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目的 分析先天性风疹综合征 (CRS)临床特征及预后 ,探讨血清特异性风疹IgM抗体的诊断价值 ,提高对预防CRS的认识。方法 对 6例新生儿期CRS的临床特征和辅助检查结果进行分析 ,并进行追踪随访。结果 6例CRS患儿的母亲均未接种风疹疫苗 ,其中 3例母亲孕早期有感染病史。 6例患儿平均入院日龄为 13d ,有 2例患儿为早产儿 ,1例患儿为过期产 ,1例患儿为小于胎龄儿。 6例患儿的主要临床表现为发热、惊厥、黄疸及肝脾肿大。所有 6例患儿及母亲血清风疹IgM抗体均阳性 ,其中 2例患儿脑脊液IgM抗体亦阳性。头颅CT异常 5例 ,脑电图异常 2例 ,脑干测听异常 2例 ,眼底检查异常 1例 ,心脏彩超异常 1例。 6例患儿中 1例死亡 ,2例有神经行为异常 ,1例正常 ,2例失访。结论 CRS的临床表现是多样的 ,特异性风疹IgM抗体检测可以作为先天性风疹感染的诊断依据 ,接种风疹疫苗是必要的。
Objective To analyze the clinical features and prognosis of congenital rubella syndrome (CRS), and to explore the diagnostic value of serum specific rubella IgM antibody and to raise awareness on the prevention of CRS. Methods The clinical features of 6 cases of neonatal CRS and the results of auxiliary examination were analyzed and followed up. Results None of the 6 CRS mothers received rubella vaccine, and 3 of the mothers had a history of infection in their first trimester. The average admission day of 6 children was 13 days, 2 cases were premature children, 1 case was obsolete and 1 case was less than gestational age. The main clinical manifestations of 6 children were fever, convulsion, jaundice and hepatosplenomegaly. All 6 children and maternal serum rubella IgM antibodies were positive, of which 2 were also positive for cerebrospinal fluid IgM antibodies. 5 cases of abnormal cranial CT, 2 cases of abnormal EEG, 2 cases of auditory brainstem abnormalities, 1 case of fundus abnormalities and 1 case of abnormal color Doppler ultrasound. One of six children died, two had neurological abnormalities, one was normal and two were lost. Conclusions The clinical manifestations of CRS are diverse. The detection of specific rubella IgM antibody can be used as the basis for the diagnosis of congenital rubella infection. It is necessary to vaccinate rubella vaccine.