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目的分析儿童单纯疱疹病毒性脑炎(HSE)临床特征和预后,探讨HSE早期诊断的重要性。方法分析2005年1月至2010年5月复旦大学附属儿科医院神经科住院的20例HSE患儿,均经脑脊液(CSF)病毒病原学确诊,观察治疗效果及预后。结果 20例患儿中发热20例(100%)、意识障碍16例(80%)、抽搐19例(95%)、精神行为异常4例(20%)、肢体偏瘫7例(35%)。CSF常规或生化异常14例(70%),其中红细胞增多9例(64%)、CSF糖<2.2mmol/L3例(21%)。头颅影像学检查19例异常(95%),颅内出血11例(58%),其中合并丘脑出血5例(45%);中脑梗塞1例(5%)。对12例进行6个月至5年的随访,完全康复1例、智力运动发育迟缓生活不能自理5例、智力发育迟缓3例、肢体运动障碍3例、合并癫痫7例。结论 HSE起病急,多为重症病情,但儿童患者临床特征可不典型。应进行细致临床观察,尽早行神经影像学检查,积极查找病原学,早期正规给予抗病毒治疗是早期诊断、改善预后的关键。
Objective To analyze the clinical characteristics and prognosis of herpes simplex virus encephalitis (HSE) in children, and to explore the importance of early diagnosis of HSE. Methods From January 2005 to May 2010, 20 children with HSE who were hospitalized in neurology department of Fudan University Pediatric Hospital were confirmed by etiological diagnosis of cerebrospinal fluid (CSF) virus. The therapeutic effect and prognosis were observed. Results 20 cases (100%) had fever, 16 cases (80%) had disturbance of consciousness, 19 cases (95%) had convulsions, 4 cases (20%) had mental disorders and 7 cases (35%) had hemiplegia. CSF routine or biochemical abnormalities in 14 cases (70%), including 9 cases of erythrocyte increase (64%), CSF sugar <2.2mmol / L3 cases (21%). Nineteen patients (95%) had craniofacial abnormalities and 11 (58%) had intracranial hemorrhage. Among them, 5 (45%) had thalamic hemorrhage and 1 (5%) had middle cerebral infarction. All the 12 patients were followed up for 6 months to 5 years. One patient was fully recovered, 5 patients were unable to take care of their mental retardation, 3 were mental retardation, 3 were dyskinesia, and 7 were complicated by epilepsy. Conclusion HSE onset is acute, mostly severe disease, but the clinical features of children may be atypical. Should be detailed clinical observation, as early as possible neuroimaging, actively looking for etiology, early formal administration of antiviral therapy is the early diagnosis and improve the prognosis of the key.