| 梁帆,张慧,商跃云,等.儿童急性坏死性脑病 12例的临床特点及预后分析[J].安徽医药,2026,30(7):1419-1424. |
| 儿童急性坏死性脑病 12例的临床特点及预后分析 |
| Clinical characteristics and prognosis of 12 cases of acute necrotizing encephalopathy in children |
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| DOI：10.3969/j.issn.1009-6469.2026.07.029 |
| 中文关键词: 急性坏死性脑病 儿童 流感病毒 新型冠状病毒 临床特点 预后 |
| 英文关键词: Acute necrotizing encephalopathy Child Influenza virus Novel coronavirus Clinical features Prognosis |
| 基金项目:天津市医学重点学科(专科)建设项目( TJYXZDXK-040A) |
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| 中文摘要: |
| 目的总结分析天津地区儿童急性坏死性脑病(ANEC)的临床特点、治疗原则和预后情况。方法回顾性分析 2022年 1月至 2024年 6月天津市儿童医院 PICU确诊的 ANEC病儿的临床资料，根据临床结局分为死亡组及存活组，比较及分析其临床表现、影像学特点、实验室指标、治疗过程及预后情况，对 ANEC的早期识别及治疗提供指导。结果共纳入 12例 ANEC病儿，男女比例为 1.4∶1.0，死亡组 8例、存活组 4例，病死率为 66.7%(8/12)。天津地区 ANEC于冬季及春季高发，前驱感染均为病毒感染，主要以新型冠状病毒及流感病毒感染为主，流感病毒与新型冠状病毒致死率差异无统计学意义。致死性 ANEC均出现高热、惊厥发作伴意识障碍，神经影像学均存在对称性丘脑受累，为多灶性损伤，脑干受累多提示预后不良。 ANEC本质为细胞炎性因子风暴及血脑屏障破坏，死亡组病儿早期凝血功能、 D-二聚体、乳酸、乳酸脱氢酶(LDH)白细胞介素 -6(IL-6)均明显异常，死亡组病儿 ANE-SS评分(急性坏死性脑病严重程度评分)为(6.63±0.92)分，存活组为(3.25±0.96)、分，差异有统计学意义，对预后具有预测作用。结论天津地区儿童急性坏死性脑病致死率高，在疾病进展早期进行快速识别及经验性治疗尤为重要。 |
| 英文摘要: |
| Objective To summarize and analyze the clinical features, treatment principles and prognosis of acute necrotizing enceph-alopathy (ANEC) in children in Tianjin.Methods The clinical data of children with ANEC diagnosed by Pediatric Intensive Care Unit(PICU) in Tianjin Children's Hospital from January 2022 to June 2024 were retrospectively analyzed, and they were divided into deathgroup and survival group according to the clinical outcomes. Statistical methods were used to compare and analyze clinical manifesta-tions, imaging features, laboratory indicators, treatment processes, and prognosis, aiming to provide guidance for early identification andtreatment of ANEC.Results A total of 12 children with ANEC , with a male-to-female ratio of 1.4∶1.0, including 8 in the death groupand 4 in the survival group, with a mortality rate of 66.7% (8/12). The incidence of ANEC in Tianjin was high in winter and spring, andthe prodromal infections were all viral infections, mainly novel coronavirus and influenza virus infections, and there was no statistical dif-ference in the fatality rate of influenza virus and novel coronavirus. Fatal ANEC all had hyperthermia, convulsive seizures with impairedconsciousness, and symmetrical thalamic involvement on neuroimaging, which was a multifocal injury, and brainstem involvement oftenindicated a poor prognosis. The essence of ANEC was the storm of inflammatory factors and the destruction of the blood-brain barrier, and the early coagulation function, D-dimer, lactate (Lac), lactate dehydrogenase (LDH), and interleukin-6 (IL-6) of the children in the deceased group were obviously abnormal. The Acute Necrotizing Encephalopathy Severity Score (ANE-SS) of children in the deathgroup was (6.63±0.92) points, while that in the survival group was (3.25±0.96) points. The difference was statistically significant, and thescore had a predictive value for prognosis.Conclusion The mortality rate of acute necrotizing encephalopathy in children in Tianjin ishigh, and rapid identification and empiric treatment are particularly important in the early stage of disease progression. |
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