流感病毒引起儿童急性坏死性脑病13例临床分析  

Clinical Analysis of 13 Children with Acute Necrotizing Encephalopathy Caused by Influenza Virus

作　　者：张霞 段丽芬[1] 王惠萍[1] 李亚玲[1] 孙莹[1] ZHANG Xia;DUAN Lifen;WANG Huiping;LI Yaling;SUN Ying(Kunming Children's Hospital,Kunming Medical University Affiliated Children's Hospital,Kunming 650228,China)

机构地区：[1]昆明市儿童医院/昆明医科大学附属儿童医院,云南昆明650228

出　　处：《中国医药指南》2023年第5期81-83,共3页Guide of China Medicine

基　　金：昆明市卫生健康委员会卫生科研课题(2019-06-01-006);昆明市卫生健康委员会卫生科研课题(2022-06-01-006);云南省科技人才和平台计划(院士专家工作站)(20191C050)。

摘　　要：目的 分析我院接诊的13例流感病毒引起儿童急性坏死性脑病的临床特点。方法 回顾昆明市儿童医院2018年1月至2020年4月患儿因流感引起的急性坏死性脑病13例,对患儿临床表现、实验室影像学检查、治疗及预后进行统计分析。结果 13例患儿平均年龄(3.4±1.6)岁,男7例,女6例。临床表现早期以发热和抽搐为主,迅速发展为意识障碍。血常规中白细胞可升高、降低,血小板降低,血红蛋白未见降低,血生化中肝功能异常最显著,表现为丙氨酸转氨酶和天冬氨酸转氨酶升高,白蛋白降低,但未见血氨升高。本组患儿中以儿为甲型流感病毒H1-2009型和H3型感染为主。脑电图检查中主要表现为背景节律减慢,神经影像学检查中对称性多灶性脑损害。治疗上予抗病毒、降低颅内压、镇静、调节免疫为主,8例(61.5%)患儿进行了1~3次血浆置换,9例(69.2%)患儿进行了无创呼吸机辅助通气,2例(15.4%)使用了有创呼吸机。最后1例(7.7%)患儿痊愈,4例(30.8%)重症患儿死亡,其余8例(61.5%)患儿均出现不同程度的神经功能损伤。结论 急性坏死性脑病是一种以双侧丘脑病变为特征的罕见急性脑病,可继发于流感病毒,其临床表现多样及迅速,可引起多脏器损害,其预后较差,病死率高,而幸存者常有神经系统后遗症。Objective To analyze the clinical characteristics of 13 children with acute necrotizing encephalopathy caused by influenza virus in our hospital. Methods A total of 13 children with acute necrotizing encephalopathy caused by influenza from January 2018 to April 2020 in Kunming Children’s Hospital was reviewed. The clinical manifestations, laboratory imaging examinations, treatment and prognosis of the children were analyzed and statistics. Results The average age of 13 children was(3.4±1.6) years, 7 males and 6 females. The early clinical manifestations are mainly fever and convulsions, which rapidly develops into disturbance of consciousness. In the blood routine, white blood cells can be increased or decreased,platelets decreased, hemoglobin was not decreased, and liver function abnormalities in blood biochemistry were the most significant, manifested by increased alanine aminotransferase and aspartate aminotransferase, decreased albumin, but blood Ammonia does not rise. Among the children in this group, children were mainly infected with influenza A virus H1-2009 and H3. The main manifestations in the EEG examination are the slowing of the background rhythm and the symmetrical multifocal brain damage in the neuroimaging examination. In treatment, antiviral, reduction of intracranial pressure, sedation and immune regulation were the main methods. 8 cases(61.5%) received 1-3 plasma exchanges, and 9 cases(69.2%) received noninvasive ventilator assisted ventilation. Two cases(15.4%) used invasive ventilator. At last, 1 case(7.7%) was cured, 4 cases(30.8%) of severely ill children died, and the remaining 8 cases(61.5%) had neurological damage to varying degrees. Conclusion Acute necrotizing encephalopathy is a rare acute encephalopathy characterized by bilateral thalamic lesions. It can be secondary to influenza virus. Its clinical manifestations are diverse and rapid, which can cause multiple organ damage. Its prognosis is poor and the mortality rate is high. The survivors often have neurological sequelae.

关 键 词：急性坏死性脑病 流感病毒 儿童 临床表现 预后 

分 类 号：R742[医药卫生—神经病学与精神病学]