中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2015年
20期
1577-1580
,共4页
黄欢欢%洪舒婷%陈素清%林希%吴斌
黃歡歡%洪舒婷%陳素清%林希%吳斌
황환환%홍서정%진소청%림희%오빈
病毒%中枢神经系统%不良预后%格拉斯哥预后评分
病毒%中樞神經繫統%不良預後%格拉斯哥預後評分
병독%중추신경계통%불량예후%격랍사가예후평분
Virus%Central nervous system%Poor prognosis%Glasgow outcome scale
目的：探讨影响急性中枢神经系统（CNS）病毒感染患儿近期不良预后的危险因素，为指导临床治疗提供依据。方法选择2010年1月至2013年6月在福建医科大学附属第一医院儿科临床诊断为急性CNS 病毒感染的住院患儿为研究对象，根据出院时格拉斯哥预后评分结果将患儿分为预后良好组和预后不良组，对2组患儿临床资料与其近期预后间关系进行单因素分析和二分类 Logistic 回归模型多因素分析。结果301例患儿纳入研究，近期预后良好组278例（92.36％），预后不良组23例（7.64％）。单因素分析显示，入院前病程、发热总时间、脑脊液白细胞计数、血钙值、早期意识障碍、多次惊厥发作、惊厥性癫持续状态、脑膜刺激征阳性、肌力异常、脑电图（EEG）重度异常、颅脑影像学（计算机断层扫描和/或磁共振成像）异常在2组间比较差异均有统计学意义（P 均约0.05）；多因素分析筛选出4个独立危险因素：早期意识障碍（0R ＝4.885，95％ CI：1.523~15.670，P ＝0.008）、多次惊厥发作（0R ＝6.352，95％ CI：1.905~21.178，P ＝0.003）、EEG 重度异常（0R ＝4.269，95％ CI：1.708~10.666，P ＝0.002）、颅脑影像学异常（0R ＝9.740，95％ CI：2.360~40.192， P ＝0.002）。结论早期意识障碍、多次惊厥发作、EEG 重度异常、颅脑影像学异常是小儿急性 CNS 病毒感染近期不良预后的危险因素。
目的：探討影響急性中樞神經繫統（CNS）病毒感染患兒近期不良預後的危險因素，為指導臨床治療提供依據。方法選擇2010年1月至2013年6月在福建醫科大學附屬第一醫院兒科臨床診斷為急性CNS 病毒感染的住院患兒為研究對象，根據齣院時格拉斯哥預後評分結果將患兒分為預後良好組和預後不良組，對2組患兒臨床資料與其近期預後間關繫進行單因素分析和二分類 Logistic 迴歸模型多因素分析。結果301例患兒納入研究，近期預後良好組278例（92.36％），預後不良組23例（7.64％）。單因素分析顯示，入院前病程、髮熱總時間、腦脊液白細胞計數、血鈣值、早期意識障礙、多次驚厥髮作、驚厥性癲持續狀態、腦膜刺激徵暘性、肌力異常、腦電圖（EEG）重度異常、顱腦影像學（計算機斷層掃描和/或磁共振成像）異常在2組間比較差異均有統計學意義（P 均約0.05）；多因素分析篩選齣4箇獨立危險因素：早期意識障礙（0R ＝4.885，95％ CI：1.523~15.670，P ＝0.008）、多次驚厥髮作（0R ＝6.352，95％ CI：1.905~21.178，P ＝0.003）、EEG 重度異常（0R ＝4.269，95％ CI：1.708~10.666，P ＝0.002）、顱腦影像學異常（0R ＝9.740，95％ CI：2.360~40.192， P ＝0.002）。結論早期意識障礙、多次驚厥髮作、EEG 重度異常、顱腦影像學異常是小兒急性 CNS 病毒感染近期不良預後的危險因素。
목적：탐토영향급성중추신경계통（CNS）병독감염환인근기불량예후적위험인소，위지도림상치료제공의거。방법선택2010년1월지2013년6월재복건의과대학부속제일의원인과림상진단위급성CNS 병독감염적주원환인위연구대상，근거출원시격랍사가예후평분결과장환인분위예후량호조화예후불량조，대2조환인림상자료여기근기예후간관계진행단인소분석화이분류 Logistic 회귀모형다인소분석。결과301례환인납입연구，근기예후량호조278례（92.36％），예후불량조23례（7.64％）。단인소분석현시，입원전병정、발열총시간、뇌척액백세포계수、혈개치、조기의식장애、다차량궐발작、량궐성전지속상태、뇌막자격정양성、기력이상、뇌전도（EEG）중도이상、로뇌영상학（계산궤단층소묘화/혹자공진성상）이상재2조간비교차이균유통계학의의（P 균약0.05）；다인소분석사선출4개독립위험인소：조기의식장애（0R ＝4.885，95％ CI：1.523~15.670，P ＝0.008）、다차량궐발작（0R ＝6.352，95％ CI：1.905~21.178，P ＝0.003）、EEG 중도이상（0R ＝4.269，95％ CI：1.708~10.666，P ＝0.002）、로뇌영상학이상（0R ＝9.740，95％ CI：2.360~40.192， P ＝0.002）。결론조기의식장애、다차량궐발작、EEG 중도이상、로뇌영상학이상시소인급성 CNS 병독감염근기불량예후적위험인소。
Objective To study the risk factors for children with acute central nervous system(CNS)viral in-fection,so that pediatrician may identify children with poor prognosis at early stages of the disease,and provide them with a theoretical basis for clinical treatment. Methods The clinical data of a cohort patients of acute CNS viral infec-tion who were hospitalized at the First Affiliated Hospital of Fujian Medical University between January 2010 and June 2013 were retrospectively collected and analyzed. According to Glasgow outcome scale on discharge,children were di-vided into good prognosis group and poor prognosis group. Clinical data and outcomes were analyzed by using univariate analysis and binary Logistic regression multivariate analysis. Results Three hundred and one cases were enrolled,278 (92. 36% )patients were assigned to the good prognosis group,and 23(7. 64% )patients were assigned to the poor prognosis group. By univariate analysis,the patients in the poor prognosis group had longer duration of sickness before admission,longer time of fever,lower white blood cell count in cerebrospinal fluid,a relatively lower calcium level,con-scious disturbance at the early stage,multiple seizures,convulsive status epilepticus,meningeal irritation sign,muscle weakness,severe changes in electroencephalogram(EEG),and abnormal neuroimaging findings(computed tomography or magnetic resonance imaging,or both)had significant differences between the good prognosis group and the poor short - term outcome groups(all P < 0. 05). By binary Logistic regression multivariate analysis,factors indicating a poor prognosis during the early stage were conscious disturbance at the early stage(0R = 4. 885,95% CI:1. 523 - 15. 670, P = 0. 008),multiple seizures(0R = 6. 352,95% CI:1. 905 - 21. 178,P = 0. 003),severe changes in EEG( 0R =4. 269,95% CI:1. 708 - 10. 666,P = 0. 002),and abnormal neuroimaging findings( 0R = 9. 740,95% CI:2. 360 -40. 192,P = 0. 002). Conclusions Conscious disturbance at the early stage,multiple seizures,severe changes in EEG and abnormal neuroimaging findings are risk factors for acute viral infection of CNS in children.
