儿童单纯疱疹病毒性脑炎41例临床特点及预后研究

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1、儿童单纯疱疹病毒性脑炎41例临床特点及预后研究【摘要】目的探讨儿童单纯疱疹病毒性脑炎(HSE)的临床特征、早期诊断的依据及影响预后的因素。方法回顾性分析41例单纯疱疹病毒性脑炎患儿的临床资料与随访结果。结果41例HSE病例发热41例(100%);惊厥29例(70.7%);头痛27例(65.8%);呕吐21例(51.2%);意识障碍25例(60.9%)，其中昏迷10例;精神异常15例(36.6%);运动失常12例(29.3%);幻视11例(26.8%)，合并脑神经症状12例(29.2%);头颅CT/MRI异常28例，病变主要累及颞叶和额叶，其中脑实质及蛛网膜下腔出血9例;脑电图

2、异常36例。转归：5例放弃，1例死亡，对32例进行1~3年随访：痊愈19例，轻度致残5例、中度致残3例、重度致残5例，合并癫痫7例。结论早期出现意识障碍及精神症状是单纯疱疹病毒性脑炎的临床表现特征，头颅CT不能作为早期诊断的依据，治疗时的病程、脑损害程度可影响预后。【关键词】单纯疱疹病毒Ⅰ型;脑炎;儿童　　[Abstract]ObjectiveHerpessimplexvirus(HSV)isanimportantetiologicagentofacutechildhoodencephalitis.Herpessimplexvirusencephalitis(HSE)hasa

3、highmortalityanddisableratio.Ifacyclovirisgivenearlier，theoutcomeofpatientswillbeimproved.Thisstudyaimedat11analyzingtheclinicalcharacteristicsandthebasisofearlydiagnoseofHSEinchildhoodanddiscussthefactorsinfluencingtheprognosis.Methods41inpatientswithHSEwereenrolledinthisstudy.Theagesrange

4、dfrom6monthsto14years，including23malesand18females.ThesecaseswerediagnosedashavingpositivespecificimmunoglobulinMantibodies(94%)ofherpessimplesvirustypes1(HSV-1)incerebrospinalfluid(CSF)and/oraminimum4-foldincreaseofanti-HSVantibodytiters(36%)inCSFattherecoveryphases.32caseswerefollowed-upf

5、rom1yearsto3yearsforevaluationofsequelae，assessmentofintellectualfacultiesandreexaminationwithCTand/orMRIofbrainwereperformed.ResultsTheclinicalmanifestationincludedfever41(100%);seizure29(70.7%);headache27(65.8%);vomit21(51.2%);alteredconsciousness25(60.9%)andincludingcoma10;mentaldysfunct

6、ion15(36.6%);ataxia12(29.2%)，cranialnerveparesis12(29.2%);visualhallucination11(26.8%).CTofbrainrevealedabnormalitiesin23casesof41patientsand5caseswithMRIofbrainrevealedabnormalities.Thetemporalandfrontallobewereinvolvedinthemostcases.Cerebralhemorrhagechangeswereseenin9cases.Infollowed-upp

7、atients，19of32showedrecovery，5casesmildlydisabled，3moderatelydisabled，and5severelydisabled.ConclusionThealtered11consciousnessandmentaldysfunctionwhichoccuratonsetaretheclinicalfeaturesofHSE.ThediagnosisofHSEinearlydonotrelyontheCTofbrain.Thedurationofil