儿童急性弛缓性脊髓炎4例临床特点分析  

Clinical characteristics analysis of 4 cases with acute flaccid myelitis in children

作　　者：葛绣山[1] 焦辉 陈倩[1] 张宝元[2] 赵林清[3] 朱汝南[3] 李淑品 马才惠 张媛媛 彭晓音[1] Ge Xiushan;Jiao Hui;Chen Qian;Zhang Baoyuan;Zhao Linqing;Zhu Runan;Li Shupin;Ma Caihui;Zhang Yuanyuan;Peng Xiaoyin(Department of Neurology,Children′s Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China;Department of Infection Management,Children′s Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China;Department of Virology,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院神经内科,北京100020 [2]首都儿科研究所附属儿童医院感染管理处,北京100020 [3]首都儿科研究所病毒学研究室,北京100020

出　　处：《中华儿科杂志》2024年第7期676-680,共5页Chinese Journal of Pediatrics

基　　金：首都卫生发展科研专项(首发2022-2G-2102)。

摘　　要：目的总结儿童急性弛缓性脊髓炎(AFM)的临床表现、诊治经验和预后。方法回顾性病例总结,对首都儿科研究所附属儿童医院神经内科2018年9月至2022年11月收治的4例临床诊断AFM患儿的病例资料进行临床特点分析。结果4例AFM患儿年龄分别为7岁、4岁3月龄、7岁1月龄、6岁5月龄,女2例、男2例。前驱呼吸道感染3例、消化道感染1例。以感染后出现不对称肢体无力为主要表现,受影响肢体范围从单一肢体到四肢。所有患儿均无脑病表现,1例患儿出现周围性面瘫。4例患儿脊髓磁共振成像均提示长节段长T1长T2信号,以灰质受累为主。2例患儿出现脑脊液细胞-蛋白分离现象。1例咽拭子病原体检出肠道病毒D68;1例患儿血液中腺病毒抗体IgM阳性;1例患儿血液中埃可病毒、柯萨奇B组病毒抗体IgG阳性。4例患儿经过糖皮质激素、人免疫球蛋白或单纯对症治疗,同时在后期康复训练下,肌力不同程度恢复,3例遗留有残疾。结论以感染后、急性、不对称肢体无力起病伴有磁共振成像脊髓中央区域异常信号的患儿需考虑AFM,目前有效治疗手段有限且预后不良。Objective To summarize the clinical manifestations,diagnosis,treatment and prognosis of acute flaccid myelitis(AFM)in children.Methods Clinical characteristics of 4 AFM cases from Department of Neurology,Children′s Hospital Affiliated to Capital Institute of Pediatrics,from September 2018 to November 2022,were analyzed retrospectively.Results The age of 4 children with AFM was 7 years,4 years and 3 months,7 years and 1 month,6 years and 5 months,respectively.There were 2 boys and 2 girls.Prodromal infection status showed 3 children of respiratory tract infection and 1 child of digestive tract infection.The main manifestation was asymmetrical limb weakness after infection,and the affected limb range was from monoplegia to quadriplegia.Cranial nerve injury was involved in 1 child,no encephalopathy.Magnetic resonance imaging in the spinal cord of all 4 children showed long T1 and T2 signals,mainly involving gray matter.Cerebrospinal fluid cell-protein separation was observed in 2 children.Pathogen detected in 1 child pharyngeal swab was enterovirus D68.Antibody IgM to adenovirus was positive in the blood of 1 child.Antibody IgG against Echo and Coxsackie B virus were positive in the blood of another child.After glucocorticoid,human immunoglobulin or simple symptomatic treatment and at the same time under later rehabilitation training,muscle strength recovered to different degrees,but there were disabilities left in 3 children.Conclusions AFM should be considered in children with acute and asymmetrical flaccid paralysis accompanied by abnormal magnetic resonance imaging signal in the central region of spinal cord,especially post-infection.The effective treatment is limited and the prognosis is poor.

关 键 词：儿童 急性弛缓性脊髓炎 急性弛缓性麻痹 肠道病毒 

分 类 号：R744.3[医药卫生—神经病学与精神病学]