新生儿肠道病毒感染课件.pptx

1、新生儿肠道病毒感染 属于小属于小RNARNA病毒科肠道病病毒科肠道病毒属，由粪毒属，由粪-口，呼吸道口，呼吸道、眼部粘膜等途径传播；、眼部粘膜等途径传播；有有4 4个病毒种，根据交叉个病毒种，根据交叉中和试验分为中和试验分为6767个血清型个血清型March,B.,et al.,Epidemiology of enteroviral meningoencephalitis in neonates and young infants.Journal of March,B.,et al.,Epidemiology of enteroviral meningoencephalitis in neon

2、ates and young infants.Journal of Paediatrics and Child Health,2014.50(3):p.216-220.Paediatrics and Child Health,2014.50(3):p.216-220.Lin,T.Y.,et al.,Neonatal enterovirus infections:emphasis on risk factors of severe and fatal infections.Pediatr Infect Dis J,2003.22(10):p.889-94.60%（87例，共146例）的病例发生于

3、夏季（5月-7月）l产前产前l产时产时l产后产后新新生儿感染的途径生儿感染的途径March,B.,et al.,Epidemiology of enteroviral meningoencephalitis in March,B.,et al.,Epidemiology of enteroviral meningoencephalitis in neonates and young infants.Journal of Paediatrics and Child Health,2014.neonates and young infants.Journal of Paediatrics and

4、Child Health,2014.50(3):p.216-220.50(3):p.216-220.146例，从中可以看到EV的高危因素包括 起病早 早产 低体重 低日龄等Lin,T.Y.,et al.,Neonatal enterovirus infections:emphasis on risk factors of severe and fatal infections.Pediatr Infect Dis J,2003.22(10):p.889-94.Abzug MJ,Levin MJ,Rotbart HA.Profile of enterovirus disease in the f

5、irst two weeks of life.Pediatr Infect Dis J1993;12:8204.2011.01-12 584例新生儿 中中枢神经系统（枢神经系统（50%50%）心心肌炎（肌炎（25%25%）败血症样综合症（败血症样综合症（25%25%）March,B.,et al.,Epidemiology of enteroviral meningoencephalitis in March,B.,et al.,Epidemiology of enteroviral meningoencephalitis in neonates and young infants.Journ

6、al of Paediatrics and Child Health,2014.neonates and young infants.Journal of Paediatrics and Child Health,2014.50(3):p.216-220.50(3):p.216-220.临床症状体征：昏迷、抽搐、易激惹、颈强直，囟门张力增高 CSFCSF：白细胞升高（白细胞升高（40-66040-660*10106 6/L/L）单核细胞为主单核细胞为主 蛋白质、葡萄糖可正常蛋白质、葡萄糖可正常Krajden,S.和.M.P.,Enterovirus infections in the neon

7、ate.1983.p.87-92.Rorabaugh ML,Berlin LE,Heldrich F,et al:Aseptic meningitis in infants younger than 2 years of age:Acute illness and neurologic complications.Pediatrics 92:206-211,1993.中枢神经系统感染中枢神经系统感染Haddad J,Messer J,Gut JP,Chaigne D,Christmann D,Willard D.Neonatal echovirus encephalitis with whit

8、e matter necrosis.Neuropediatrics1990;21:215217.首次报道一例足月顺产男婴，因艾可病毒感染导致脑炎，MRI提示脑白质损伤，同时头颅B超级CT未提示相关改变。M.A.Verboon-Maciolek,M.P.,et al.,White matter damage in neonatal enterovirus meningoencephalitis.NEUROLOGY.66(2006):p.12671269报道了6例（3名早产儿，3名足月儿）EV感染引起脑膜脑炎，通过MRI发现轻重不一的脑白质损害，类似于脑白质软化；同时，头颅B超也提示了相似的表现M

9、.A.Verboon-Maciolek,M.P.,et al.,White matter damage in neonatal enterovirus meningoencephalitis.NEUROLOGY.66(2006):p.12671269在后续的随访中发现，脑白质损害的患儿预后不良，伴有行走困难、癫痫、严重的学习困难等后遗症，其中，随访中未发现后遗症的为足月儿，这可能与发育过程中脑白质对疾病的易感性有关发病后发病后6 6天天发病后发病后1919天天发病后发病后5555天天一例12天，37周CoxB2所致脑膜脑炎，DWI即提示高信号影，复查MRI证实严重的脑白质损害，提示早期运用DW

10、I的价值。1.Hirata等人认为，该病理改变是由于细胞毒性水肿；2.病变发展累及脑白质，表现为白质软化；3.小胶质细胞活化，释放氧及活性氮，同时炎症因子的作用，尤其是TNF-，IL-是损伤的主要机制；O.Hirata,N.I.Y.M.,A Case of Neonatal Coxsackie B2 Meningo-Encephalitis in which Serial Magnetic Resonance Imaging Findings Reveal the Development of Lesions.D epartment of Pediatrics,H iroshima Unive

11、rsity Graduate School of Biomedical Science,H iroshima,J apan,29(Neuropediatrics 2011;42:156158).M.A.Verboon-Maciolek,M.P.,et al.,White matter damage in neonatal enterovirus meningoencephalitis.NEUROLOGY.66(2006):p.12671269Wu,T.,et al.,Enterovirus infections are associated with white matter damage i

12、n neonates.Journal of Paediatrics and Child Health,2014.50(10):p.817-822.收治了12例EV所致脑炎患儿（35-39W），其MRI均提示脑白质损害，类似于早产儿的脑白质软化。其中2名预后不良。Wu,T.,et al.,Enterovirus infections are associated with white matter damage in neonates.Journal of Paediatrics and Child Health,2014.50(10):p.817-822.在后续的随访中发现，（生后6月、18月），其中2名仍有不同程度的白质损伤存在另外10名在18月是随访MRI已正常。肠道病毒感染累及中枢神经系统；肠道病毒感染累及中枢神经系统；神经系统病变可表现为脑白质损害；神经系统病变可表现为脑白质损害；MRIMRI可提示脑白质损害，优于可提示脑白质损害，优于B B超及超及CTCT；脑白质损害与预后相关；脑白质损害与预后相关；总结总结 脑白质损害对何种血清型易感仍未知；脑白质损害对何种血清型易感仍未知；是否与炎症反应有关，机制尚不明确；是否与炎症反应有关，机制尚不明确；脑白质损害是否与孕周相关；脑白质损害是否与孕周相关；问题问题Thank you Thank you！