Calgary晕厥惊厥评分及其改良评分在儿童晕厥和癫痫鉴别诊断中的意义  

Significance of the Calgary Syncope Seizure Scores and the Modified Calgary Syncope Seizure Scores for dif-ferential diagnosis of syncope or epilepsy in children

作　　者：祝立平[1,2] 吴礼嘉[1] 邹润梅[1] 林萍[1] 李芳[1] 罗海燕[1] 毛定安[1] 王成[1] 

机构地区：[1]中南大学湘雅二医院儿童医学中心儿童心血管专科,中南大学儿科学研究所,长沙410011 [2]长沙市中心医院新生儿科,410004

出　　处：《中华实用儿科临床杂志》2016年第1期19-22,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：湖南省发展改革委员会课题[湘财企指2015（83）号]

摘　　要：目的探讨Calgary晕厥惊厥评分（CSSS）及Calgary晕厥惊厥改良评分（MCSSS）在儿童晕厥和癫痫鉴别诊断中的意义。方法2013年10月至2014年4月在中南大学湘雅二医院儿童晕厥专科门诊及儿童神经专科门诊就诊，至少有1次一过性意识丧失（TLOC）病史并确诊为晕厥或癫痫的儿童201例，男95例，女106例；年龄5-18岁[（11．76±3．03）岁]。采用CSSS、MCSSS及其受试者工作特征（ROC）曲线分析不同评分对鉴别儿童晕厥或癫痫的预测价值及意义。结果CSSS晕厥儿童为-4（-6，1），癫痫儿童为2（-3，5），二者差异有统计学意义（Z=-11．63，P〈0．01）。以CSSS≥1分为界值对儿童晕厥或癫痫进行鉴别的灵敏度和特异度分别为91．46％及95．80％，Youden指数为0．87。当CSSS≥1分时，可能为癫痫。MCSSS晕厥儿童为-4（-6，1），癫痫儿童为3（-3，6），二者差异有统计学意义（Z=-11．71，P〈0．01）。以MCSSS≥1分为界值对晕厥或癫痫患儿进行鉴别的灵敏度和特异度分别为92．68％及96．64％，Youden指数为0．89。当MCSSS≥1分时，可能为癫痫。结论CSSS及MCSSS可作为儿童临床上鉴别晕厥和癫痫的初步方法，MCSSS较CSSS更加客观，在临床工作中易于操作。Objective To analyze the significance of the Calgary Syncope Seizures Scores （CSSS） and the Modified Calgary Syncope Seizure Scores （MCSSS） for differential diagnosis of syncope or epilepsy in children. Methods Totally 201 children[95 male,and 106 female,aged 5 - 18 years,mean age （11.76 ±3.03） years] with syncope or epilepsy who visited the syncope clinic or admitted to the Department of Nerve Specialty Clinic of Pediatrics, the Second Xiangya Hospital of Central South University from October 2013 to April 2014 were included in the study. Patients were eligible if they had 〉I 1 loss of consciousness. The diagnosis was analyzed by the CSSS and the MCSSS and receiver operating characteristic （ ROC ） curve was used to explore the predictive value of different scores in differential diagnosis of syncope or epilepsy in children. Results There were significant differences in the CSSS be- tween syncope t - 4 （ - 6,1 ） ] and epilepsy [ 2 （ - 3,5 ） 1 in children （ Z = - 11.63, P 〈 0.01 ）. When the score was 〉t 1, the sensitivity and specificity of the differential diagnosis between syncope and epilepsy were 91.46% and 95.80% , respectively ; and Youden index was 0.87. Epilepsy should be considered when the score was i〉 1. There were significant differences in the MCSSS between syncope [ - 4 （ - 6,1 ） ] and epilepsy [ 3 （ - 3,6 ） ] in children （ Z = - 11.71, P 〈 0. 01 ）. When the score was ≥ 1, the sensitivity and specificity of the differential diagnosis between syncope and epilep- sy were 92.68% and 96.64%, respectively;and Youden index was 0.89. Epilepsy should be considered when the score was ≥ 1. Conclusions CSSS and MCSSS might be used as an initial diagnostic method in differential diagnosis be- tween syncope and epilepsy in children, based on the history of the patients. MCSSS in the differential diagnosis between syncope and epilepsy in children was more objective,easier to operate in the clinical work than CSSS.

关 键 词：Calgary评分 晕厥 惊厥 癫痫 血管迷走神经性 儿童 

分 类 号：R742.1[医药卫生—神经病学与精神病学]