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Lancet：儿童瘫痪或与呼吸道病毒暴发相关

2015-01-30 马宏伟 译 医学论坛网

儿童瘫痪呼吸病毒
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一组美国科罗拉多州儿童因肌无力或瘫痪接受治疗,这可能与一种通常罕见的呼吸道病毒--肠病毒D68(EV-D68)的全国性爆发相关，这种病毒是超过100种非脊髓灰质炎病毒之一。 该项研究发表在《柳叶刀》杂志上，表明2014年在美国导致数千例呼吸道疾病的EV-D68病毒与严重的儿童神经系统疾病之间的潜在联系。 “由于全球消除脊髓灰质炎的努力,儿童急性弛缓性麻痹(AFP，一种单个或多个肢体麻痹

一组美国科罗拉多州儿童因肌无力或瘫痪接受治疗,这可能与一种通常罕见的呼吸道病毒--肠病毒D68(EV-D68)的全国性爆发相关，这种病毒是超过100种非脊髓灰质炎病毒之一。

该项研究发表在《柳叶刀》杂志上，表明2014年在美国导致数千例呼吸道疾病的EV-D68病毒与严重的儿童神经系统疾病之间的潜在联系。

“由于全球消除脊髓灰质炎的努力,儿童急性弛缓性麻痹(AFP，一种单个或多个肢体麻痹的状态)的集群发病已很少见。在脊髓灰质炎病毒不再流行的地区(北美、亚洲和欧洲)，儿童AFP的爆发可能与其他一些病毒(例如，肠病毒71和西尼罗河病毒)的感染相关，这12个新增病例提高了EV-D68在这些候选病毒名单中出现的可能性。”美国科罗拉多州奥罗拉市科罗拉多州儿童医院儿童传染病医生和研究员Kevin Messacar博士解释说。

2014年8月1日至2014年10月31日,科罗拉多州儿童医院的Messacar博士及其同事们注意到，在一次呼吸道疾病大暴发的期间，有几个孩子表现为四肢疲软,许多儿童鼻病毒和肠道病毒检测阳性,其中一些被确定为EV-D68。这促使他们回顾审查过去3个月内住院、报告有肌肉无力或瘫痪、且核磁共振扫描显示有脊髓灰质损害的所有病例。

十二名儿童满足上述标准。孩子们表现为不同程度的胳膊和腿的肌肉无力、吞咽困难和/或面神经麻痹。所有儿童在神经症状出现前一周有发烧和呼吸系统疾病病史。其中十例有脊髓病变，九例病变在脑干。十一名儿童曾接种过脊髓灰质炎疫苗。

尽管经过治疗,所有十名肢体无力的儿童仍症状持续,也尚不清楚瘫痪是否将是永久性的。三名儿童显示有脑神经功能障碍改善(面神经麻痹和/或吞咽困难)。八名儿童的肠道病毒阳性或鼻病毒检测阳性,其中五例确定为EV-D68。

资深作者、科罗拉多州儿童医院微生物流行病学家Samuel Dominguez博士说，“在过去4年里的任何3个月期间内，我们医院最多见过四名出现一个或两个肢体麻痹无力的类似儿童病例。这十二例是既往的三倍。”

Dominguez补充说,“这种新型不同的的神经系统疾病会在多大程度上播散尚不可知,但它似乎并不局限在科罗拉多或美国。自从这个发病集群报告后，在全美共有107例类似病例报告，也有1例在法国。如果进一步调查研究证实EV-D68与急性弛缓性瘫痪及颅神经功能障碍相关，EV-D68将被添加到可能引起严重的、潜在不可逆神经功能损害的非脊髓灰质炎肠道病毒列表中，也将会优先考虑寻找有效的抗病毒治疗和疫苗。”

原始出处：

Kevin Messacar,Teri L Schreiner,John A Maloney,Adam Wallace, Jan Ludke,M Stephen Oberste, W Allan Nix, Christine C Robinson,Mary P Glodé, Mark J Abzug, Dr Samuel R Dominguez,A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado, USA.Lancet 28 January 2015

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    2015-04-12 x35042875

    患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=20905, encodeId=522d20905d1, content=患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sun Apr 12 07:45:00 CST 2015, time=2015-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16501, encodeId=057e165018c, content=?学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f2fb1607679, createdName=orthoW, createdTime=Thu Feb 19 21:28:00 CST 2015, time=2015-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1827990, encodeId=25c9182e99094, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Mon Jun 15 21:54:00 CST 2015, time=2015-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15281, encodeId=0dfb152815a, content=牛，新病毒！, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3de41612568, createdName=xjtumed09, createdTime=Sun Feb 08 11:33:00 CST 2015, time=2015-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282368, encodeId=f695128236886, content=<a href='/topic/show?id=700239e0772' target=_blank style='color:#2F92EE;'>#呼吸道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39707, encryptionId=700239e0772, topicName=呼吸道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Sun Feb 01 02:54:00 CST 2015, time=2015-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442957, encodeId=0bbb144295ee6, content=<a href='/topic/show?id=fe69e126189' target=_blank style='color:#2F92EE;'>#瘫痪#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71261, encryptionId=fe69e126189, topicName=瘫痪)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=45265003536, createdName=ms1948154235210413, createdTime=Sun Feb 01 02:54:00 CST 2015, time=2015-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14883, encodeId=860d1488398, content=新病毒牛, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Fri Jan 30 19:54:00 CST 2015, time=2015-01-30, status=1, ipAttribution=)]
    2015-02-19 orthoW

    ?学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=20905, encodeId=522d20905d1, content=患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sun Apr 12 07:45:00 CST 2015, time=2015-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16501, encodeId=057e165018c, content=?学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f2fb1607679, createdName=orthoW, createdTime=Thu Feb 19 21:28:00 CST 2015, time=2015-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1827990, encodeId=25c9182e99094, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Mon Jun 15 21:54:00 CST 2015, time=2015-06-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15281, encodeId=0dfb152815a, content=牛，新病毒！, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3de41612568, createdName=xjtumed09, createdTime=Sun Feb 08 11:33:00 CST 2015, time=2015-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282368, encodeId=f695128236886, content=<a href='/topic/show?id=700239e0772' target=_blank style='color:#2F92EE;'>#呼吸道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39707, encryptionId=700239e0772, topicName=呼吸道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Sun Feb 01 02:54:00 CST 2015, time=2015-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442957, encodeId=0bbb144295ee6, content=<a href='/topic/show?id=fe69e126189' target=_blank style='color:#2F92EE;'>#瘫痪#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71261, encryptionId=fe69e126189, topicName=瘫痪)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=45265003536, createdName=ms1948154235210413, createdTime=Sun Feb 01 02:54:00 CST 2015, time=2015-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14883, encodeId=860d1488398, content=新病毒牛, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4a5105539, createdName=lovetcm, createdTime=Fri Jan 30 19:54:00 CST 2015, time=2015-01-30, status=1, ipAttribution=)]
    2015-06-15 howi

    #Lancet#

    0

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    2015-02-08 xjtumed09

    牛，新病毒！

    0

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    2015-02-01 zhmscau

    #呼吸道#

    0

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    2015-02-01 ms1948154235210413

    #瘫痪#

    0

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    2015-01-30 lovetcm

    新病毒牛

    0