人类疱疹病毒6型感染所致儿童急性坏死性脑病一例  

Acute necrotizing encephalopathy in a child caused by human herpesvirus-6 infection

作　　者：唐志慧 梅道启 王媛[1] 陈国洪 马燕丽 陈晓轶 梅世月 张耀东 王潇娜 董世杰 Tang Zhihui;Mei Daoqi;Wang Yuan;Chen Guohong;Ma Yanli;Chen Xiaoyi;Mei Shiyue;Zhang Yaodong;Wang Xiaona;Dong Shijie(Department of Neurology,Children′s Hospital Affiliated to Zhengzhou University,Henan Children′s Hospital,Zhengzhou Children′s Hospital,Zhengzhou 450018,China;Henan Provincial Key Laboratory of Children's Genetics and Metabolic Diseases,Henan Engineering Research Center of Childhood Neurodevelopment,Zhengzhou 450018,China;Department of Imaging,Children′s Hospital Affiliated to Zhengzhou University,Henan Children′s Hospital,Zhengzhou Children′s Hospital,Zhengzhou 450018,China)

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院,郑州儿童医院东区神经内科450018 [2]河南省儿童遗传代谢性疾病重点实验室,河南省儿童神经发育工程研究中心,郑州450018 [3]郑州大学附属儿童医院,河南省儿童医院,郑州儿童医院东区影像科,450018

出　　处：《中华神经科杂志》2021年第1期34-39,共6页Chinese Journal of Neurology

基　　金：国家自然科学基金(81701125);河南省科技攻关项目(2018020633,2018020603,2018020616);河南省高等学校重点科研项目计划(18A310029)。

摘　　要：目的探讨1例人类疱疹病毒6型(HHV-6)感染所致儿童急性坏死性脑病(ANE)的临床及影像学特点。方法回顾性分析郑州大学附属儿童医院于2019年3月确诊的1例HHV-6感染所致的ANE患儿,总结临床表现及其影像学特征。结果患儿1岁7个月,感染发热后出现急性脑病,有反复惊厥、意识障碍,血清转氨酶升高,脑脊液细胞数正常,蛋白升高。脑脊液PMseq病原微生物高通量基因检测示人类β疱疹病毒6B型。头颅磁共振成像示双侧丘脑、脑干、小脑等处多发斑片状异常信号,应用激素及丙种球蛋白抗炎、血浆置换、控制惊厥对症治疗后好转。结论ANE是一种罕见的急性、暴发性重症脑病,其特征性影像学改变为对称性多灶性脑损害、双侧丘脑受累为主,对于病毒感染后出现频繁惊厥、意识障碍的婴幼儿应警惕ANE的可能。Objective To analyze the clinical and imaging characteristics of acute necrotic encephalopathy(ANE)in a child with human herpesvirus-6(HHV-6)infection.Methods Retrospective analysis was performed on the clinical data and imaging features of a case of HHV-6 related ANE from Children′s Hospital Affiliated to Zhengzhou University in March 2019.Results The one year and seven month-old child had acute encephalopathy,recurrent convulsions,consciousness disorders,elevated serum transaminase.The number of cerebrospinal fluid(CSF)cells was normal and the protein increased.High throughput gene testing of CSF showed HHV-6.Cranial magnetic resonance imaging showed multiple symmetry damage in the bilateral thalamus,brainstem,and cerebellum.The symptoms improved after the treatment of glucocorticoids,intravenous immunoglobulin,and plasmapheresis.Conclusions ANE is a rare severe encephalopathy,the characteristic imaging change of which is symmetry multifocal cerebral damage,especially in the bilateral thalamus.ANE should be considered for patients with frequent convulsions and disturbance of consciousness after virus infection.

关 键 词：疱疹病毒6型 人 丘脑 急性坏死性脑病 儿童 高通量基因测序 

分 类 号：R725.1[医药卫生—儿科] R748[医药卫生—临床医学]