感染人类疱疹病毒6B型引发心包炎合并暴发性糖尿病1例报告  

A case of pericarditis caused by HHV-6B complicated with fulminant diabetes mellitus

作　　者：丁洁 金丹群 许愿愿 DING Jie;JIN Danqun;XU Yuanyuan(Department of Critical Care Medicine,Anhui Children's Hospital,Hefei,Anhui 230022,China)

机构地区：[1]安徽省儿童医院重症医学科,安徽合肥230022

出　　处：《中国热带医学》2024年第7期880-884,892,共6页China Tropical Medicine

基　　金：安徽省重点研究与开发计划项目(No.201904a07020101);安徽省卫生健康科研项目(No.AHWJ2023A20507)。

摘　　要：人类疱疹病毒6B型(human herpes virus 6B,HHV-6B)感染是在免疫功能正常儿童中引起的原发感染,主要症状为幼儿急疹,多为高热3~5 d后体温突然降低,随后出现皮疹,一般病情较轻、呈自限性。2021年11月7日安徽省儿童医院儿童重症监护室(pediatric intensive care unit,PICU)收治了1例1岁3个月感染HHV-6B的患儿。患儿临床表现以心包积液、休克,高血糖症状为主,采集心包积液、血液样本进行病原体高通量测序显示为HHV-6B感染,同时糖尿病相关抗体、全基因组、全外显染色体、线粒体等基因检测结果正常。经过抽取心包积液解除梗阻以改善心功能、液体复苏、血管活性药物、连续肾脏替代治疗(continuous renal replacement therapy,CRRT)、阿昔洛韦抗病毒、胰岛素控制血糖等治疗后,患儿康复出院,内分泌科每3~5个月随访患儿,调整胰岛素用量控制血糖。总结临床资料并结合文献复习,HHV-6B可直接侵犯并参与免疫紊乱引起的免疫损伤,可能对感染HHV-6B免疫功能正常的儿童造成严重后果。Human herpes virus 6B(HHV-6B)is primarily known for causing primary infections in immunocompetent children,usually presenting as infantile rash.The main symptoms include a high fever lasting 3-5 days followed by a sudden drop in temperature and the emergence of a rash.Generally,the disease is mild and self-limiting.On November 7,2021,the Pediatric Intensive Care Unit(PICU)of Anhui Children′s Hospital admitted a 1-year-3-month-old child infected with HHV-6B.The clinical manifestations of the child mainly included pericardial effusion,shock,and hyperglycemia.Pathogen highthroughput sequencing on pericardial effusion and blood samples confirmed HHV-6B infection,while diabetes-related antibodies,whole genome sequencing,whole exome sequencing,chromosome analysis,and mitochondrial gene testing all yielded normal results.After comprehensive treatment including extraction of pericardial effusion to relieve obstruction for improved cardiac function,fluid resuscitation,vasoactive drugs administration,continuous renal replacement therapy(CRRT),acyclovir antiviral therapy,and insulin control for blood sugar management;the child eventually recovered and was discharged from hospital.Regular follow-ups at the endocrinology department are scheduled every 3-5 months to adjust insulin levels for blood glucose control.According to clinical data and literature review findings indicate that HHV-6B can invade directly and cause immune damage through immune dysregulation,potentially leading to severe outcomes in immunocompetent children.

关 键 词：人类疱疹病毒6B型 心包炎 暴发性糖尿病 幼儿 

分 类 号：R720.597[医药卫生—急诊医学]