain MRI.

关 键 词：脑炎 单纯疱疹病毒 婴儿 新生 临床特征 预后 

分 类 号：R722.13[医药卫生—儿科]