Fang Yanling, Lian Chaowei, Huang Dali, Xu Liping
Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, China.
Zhangzhou Zhengxing Hospital, Zhangzhou, China.
Front Neurol. 2020 Nov 12;11:543013. doi: 10.3389/fneur.2020.543013. eCollection 2020.
To explore the clinical related factors of neonatal hand-foot-mouth disease (HFMD) complicated with encephalitis. The neonatal HFMD complicated with encephalitis treated in our hospital from July 2015 to July 2020 was taken as the object of study. According to the NBNA score at discharge, the patients were divided into normal group and abnormal group. The clinical symptoms, auxiliary examination and prognosis of the two groups were compared. (1) General condition: there was no significant difference in sex, age, duration of fever, treatment time and etiological test between the two groups ( > 0.05). (2) Clinical symptoms and signs: there was significant difference in abnormal consciousness between the two groups ( < 0.05). However, there was no significant difference in skin rash, respiratory system symptoms, digestive system symptoms, signs of high intracranial pressure, increased muscle tone and weakening of primitive reflex ( > 0.05). (3) Auxiliary examination: the number of white blood cells and the level of cytokines (CK-BB, UCH-L1) in cerebrospinal fluid (CSF) in the group with abnormal NBNA score were significantly higher than those in the group with normal NBNA score ( < 0.05). The serum IgM level in the abnormal NBNA score group was higher than that in the normal NBNA score group, and the serum IgG level in the abnormal NBNA score group was lower than that in the normal NBNA score group, and the difference was statistically significant ( < 0.05). The abnormal rate of Craniocerebral MRI in abnormal NBNA score group was higher than that in normal NBNA score group, and there was significant difference between the two groups ( < 0.05). There was no significant difference in the levels of protein, sugar, chloride, lactate dehydrogenase, and MMP-9 in CSF and the abnormal rate of amplitude integrated EEG (aEEG) between the two groups ( > 0.05). (4) The prognoses of patients with normal and abnormal NBNA score are good, and there are not significantly differences in the prognosis between the two groups ( > 0.05). (1) Neonatal HFMD complicated with encephalitis occurs more than 10 days after birth, there is no obvious abnormality in male and female, the vast majority of newborns have febrile symptoms, rash is not its specific manifestation, and most of them are atypical. (2) The positive rate of HFMD-related virus detected in CSF of neonatal HFMD is high. For newborns with abnormal consciousness, CSF examination should be accomplished in time, which has certain clinical significance for early diagnosis and treatment of severe newborns. (3) The increase of white blood cell count and cytokines (CK-BB, UCH-L1) in CSF of neonatal HFMD complicated with encephalitis has a certain clinical reference value for early diagnosis and identification of severe newborns. (4) There is a certain humoral immune disorder in newborns with HFMD complicated with encephalitis, but the overall prognosis is better due to the protective effect of maternal IgG.
探讨新生儿手足口病（HFMD）合并脑炎的临床相关因素。选取2015年7月至2020年7月在我院治疗的新生儿HFMD合并脑炎患者作为研究对象。根据出院时的NBNA评分，将患者分为正常组和异常组。比较两组的临床症状、辅助检查及预后情况。（1）一般情况：两组在性别、年龄、发热持续时间、治疗时间及病原学检测方面差异无统计学意义（P＞0.05）。（2）临床症状及体征：两组在意识异常方面差异有统计学意义（P＜0.05）。然而，在皮疹、呼吸系统症状、消化系统症状、颅内压增高体征、肌张力增高及原始反射减弱方面差异无统计学意义（P＞0.05）。（3）辅助检查：NBNA评分异常组脑脊液（CSF）中的白细胞数量及细胞因子（CK - BB、UCH - L1）水平显著高于NBNA评分正常组（P＜0.05）。NBNA评分异常组血清IgM水平高于NBNA评分正常组，血清IgG水平低于NBNA评分正常组，差异有统计学意义（P＜0.05）。NBNA评分异常组颅脑MRI异常率高于NBNA评分正常组，两组间差异有统计学意义（P＜0.05）。两组CSF中蛋白、糖、氯化物、乳酸脱氢酶及MMP - 9水平以及振幅整合脑电图（aEEG）异常率差异无统计学意义（P＞0.05）。（4）NBNA评分正常和异常患者的预后均良好，两组预后差异无统计学意义（P＞0.05）。（1）新生儿HFMD合并脑炎多在出生10天后发病，男女无明显异常，绝大多数新生儿有发热症状，皮疹不是其特异性表现，且多为非典型表现。（2）新生儿HFMD脑脊液中检测出HFMD相关病毒的阳性率较高。对于有意识异常的新生儿，应及时进行脑脊液检查，对重症新生儿的早期诊断和治疗具有一定临床意义。（3）新生儿HFMD合并脑炎脑脊液中白细胞计数及细胞因子（CK - BB、UCH - L1）升高对重症新生儿的早期诊断及鉴别有一定临床参考价值。（4）HFMD合并脑炎的新生儿存在一定的体液免疫紊乱，但因母体IgG的保护作用，总体预后较好。
