儿童急性播散性脑脊髓炎的临床特征及预后分析  

Clinical characteristics and prognosis of acute disseminated encephalomyelitis in children

作　　者：乔平云 殷小静[1] 徐凯丽 王莉[1] Qiao Pingyun;Yin Xiaojing;Xu Kaili;Wang Li(Children’s Hospital Affiliated to Zhengzhou University,Henan Provincial Children’s Hospital,Zhengzhou Children’s Hospital,Zhengzhou 450000,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,450000

出　　处：《中国实用医刊》2022年第2期32-34,共3页Chinese Journal of Practical Medicine

摘　　要：目的:分析儿童急性播散性脑脊髓炎(ADEM)的临床特征及预后。方法:回顾性分析2016年1月至2021年6月郑州儿童医院收治的23例ADEM患儿的临床特征、辅助检查结果、治疗方案和预后情况。结果:23例ADEM患儿主要临床症状为发热、意识障碍、惊厥、头痛、肢体活动障碍、共济失调、吞咽困难、外斜视、语言障碍、视物不清等,患儿神经系统主要体征为病理反射阳性、颅神经损伤、肌力下降、踝阵挛、脑膜刺激征等。实验室检查见髓鞘少突胶质细胞糖蛋白(MOG)抗体阳性9例(39.13%)。23例患儿MRI均显示有异常,病灶主要分布于脑白质,也有部分患儿累及深灰质。19例患儿采用免疫球蛋白和糖皮质激素进行联合治疗,4例患儿仅接受糖皮质激素治疗。6例患儿达到临床治愈标准,13例明显好转,1例重症患儿因呼吸衰竭死亡,3例治疗后留下后遗症。结论:儿童ADEM尚无统一的诊断标准,MOG抗体检测和影像学检查是重要的诊断依据,结合患儿临床症状和体征,可提高诊断率。对于儿童ADEM,临床医生应做到早诊断、早治疗,以便改善预后。Objective To analyze the clinical features and prognosis of acute disseminated encephalomyelitis(ADEM)in children.Methods The clinical features,auxiliary examination results,treatment plans and prognosis of 23 children with ADEM treated in Zhengzhou Children’s Hospital from January 2016 to June 2021 were analyzed retrospectively.Results The main clinical symptoms of 23 ADEM children were fever,convulsion,limb movement disorder,headache,dizziness,lethargy,convulsion,disturbance of consciousness,ataxia,fatigue and dysphagia,the main signs of nervous system in children were muscle decline,cranial nerve injury,positive pathological reflex,hyperreflexia,decreased muscle strength,ankle clonus,meningeal irritation,etc.Nine cases(39.13%)were positive for myelin oligodendrocyte glycoprotein(MOG)antibody of laboratory.MRI findings of 23 children showed abnormalities.The lesions were mainly distributed in white matter layer of brain,and some children involved deep gray matter.Nineteen cases were treated with immunoglobulin and glucocorticoid,and 4 cases were only treated with glucocorticod.Six cases reached the clinical cure standard,and 13 cases improved obviously,one severe child died of respiratory failure,and 3 cases had sequela after treatment.Conclusions There is no unified diagnostic standard for ADEM in children,and MOG antibody detection and imaging examination are important diagnostic basis.Combined with clinical symptoms and signs of children,the diagnostic rate can be improved.For children with ADEM,clinicians should make early diagnosis and early treatment in order to improve the prognosis of children.

关 键 词：儿童 急性播散性脑脊髓炎 髓鞘少突胶质细胞糖蛋白 

分 类 号：R741[医药卫生—神经病学与精神病学]