手足口病并发脑干脑炎19例临床分析

目的总结广东地区手足口病并发脑干脑炎患儿的临床特征，为手足口病并发脑干脑炎的诊断和治疗提供依据。方法收集2008年5～7月诊断为手足口病并发脑干脑炎患儿的临床资料,分析临床表现、实验室检查、神经电生理检查、影像学检查、治疗及转归等特征。选择同期诊断为手足口病并发病毒性脑炎的患儿作为对照组，进行脑干脑炎危险因素的单因素和多因素Logistic回归分析。 结果19例手足口病并发脑干脑炎患儿进入分析。①临床表现：19例患儿均有发热和皮疹；神经系统症状多见于肢体震颤（15例），眼球异常运动（游动或上翻）（12例），烦躁和惊恐（8例）；脑神经损害多见于单侧脑神经损害（14例），舌咽和迷走神经麻痹（9例）。15例出现呼吸衰竭，3例出现肺出血。②实验室检查：外周血WBC升高8例；血糖在正常范围；脑脊液压力升高4例。③神经电生理检查：8例EEG异常，14例脑干听觉诱发电位（BAEP）异常。④影像学检查：3例胸部X线检查提示双肺渗出性病变；15例行头颅CT检查均未见异常；3例头颅MRI检查提示脑干异常信号病灶。⑤转归：2例死于中枢性呼吸和循环衰竭，余17例治愈出院，随访6个月未见神经系统症状。⑥单因素Logistic回归分析显示，肢体震颤、呼吸节律改变、呼吸衰竭、眼球异常运动（游动或上翻）、饮水呛咳、口角歪斜、舌体震颤、末梢循环不良、交叉瘫及BAEP异常与脑干脑炎的发生有关；多因素Logistic回归分析显示，肢体震颤和眼球异常运动（游动或上翻）和BAEP异常是手足口病并发脑干脑炎的危险因素（OR分别为436.9，52.2和93.5）。 结论外周血WBC、血糖以及脑脊液检查对手足口病并发脑干脑炎的诊断不具有特异性。手足口病患儿如出现肢体震颤、眼球异常运动（游动或上翻）等症状，应警惕脑干脑炎的发生。 BAEP检查对脑干损伤有较好的诊断价值。及时和规范治疗后大多数患儿的预后良好。

Clinical analysis of 19 children with brainstem encephalitis associated with hand, foot and mouth disease

ObjectiveTo summarize the clinical features of brainstem encephalitis associated with hand, foot and mouth disease(HFMD) of Guangdong in 2008 and provide the basis for the diagnosis of the disease.MethodsThe clinical data of 19 children diagnosed as brainstem encephalitis associated with HFMD in May to July 2008 were collected. The clinical manifestation, laboratory examination, neuro-electrophysiology, imaging examination, treatment， prognosis and other characteristics were analyzed. The results were statistically analyzed by single factor and multiple factors analysis between above group and control group.ResultsThe data of 19 cases with brainstem encephalitis associated with HFMD were as follows, ① All of the 19 cases had fever and rash. The neurological symptoms such as limb tremor, abnormalities of eye movements(ocular drift or superduction), irritability, panic, walking instability and consciousness dysfunction were prevalent. The cranial nerves were damaged mainly on the single side, glossopharyngeal and vagus nerve paralysis were more common. Fifteen cases had respiratory failure, and three patients had pulmonary hemorrhage. ②Peripheral blood WBC number rised in 8 cases.Cerebrospinal fluid pressure ascended in 4 cases. ③EEG examination showed 8 cases were abnormal, and 14 cases were found abnormal in brainstem auditory evoked potential . ④X-ray of three cases showed lungs exudative lesions.Head CT examinations found nothing abnormal ,while 3 cases had abnormal MRI manifestations. ⑤ Two patients died of central respiratory and circulatory failure.Seventeen patients were cured and showed no neurological symptoms when followed up for 6 months. ⑥Single factor Logistic analysis showed brainstem encephalitis had great possibility to occur when following conditions appeared,such as limb tremor,change of respiratory rhythm,respiratory failure, abnormalities of eye movements(ocular drift or superduction) ,bucking in drinking,deviated mouth , tongue tremor,poor distal circulation,cross-paralysis and abnormal BAEP.Multiple factors Logistic analysis showed that limb tremor,abnormalities of eye movements(ocular drift or superduction) and abnormal BAEP were the risk factors for HFMD combined with brainstem encephalitis(OR=436.9,52.2,93.5,respectively).ConclusionsPeripheral blood WBC, blood glucose and cerebrospinal fluid examinations were not specitic for brainstem encephalitis associated with HFMD. In children cases of HFMD showing limb tremor, abnormalities of eye movements(ocular drift or superduction) and above mentioned symptoms, brainstem encephalitis was suggested. BAEP had good diagnostic value for brainstem injury. Most cases with brainstem encephalitis associated with HFMD had good prognosis after timely and standard treatment.