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目的 分析儿童单纯疱疹病毒性脑炎 (HSE)的临床特征 ,探讨其诊断依据及影响预后的因素。方法 对 2 2例经脑脊液病毒病原学确诊的HSE患儿的临床特征进行分析 ,并对治疗效果进行观察和随访。结果 发热 2 2例 (10 0 % ) ,意识障碍 18例 (81% ) ,其中昏迷 12例 [采用GlasgowComaScale(GCS)评分、GCS≤ 4分 3例、5～ 7分 5例、8～ 9分 4例 ],嗜睡 6例。惊厥 16例 (72 % ) ,呕吐 13例(5 9% ) ,头痛 10例 (4 5 % ) ,精神症状 8例 (36 % )。合并颅神经麻痹 10例 (4 5 % ) ,肢体瘫痪 7例 (31% )。应用酶联免疫吸附方法测定脑脊液 (CSF )HSV IgM阳性者 13例、特异性IgG抗体局部产生指数 :血清/CSF比值≤ 2 0者 7例、双份CSF标本恢复期特异性HSV IgG 4倍以上升高者 4例 ;或采用聚合酶链反应 (PCR)技术测定脑脊液HSV DNA阳性者 3例。头颅CT和 (或 )MRI提示异常者 19例 ,病变部位以额、颞叶为主 12例 ,7例伴颅内出血。对 15例患儿进行 6个月～ 6年的随访 ,完全康复 5例 ,轻度残疾 3例 ,中度残疾 5例 ,重度残疾 2例 ,合并癫者 7例。结论 HSE临床可分轻重两型 ,早期意识障碍及精神症状是本病特征。脑脊液病毒学检测阳性为确诊依据。起始治疗时的病程、意识状态、及脑内病变程度是影响预后的重要因素。
Objective To analyze the clinical features of herpes simplex virus encephalitis (HSE) in children and explore the basis of its diagnosis and the factors affecting the prognosis. Methods The clinical features of 22 HSE patients diagnosed by cerebrospinal fluid etiology were analyzed, and the therapeutic effects were observed and followed up. Results There were 22 cases (10%) of fever and 18 cases (81%) of unconsciousness, of which 12 cases were unconscious [GlasgowComaScale (GCS) score, GCS≤4 points and 3 cases, 5 to 7 points and 5 cases, 8 to 9 points 4 cases], drowsiness in 6 cases. Seizures in 16 cases (72%), vomiting in 13 cases (59%), headache in 10 cases (45%), mental symptoms in 8 cases (36%). Cranial nerve paralysis in 10 cases (45%), limb paralysis in 7 cases (31%). Serum CSF CSF IgM IgM was detected by enzyme-linked immunosorbent assay (ELISA) in 13 cases. The specific IgG antibody local production index was 7 in serum / CSF ratio ≤ 20 and more than 4 times of HSV IgG in double CSF Elevated in 4 cases; or polymerase chain reaction (PCR) to determine cerebrospinal fluid HSV DNA positive in 3 cases. Head CT and (or) MRI abnormalities in 19 cases, lesions in the amount of temporal lobe in 12 cases, 7 cases with intracranial hemorrhage. Fifteen children were followed up for 6 months to 6 years. Five cases were completely recovered, three cases had mild disability, five cases with moderate disability, two cases with severe disability and seven cases with combined epilepsy. Conclusion HSE can be divided into two types of light and heavy, early consciousness and mental symptoms are the characteristics of the disease. Positive detection of cerebrospinal fluid virology based on the diagnosis. The duration of initial treatment, the state of consciousness, and the extent of intracerebral lesions are important prognostic factors.