Outcome of enterovirus 71 infections with or without stage-based management: 1998 to 2002
Outcome of enterovirus 71 infections with or without stage-based management: 1998 to 2002
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DOI：
10.1097/00006454-200404000-00010
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发表时间：
2004-04-01
影响因子：
3.6
通讯作者：
Lin, TY
中科院分区：
文献类型：
--
作者：
Chang, LY;Hsia, SH;Lin, TY
背景资料。肠道病毒71型(EV71)感染可能经历四个阶段，其中之一是心肺衰竭。在台湾，1998年EV71心肺衰竭患者几乎全部死亡。为了改善EV71患者的临床转归，我们于2000年制定了分期管理方案。回顾了长庚儿童医院196例未进行分期治疗的EV71患者(1998~1999年)和331例EV71患者(2000~2002年)的人口学特征、临床症状、病死率和后遗症。我们对两组的结果进行比较和分析。在没有接受分期治疗的患者中，83%(15/18)的中枢神经系统(CNS)受累和心肺衰竭患者在感染的急性期死亡。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。分阶段治疗的患者中，33%(12/36)的中枢神经系统合并心肺衰竭患者急性期死亡，8%(3/36)的患者在恢复期死亡，14%(5/36)的患者恢复正常，43%(16/36)的患者有严重的后遗症，如中枢性低通气量、吞咽困难和肢体无力(P<；0.001)。多因素分析显示，年龄>2岁和脑脊液白细胞计数与急性死亡率相关[95%可信区间分别为1.90~105.3，P=0.001；95%可信区间1.1~66.6，P=0.04]，但分期治疗与急性死亡率降低显著相关(95%可信区间0.007~0.24；P=0.0004)。分期治疗并不影响单独累及中枢神经系统的病例的预后。分期治疗降低了EV71相关心肺衰竭的病死率，但三分之二的幸存者有严重的后遗症。
Background. 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.Methods. 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.Results. 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 cerebrospinal fluid white blood cell count >100/mul 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.Conclusions. "Stage-based management reduced the case fatality rate of EV71-related cardiopulmonary failure, but two-thirds of the survivors had severe sequelae.