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目的探讨EB病毒(EBV)脑炎的临床表现、发病机制、诊断方法及预后。方法回顾性分析2006年7月至2009年10月我院收治的14例EBV脑炎临床特点。结果 14例患儿脑脊液和血清EBVCA(衣壳抗原)-IgM均阳性。其中6例进行脑脊液EBVDNA检测,3例阳性。2例具有传染性单核细胞增多症的典型症状,淋巴结及肝肿大2例,单纯淋巴结肿大3例,脾肿大1例,皮疹3例。14例均有发热,抽搐7例,嗜睡7例,昏迷1例,共济失调及构音障碍1例;2例出现EBV相关噬血细胞综合征。8例脑电图异常。7例头颅MRI异常,病变包括额叶、颞叶、丘脑、基底节、小脑等部位,3例诊断中枢神经系统脱髓鞘病变。14例给予抗病毒治疗。5例(包括3例脱髓鞘病及2例噬血细胞综合征)给予糖皮质激素治疗。出院后随访6个月至1年,12例痊愈,存在基底节及丘脑病变的2例患儿出现后遗症,其中1例遗留癫痫,1例左侧肢体活动障碍。结论 EBV脑炎可以缺乏传染性单核细胞增多症的典型症状,临床表现多样,临床上对合并淋巴结肿大、肝脾肿大、皮疹等表现的病毒性脑炎患儿,以及传染性单核细胞增多症治疗中出现神经系统症状的患儿,要警惕EBV脑炎可能。EBV脑炎可累及额叶、颞叶、丘脑、基底节、小脑等部位,亦可出现中枢神经系统脱髓鞘病变。大多数EBV脑炎预后良好,存在基底节及丘脑病变的患儿易出现后遗症。
Objective To investigate the clinical manifestations, pathogenesis, diagnosis and prognosis of Epstein-Barr virus (EBV) encephalitis. Methods The clinical features of 14 EBV encephalitis admitted to our hospital from July 2006 to October 2009 were analyzed retrospectively. Results CSF and serum EBVCA (capsid antigen) -IgM were all positive in 14 cases. Six cases of cerebrospinal fluid EBVNA detection, 3 cases were positive. 2 cases with infectious mononucleosis syndrome typical symptoms, lymph nodes and hepatomegaly in 2 cases, simple lymphadenopathy in 3 cases, splenomegaly in 1 case, 3 cases of rash. All 14 cases had fever, convulsions in 7 cases, lethargy in 7 cases, coma in 1 case, ataxia and dysarthria in 1 case; 2 cases of EBV-associated hemophagocytic syndrome. 8 cases of abnormal EEG. Seven cases of abnormal cranial MRI, lesions including the frontal lobe, temporal lobe, thalamus, basal ganglia, cerebellum and other parts, 3 cases of central nervous system demyelinating lesions. 14 cases given antiviral therapy. Five patients (including three demyelinating diseases and two hemophagocytic syndromes) were treated with glucocorticoids. After discharge from hospital for 6 months to 1 year, 12 cases recovered, and 2 cases of basal ganglia and thalamic lesions showed sequelae, including 1 case of epilepsy and 1 case of left limb dysfunction. Conclusions EBV encephalitis may lack typical symptoms of infectious mononucleosis. The clinical manifestations of EBV encephalitis are diverse. Clinically, children with viral encephalitis complicated with lymphadenopathy, hepatosplenomegaly, rash and so on, as well as infectious mononuclear Children with neurological symptoms in the treatment of cytobyrosis should be alert to the possibility of EBV encephalitis. EBV encephalitis can affect the frontal lobe, temporal lobe, thalamus, basal ganglia, cerebellum and other parts of the central nervous system demyelination can also occur. The majority of EBV encephalitis have a good prognosis, with sequelae in children with basal ganglia and thalamic lesions.