合并急性弛缓性瘫痪的肠道病毒71型相关手足口病临床及MRI特征研究

目的探讨合并急性弛缓性瘫痪(AFP)的肠道病毒7l型(EV71)相关手足口病(HFMD)的临床及MRI特征。方法回顾性分析14例伴有AFP的EV71型相关HFMD患儿临床及MRI资料,并总结其临床及MRI特征。结果 14例患儿中,单上肢瘫痪1例、单下肢瘫痪1例、双上肢瘫痪2例、双下肢瘫痪1例、单侧偏瘫3例、四肢瘫痪6例,临床表现为相应受累肢体不同程度的肌力下降、肌张力减弱、腱反射减弱或消失。典型MRI表现为矢状位脊髓长条形、横断位相应节段脊髓前角斑片状长T1长T2信号灶。本组中同时合并脑干脑炎6例,MRI表现为延髓和桥脑背侧长T1长T2信号灶。结论 MRI是评价伴有AFP的EV71型相关HFMD脊髓及脑部病变范围、程度及观察预后的最有效影像学检查手段。伴有AFP的EV71型相关HFMD的MRI表现具有相对特异性,损害部位常位于脊髓前角、延髓及脑桥背侧。

Clinical and MRI Features of Hand-foot-mouth Disease Related to Enterovirus 71 and Associated with Acute Flaccid Paralysis

Objective To investigate the clinical and MRI characteristics of hand-foot-mouth diseases related to enterovirus 71(EV71) combined with acute flaccid paralysis(AFP).Methods The clinical and MRI manifestations of fourteen infants suffered from hand-foot-mouth diseases related to enterovirus 71(EV71) combined with AFP were retrospectively analyzed.Results Among the fourteen infants with AFP,one had paralysis of unilateral upper limbs,one had paralysis of the unilateral lower limbs,two had paralysis of bilateral upper limbs,one had paralysis of bilateral lower limbs,three had hemiplegia,and six had quadriplegia.All cases clinically presented acute limb myasthenia with tendon reflex and muscular tension lowered.On the spinal MRI,the lesions involved the anterior hom regions of spinal cord had hyperintensity on T2-weighted images and hypointensity on T1-weighted images,which were elongated on sagittal images and patchy on transverse images.Six patients simultaneously contained brainstem encephalitis.MRI showed that the lesions located at the posterior portions of the medulla,pons.The lesions had hyperintensity on T2-weighted images and hypointensity on T1-weighted images.Conclusion MRI is the most effective method on evaluating the range,degree and prognosis of the injuries on spinal cord and brain of hand-foot-mouth diseases related to enterovirus 71(EV71) combined with AFP.MRI findings have relative specificity.The hand-foot-mouth diseases related to enterovirus 71(EV71) combined with AFP often involve the anterior horn of the spinal cord,medulla oblongata and pons.