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目的探讨手足口病致急性弛缓性麻痹的临床特点。方法对15例手足口病伴急性弛缓性麻痹患儿进行临床观察,行头颅和脊髓磁共振检查及脑脊液、心肌酶检测。结果手足口病所致急性弛缓性麻痹多见于2岁以下儿童,麻痹前期可有皮疹,多呈单峰热,约86.67%的患者合并中枢神经系统受累(脑炎、脑膜炎、脑膜脑炎)。患儿瘫痪1周后,患肢运动功能开始恢复,住院期间可见到明显改善,轻症者1~2个月后恢复。结论手足口病合并中枢神经系统病变(86.67%),如脑炎、脑膜炎、脑膜脑炎等,较脊髓灰质炎更为常见。皮疹、心肌损害比例高于脊髓灰质炎,可能由于非脊髓灰质炎肠道病毒侵犯范围更广(包括皮肤、黏膜)有关。大部分手足口病患儿恢复早,预后好于脊髓灰质炎,可能是由于病理上组织炎症重于神经毒性所致。
Objective To investigate the clinical features of acute flaccid paralysis caused by hand-foot-mouth disease. Methods Fifteen children with HFMD accompanied with acute flaccid paralysis were enrolled in this study. Their skull and spinal cord were examined with MRI and cerebrospinal fluid and myocardial enzymes. Results Hand-foot-mouth disease caused by acute flaccid paralysis more common in children under 2 years old, paralysis may have a rash, mostly single peak fever, about 86.67% of patients with central nervous system involvement (encephalitis, meningitis, meningoencephalitis) . After 1 week of paralysis in children, limb motor function began to recover, significant improvement can be seen during hospitalization, mild symptoms 1 to 2 months after recovery. Conclusion HFMD complicated with central nervous system diseases (86.67%), such as encephalitis, meningitis and meningoencephalitis, are more common than poliomyelitis. Rash, the proportion of myocardial damage than polio, may be due to non-polio enterovirus invasion of a wider range (including the skin, mucous membranes). Most children with HFMD recovered early and had a better prognosis than poliomyelitis, probably due to the fact that histopathological inflammation is more severe than neurotoxicity.