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目的总结累及神经系统的肠道病毒71型(EV71)感染所致重症手足口病(HFMD)的临床特点及治疗情况。方法以35例累及神经系统的EV71感染所致重症HFMD患儿为研究对象,回顾性分析其实验室及影像学检查,观察患儿生命体征、临床症状以及治疗和转归。结果 35例中男21例,女14例;<3岁33例;居住农村30例,城市5例。患儿均有手、足、臀部皮疹及口腔疱疹溃疡,但皮疹稀少。发热,热程>3 d;于病程第2-5天出现中枢神经系统损害症状,12例伴血压升高、心率增快、出汗、四肢末梢冷等自主神经兴奋表现。血WBC升高25例,血糖升高11例,PLT降低2例,CRP升高13例,脑脊液异常28例,心肌酶谱升高9例,CD4+/CD8+T淋巴细胞降低21例,血清免疫球蛋白检测均正常。胸片示单侧或双侧大片阴影5例,心电图异常26例,头颅CT异常3例,MRI异常6例。35例均应用甘露醇和地塞米松治疗,并予对症治疗。27例痊愈出院,7例遗留迟缓性麻痹,1例死亡。结论EV71感染可累及多系统多器官,病程第3-5天为高危期,加用静脉丙种球蛋白对患儿的预后无明显影响。
Objective To summarize the clinical features and treatment of severe hand-foot-mouth disease (HFMD) caused by enterovirus 71 (EV71) infection involving the nervous system. Methods 35 children with severe HFMD caused by EV71 infection involving the nervous system were studied retrospectively. Their laboratory and imaging findings were retrospectively analyzed. The vital signs, clinical symptoms, treatment and prognosis were observed. Results Among the 35 cases, 21 were males and 14 were females; 33 were under 3 years of age; 30 were living in rural areas and 5 were in urban areas. Children have hands, feet, buttocks, rash and herpes ulcer, but rare rash. Fever, fever> 3 d; in the course of the first 2-5 days of central nervous system damage symptoms, 12 cases with elevated blood pressure, heart rate, sweating, extremities cold and other autonomic nervous excitement performance. Blood WBC increased in 25 cases, 11 cases of elevated blood glucose, PLT decreased in 2 cases, CRP increased in 13 cases, cerebrospinal fluid abnormalities in 28 cases, elevated myocardial enzymes in 9 cases, CD4 + / CD8 + T lymphocytes decreased in 21 cases, serum immunization Globulin test are normal. Chest radiograph showed unilateral or bilateral large shadow in 5 cases, electrocardiogram abnormalities in 26 cases, cranial CT abnormalities in 3 cases, MRI abnormalities in 6 cases. 35 cases were treated with mannitol and dexamethasone, and symptomatic treatment. 27 patients were discharged, 7 patients had delayed paralysis and 1 patient died. Conclusions EV71 infection can affect multiple systems and multiple organs. The course of disease is high risk in 3-5 days. Adding intravenous gamma globulin has no significant effect on the prognosis of children.