Chang Luan-Yin, Hsia Shao-Hsuan, Wu Chang-Teng, Huang Yhu-Chering, Lin Kuang-Lin, Fang Tsui-Yen, Lin Tzou-Yien
Divisions of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, 5 Fu-Hsing Street, Kweishan, Taoyuan, Taiwan.
Pediatr Infect Dis J. 2004 Apr;23(4):327-32. doi: 10.1097/00006454-200404000-00010.
Enterovirus 71 (EV71) infection may progress through four stages, one of which is cardiopulmonary failure. In Taiwan in 1998 almost all the EV71 patients with cardiopulmonary failure died. To improve clinical outcome of EV71 patients, we developed a stage-based management program in 2000.
The medical records of 196 EV71 patients who did not have stage-based management (1998 to 1999) and of 331 EV71 patients who did (2000 to 2002) at Chang Gung Children's Hospital were reviewed for demographic characteristics, clinical syndromes, case-fatality rates and sequelae. We compared and analyzed the results for the 2 groups.
Of the patients who did not receive stage-based management, 83% (15 of 18) of cases with both central nervous system (CNS) involvement and cardiopulmonary failure died during the acute stage of the infection. Two patients died at convalescence, and 1 had sequelae of dysphagia and limb weakness. By contrast of the patients who received stage-based management, 33% (12 of 36) of patients with CNS and cardiopulmonary failure died during the acute stage, 8% (3 of 36) died at convalescence, 14% (5 of 36) recovered and 43% (16 of 36) had severe sequelae of central hypoventilation, dysphagia and limb weakness (P < 0.001). For cases with CNS and cardiopulmonary failure, multivariate analysis showed that age older than 2 years and cerebro-spinal fluid white blood cell count >100/microl were associated with a increase in acute mortality [95% confidence interval (CI) 1.9 to 105.3, P = 0.001; 95% CI 1.1 to 66.6, P = 0.04, respectively], but stage-based management was significantly associated with a reduction in acute mortality (95% CI 0.007 to 0.24; P = 0.0004). Stage-based management did not affect the outcome of cases with CNS involvement alone.
Stage-based management reduced the case fatality rate of EV71-related cardiopulmonary failure, but two-thirds of the survivors had severe sequelae.
肠道病毒71型（EV71）感染可能会经历四个阶段，其中之一是心肺衰竭。1998年在台湾，几乎所有出现心肺衰竭的EV71患者都死亡了。为改善EV71患者的临床结局，我们于2000年制定了一项基于阶段的管理方案。
回顾了长庚儿童医院196例未接受基于阶段管理的EV71患者（1998年至1999年）以及331例接受了基于阶段管理的EV71患者（2000年至2002年）的病历，以了解其人口统计学特征、临床综合征、病死率和后遗症情况。我们对两组结果进行了比较和分析。
在未接受基于阶段管理的患者中，83%（18例中的15例）同时累及中枢神经系统（CNS）和出现心肺衰竭的病例在感染急性期死亡。2例患者在恢复期死亡，1例有吞咽困难和肢体无力的后遗症。相比之下，接受基于阶段管理的患者中，33%（36例中的12例）CNS和心肺衰竭患者在急性期死亡，8%（36例中的3例）在恢复期死亡，14%（36例中的5例）康复，43%（36例中的16例）有中枢性通气不足、吞咽困难和肢体无力的严重后遗症（P<0.001）。对于CNS和心肺衰竭的病例，多因素分析显示，年龄大于2岁和脑脊液白细胞计数>100/微升与急性死亡率增加相关[95%置信区间（CI）1.9至105.3，P = 0.001；95%CI 1.1至66.6，P = 0.04]，但基于阶段的管理与急性死亡率降低显著相关（95%CI 0.007至0.24；P = 0.0004）。基于阶段的管理对仅累及CNS的病例结局无影响。
基于阶段的管理降低了EV71相关心肺衰竭的病死率，但三分之二的幸存者有严重后遗症。
