儿童病毒性脑炎多中心诊断治疗研究

目的　探讨儿童病毒性脑炎的诊断与治疗问题。方法　以多中心、前瞻开放、随机对比方法观察儿童病毒性脑炎的临床症状、体征及脑脊液常规生化 ;以聚合酶链反应 (PCR)技术检测儿童病毒性脑炎脑脊液病原 ;在综合治疗的前提下 ,以单一抗病毒药物治疗儿童病毒性脑炎。结果　本组 14 3例病毒性脑炎中发热 134例(93 7% ) ,头痛 86例 (6 4 7% ) ,呕吐 87例 (6 0 8% ) ,呕吐伴头痛 5 9例 ,惊厥发作 4 7例 (32 9% ) ,以全身阵挛发作为主 ;有精神症状 87例 (6 0 8% ) ,意识障碍 2 5例 (17 5 % ) ,颈抵抗 4 6例 (32 2 % ) ,运动障碍 2 0例 ,锥体束征 9例 ;脑脊液常规生化检查异常 90例 ,其中 86例白细胞增多 ,16例蛋白定量增高。 14 3例均做了脑脊液病原学检测 ,病毒阳性 84例 (5 8 7% ) ,其中肠道病毒阳性 4 0例 ,DNA病毒阳性 4 4例 ,另外还检测出了 6例支原体。在症状、体征和脑脊液常规生化检查阳性的 4 6例中 ,脑脊液病毒学阳性 2 6例 (5 6 5 % ) ,在症状和脑脊液常规生化检查阳性者 4 4例中 ,脑脊液病毒学阳性 2 3例 (5 2 3% )。在脑脊液病原学不明的情况下 ,在综合治疗的基础上 ,三种抗病毒药物单药抗病毒治疗临床疗效无差别。结论　除常规诊断条件外 ,病毒病原学检查十分重要 ,抗病毒治疗以覆盖更广

Diagnosis and treatment of children viral encephalitis: A multicenter study

Objective To study the diagnosis and treatment of children viral encephalitis.Methods The clinical manifestations were observed by using multicenter,prospective and random placebo control method; cerebrospinal fluid viral pathogens were detected by PCR technique; children with viral encephalitis were treated with single anti-virus medicines based on general therapy.Results Of 143 children with viral encephalitis,134 (93.7%) had fever,86 (64.7%)had headache,87(60.8%)vomiting,59 (41.2%)vomiting with headache,47 (32.9%)convulsion onset,mainly clonic spasm; 87 were with mental symptoms,25 (17.5%) with consciousness disorders,46 (32.2%) neck resistance,20 dyskinesia and 9 pyramidal tract syndrome; routine biochemical test found 90 abnormal cases,of which 86 had leukocytosis and 16 had increased protein content.Cerebrospinal pathogenic test of all the 143 cases detected 84 (58.7%) virus positive,of which,40 were enterovirus positive and 44 DNA virus positive,and 6 mycoplasma positive.Among 46 cases with positive results of symptoms,signs and routine cerebrospinal fluid test,26 (56.5%) were virus positive; among 44 cases with positive results of symptoms and routine cerebrospinal fluid test,23 (52.3%) were virus positive.When the pathogens were unknown,there was no significant difference between the effects of three single anti-viral agents based on general therapy.Conclusion Viral detection is very important,in addition to routine diagnostic methods.Anti-virus treatment should cover more viruses.