大剂量糖皮质激素在儿童急性坏死性脑病中的应用  

High-dose glucocorticoid therapy for pediatric acute necrotizing encephalopathy

作　　者：李科纯 钱素云[1] 樊超男[1] Li Kechun;Qian Suyun;Fan Chaonan(Pediatric Intensive Care Unit,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院重症医学科,100045

出　　处：《中国小儿急救医学》2025年第2期90-93,共4页Chinese Pediatric Emergency Medicine

基　　金：北京市科技新星计划交叉项目(20240484656);北京市研究型病房示范建设项目(BCRW202101)。

摘　　要：急性坏死性脑病(ANE)是一种罕见的感染诱发神经系统疾病,主要影响5岁以下儿童,具有较高的病死率和致残率。早期静脉注射大剂量糖皮质激素被公认为是实现最佳疗效的关键,但缺乏标准化给药方案,其最佳剂量、给药时机等有待进一步验证。此外,激素联合静脉注射免疫球蛋白、血液净化、托珠单抗和抗病毒等综合治疗可能改善ANE的治疗效果,降低神经系统后遗症的发生率及病死率。本文总结近年来大剂量糖皮质激素治疗ANE的应用现状,并分析不同种类、剂量糖皮质激素及不同给药时机的疗效差异,以期为未来优化治疗方案提供有价值的参考。Acute necrotizing encephalopathy(ANE)is a rare post-infectious neurological disease primarily affecting children under 5 years old,with a high mortality and disability rate.Early administration of high-dose glucocorticoids is widely recognized as crucial for optimal efficacy of treatment.However,standardized guidance is lacking,and the optimal dosage as well as timing for administration require validation in larger patient populations.Additionally,combination therapies involving intravenous immunoglobulin,plasmapheresis,tocilizumab,and antiviral treatments may enhance efficacy and reduce mortality rates and neurological sequelae.This review summarized the current application status of highdose glucocorticoid therapy for ANE in recent years and analyzed the differences in efficacy among different types and doses of glucocorticoids,as well as different timing of administration,with the aim of providing valuable references for optimizing treatment regimens in the future.

关 键 词：急性坏死性脑病 糖皮质激素 冲击治疗 预后 

分 类 号：R742[医药卫生—神经病学与精神病学]