Wang Shih-Min, Liu Ching-Chuan
Department of Emergency Medicine, College of Medicine, National Cheng Kung University and Hospital, 138 Sheng Li Road, Tainan, 70428, Taiwan.
Expert Rev Anti Infect Ther. 2009 Aug;7(6):735-42. doi: 10.1586/eri.09.45.
Enterovirus 71 (EV71) has emerged as a major cause of neurological threat in the world following the eradication of poliovirus. Most EV71 infections commonly result in hand-foot-mouth disease or herpangina, and some cases are associated with brainstem encephalitis and acute flaccid paralysis. Mortality was high in EV71 brainstem encephalitis complicated with pulmonary edema, particularly in children below 5 years of age. Destruction of vasomotor in the brainstem by EV71 produces autonomic nervous system dysregulation prior to the pulmonary edema. The pulmonary edema is the result of increased pulmonary vascular permeability caused by the direct brainstem lesions and/or a systemic inflammatory response syndrome produced by the release of cytokines and chemokines. There is currently no specific antiviral agent to treat or vaccine to prevent EV71 diseases. Treating severe EV71 brainstem encephalitis patients with intravenous IgG and milrinone is associated with significantly decreased mortality by attenuated sympathetic activity and cytokine production.
在脊髓灰质炎病毒被根除后，肠道病毒71型（EV71）已成为全球神经系统威胁的主要原因。大多数EV71感染通常导致手足口病或疱疹性咽峡炎，部分病例与脑干脑炎和急性弛缓性麻痹有关。EV71脑干脑炎并发肺水肿时死亡率很高，尤其是5岁以下儿童。EV71对脑干血管运动功能的破坏在肺水肿发生前导致自主神经系统失调。肺水肿是由直接的脑干病变和/或细胞因子及趋化因子释放产生的全身炎症反应综合征引起的肺血管通透性增加的结果。目前尚无治疗EV71疾病的特异性抗病毒药物或预防疫苗。用静脉注射免疫球蛋白和米力农治疗重症EV71脑干脑炎患者，可通过减弱交感神经活动和细胞因子产生而显著降低死亡率。
