中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
16期
1870-1874
,共5页
吕祖芳%李明磊%张立明%赵华锋%张爱梅
呂祖芳%李明磊%張立明%趙華鋒%張愛梅
려조방%리명뢰%장립명%조화봉%장애매
脑炎,病毒性%神经元特异性烯醇化酶%脑电图%磁共振成像%预后
腦炎,病毒性%神經元特異性烯醇化酶%腦電圖%磁共振成像%預後
뇌염,병독성%신경원특이성희순화매%뇌전도%자공진성상%예후
Encephalitis,viral%Phosphopyruvate hydratase%Electroencephalogram%Magnetic resonance imaging%Prognosis
目的：探讨血清特异性烯醇化酶（ NSE）、脑电图（ EEG）、颅脑磁共振成像（ MRI）对病毒性脑炎合并惊厥患儿预后的评估价值。方法收集2008年1月-2012年12月潍坊市人民医院住院确诊为病毒性脑炎合并惊厥的患儿65例，于病程3 d内同期进行血清NSE、EEG、颅脑MRI检查，详细记录临床资料，对检查异常患儿分组为NSE异常组、EEG异常组、MRI异常组，伴有昏迷、局灶体征为重症，记录3组患儿重症发生率；治疗后2周~3个月进行1~3次复查，3个月时记录3组患儿恢复正常率；临床随访半年，对患儿神经功能进行评估，记录3组患儿神经系统后遗症发生率。采用单因素和多因素Logistic回归法分析影响患儿预后的因素。结果65例患儿NSE异常43例（66.2％），EEG异常58例（89.2％），MRI异常36例（55.4％）。NSE、EEG、MRI异常患儿重症发生率、恢复正常率、后遗症发生率比较，差异均有统计学意义（P＜0.05）；其中MRI异常组重症发生率高于EEG异常组（P＜0.01）；EEG、NSE异常组恢复正常率均高于MRI异常组（P＜0.01）；MRI异常组后遗症发生率高于EEG异常组（P＜0.01）。单因素Logistic回归分析结果显示，NSE异常、EEG异常、MRI异常及合并多脏器损伤对病毒性脑炎合并惊厥患儿的预后有影响（P＜0.05）。多因素Logistic回归分析结果显示，NSE异常、MRI异常及合并多脏器损伤为病毒性脑炎合并惊厥患儿预后不良的危险因素（ P＜0.05）。结论血清NSE、EEG、MRI是病毒性脑炎合并惊厥患儿重要辅助检查方法，NSE、MRI异常者预后不良，MRI对预后判断价值最大。三者从不同角度反映脑损伤情况，结合分析、动态观察对正确诊断、判断病情、治疗效果及预后评估有重要意义，为患儿恢复期进行早期康复治疗以改善预后提供了有价值的临床依据。
目的：探討血清特異性烯醇化酶（ NSE）、腦電圖（ EEG）、顱腦磁共振成像（ MRI）對病毒性腦炎閤併驚厥患兒預後的評估價值。方法收集2008年1月-2012年12月濰坊市人民醫院住院確診為病毒性腦炎閤併驚厥的患兒65例，于病程3 d內同期進行血清NSE、EEG、顱腦MRI檢查，詳細記錄臨床資料，對檢查異常患兒分組為NSE異常組、EEG異常組、MRI異常組，伴有昏迷、跼竈體徵為重癥，記錄3組患兒重癥髮生率；治療後2週~3箇月進行1~3次複查，3箇月時記錄3組患兒恢複正常率；臨床隨訪半年，對患兒神經功能進行評估，記錄3組患兒神經繫統後遺癥髮生率。採用單因素和多因素Logistic迴歸法分析影響患兒預後的因素。結果65例患兒NSE異常43例（66.2％），EEG異常58例（89.2％），MRI異常36例（55.4％）。NSE、EEG、MRI異常患兒重癥髮生率、恢複正常率、後遺癥髮生率比較，差異均有統計學意義（P＜0.05）；其中MRI異常組重癥髮生率高于EEG異常組（P＜0.01）；EEG、NSE異常組恢複正常率均高于MRI異常組（P＜0.01）；MRI異常組後遺癥髮生率高于EEG異常組（P＜0.01）。單因素Logistic迴歸分析結果顯示，NSE異常、EEG異常、MRI異常及閤併多髒器損傷對病毒性腦炎閤併驚厥患兒的預後有影響（P＜0.05）。多因素Logistic迴歸分析結果顯示，NSE異常、MRI異常及閤併多髒器損傷為病毒性腦炎閤併驚厥患兒預後不良的危險因素（ P＜0.05）。結論血清NSE、EEG、MRI是病毒性腦炎閤併驚厥患兒重要輔助檢查方法，NSE、MRI異常者預後不良，MRI對預後判斷價值最大。三者從不同角度反映腦損傷情況，結閤分析、動態觀察對正確診斷、判斷病情、治療效果及預後評估有重要意義，為患兒恢複期進行早期康複治療以改善預後提供瞭有價值的臨床依據。
목적：탐토혈청특이성희순화매（ NSE）、뇌전도（ EEG）、로뇌자공진성상（ MRI）대병독성뇌염합병량궐환인예후적평고개치。방법수집2008년1월-2012년12월유방시인민의원주원학진위병독성뇌염합병량궐적환인65례，우병정3 d내동기진행혈청NSE、EEG、로뇌MRI검사，상세기록림상자료，대검사이상환인분조위NSE이상조、EEG이상조、MRI이상조，반유혼미、국조체정위중증，기록3조환인중증발생솔；치료후2주~3개월진행1~3차복사，3개월시기록3조환인회복정상솔；림상수방반년，대환인신경공능진행평고，기록3조환인신경계통후유증발생솔。채용단인소화다인소Logistic회귀법분석영향환인예후적인소。결과65례환인NSE이상43례（66.2％），EEG이상58례（89.2％），MRI이상36례（55.4％）。NSE、EEG、MRI이상환인중증발생솔、회복정상솔、후유증발생솔비교，차이균유통계학의의（P＜0.05）；기중MRI이상조중증발생솔고우EEG이상조（P＜0.01）；EEG、NSE이상조회복정상솔균고우MRI이상조（P＜0.01）；MRI이상조후유증발생솔고우EEG이상조（P＜0.01）。단인소Logistic회귀분석결과현시，NSE이상、EEG이상、MRI이상급합병다장기손상대병독성뇌염합병량궐환인적예후유영향（P＜0.05）。다인소Logistic회귀분석결과현시，NSE이상、MRI이상급합병다장기손상위병독성뇌염합병량궐환인예후불량적위험인소（ P＜0.05）。결론혈청NSE、EEG、MRI시병독성뇌염합병량궐환인중요보조검사방법，NSE、MRI이상자예후불량，MRI대예후판단개치최대。삼자종불동각도반영뇌손상정황，결합분석、동태관찰대정학진단、판단병정、치료효과급예후평고유중요의의，위환인회복기진행조기강복치료이개선예후제공료유개치적림상의거。
Objective To explore the prognostic value of serum neuron specific enolase( NSE),electroencephalo-gram( EEG ) and brain magnetic resonance imaging ( MRI ) for children with viral encephalitis combined with convul-sion. Methods 65 children diagnosed as viral encephalitis combined with convulsion admitted to the People's Hospital of Weifang form January 2008 to December 2012 were involved into the study. According to the results of serum NSE,EEG and brain MRI, the children were divided into abnormal NSE group,abnormal EEG group and abnormal MRI group. The children with coma and focal signs were defined as severe cases. The rate of severe case,the recovery rate after three months and the sequela rate of nerv-ous system after six months were recorded and the factors influencing prognosis were analyzed by univariate and multivariate Logis-tic regression analysis. Results Among the 65 children,43 cases had abnormal NSE( 66. 2%),58 cases had abnormal EEG (89. 2%)and 36 cases had abnormal MRI(55. 4%). The severe case rate,recovery rate and sequela rate of the three groups all showed statistically significant differences(P<0. 05). The severe case rate in abnormal MRI group was higher than the ab-normal EEG group( P<0. 01 ) . The recovery rate in abnormal EEG group and abnormal NSE group was higher than abnormal MRI group(P<0. 01). The sequela rate in abnormal MRI group was higher than abnormal EEG group(P<0. 01). Univariate Logistic analysis showed that abnormal NSE,EEG,MRI and the combination with multiple organ damage could influence the prognosis of children with viral encephalitis combined with convulsion(P<0. 05). Multivariate Logistic analysis showed that ab-normal NSE,MRI and the combination of multiple organ damage are risk factors for bad prognosis(P<0. 05). Conclusion Serum NSE,EEG and brain MRI are important auxiliary examination methods for children with viral encephalitis and convulsion, among which MRI is most valuable one. The children with abnormal serum NSE and brain MRI usually have poor prognosis. The a-bove-mentioned three indicators can reflect brain damage from different angles,and combined analysis and dynamic observation have important clinical significance to correctly determine the condition and treatment effects,assess prognosis and provide valua-ble clinical basis for the children in order to improve the prognosis through early intervention in the rehabilitation of the patients.
