儿童病毒性脑炎急性期临床病理特征对继发癫痫的影响  

Risk Factors and Prognosis of Secondary Epilepsy in Children with Viral Encephalitis

作　　者：黄亮[1,2] 俞丹[3] 罗蓉[3] 李敏[4] 周晖[3] 蔡晓唐[3] 汪志凌[3] 

机构地区：[1]四川大学华西第二医院药学部/循证药学中心,成都610041 [2]出生缺陷与相关妇儿疾病教育部重点实验室,成都610041 [3]四川大学华西第二医院儿科,成都610041 [4]四川大学华西药学院,成都610041

出　　处：《四川大学学报（医学版）》2017年第2期257-262,共6页Journal of Sichuan University(Medical Sciences)

基　　金：四川省科技厅学术和技术带头人培养基金(No.2012DTPY0030)资助

摘　　要：目的探讨儿童病毒性脑炎急性期临床病理特征对继发癫痫的发生、控制情况和预后的影响。方法纳入2010年1月至2014年1月我院收治的病毒性脑炎患儿,回顾性分析其继发性癫痫控制情况,运用格拉斯哥预后量表评价患儿预后,对急性期临床病理特征(包括临床表现、病毒学、脑电监测、影像学等)资料进行统计分析,采用多因素logistic回归分析病毒性脑炎继发癫痫、癫痫控制差及预后不良的危险因素。结果(1)共纳入506例病毒性脑炎患儿,经1.5年以上随访,继发癫痫58例(11.46%)。(2)Logistic回归分析示急性期反复抽搐发作(标准偏回归系数=3.602)、脑电监测到临床发作(标准偏回归系数=3.061)、癫痫持续状态(标准偏回归系数=2.711)、精神行为性格改变(标准偏回归系数=1.850)为病毒性脑炎患儿继发癫痫的危险因素。(3)继发性癫痫患儿中40例控制好(74.07%),其中37例(92.5%)使用≤2种抗癫痫药物;logistic回归分析未提示病毒性脑炎继发癫痫患儿癫痫控制差的危险因素。(4)格拉斯哥预后量表评分示24例预后不良(41.38%),主要表现为智力运动落后(20例,83.33%)。单因素分析提示急性期癫痫持续状态在继发性癫痫患儿不同预后组间存在差异(P<0.05),logistic回归分析未提示病毒性脑炎继发癫痫患儿预后不良的危险因素。结论急性期精神行为性格改变、多次抽搐发作、癫痫持续状态、脑电监测到临床发作是儿童病毒性脑炎继发性癫痫的危险因素,但急性期的临床病理特征与病毒性脑炎继发癫痫临床控制差和临床预后不良无关。Objective To investigate the clinical features of viral encephalitis in children at acute stage, and the relationship of these clinical features with post viral encephalitic epilepsy. Methods The children with viral encephalitis treated in West China Second University Hospital between January 2010 and January 2014 were enrolled. The clinical features included general conditions, clinical manifestations, video electroencephalogram （VEEG）, neuroimaging, virology, prognosis and antiepileptic drugs. The logistic regression model analysis was utilized to analyze the risk factors for the occurrence, bad control, and poor prognosis of post viral encephalitic epilepsy. Results Total 506 children with viral encephalitis were enrolled. Of these, 58（11.46%）developed epilepsy with a follow-up period more than 1.5 years. The logistic regression analysis showed that the risk factors were repetitive seizures （SB =3.602）, detection of clinical seizures in EEG （SB =3.061）, status epilepticus （SB =2.711） and mental/behavior disorder （SB =1.850）. Among 58 epilepsy cases, 40（74.07%） had favorable seizure control, including 37 cases （92.5%） using no more than two kinds of antiepileptic drugs. With Glasgow Outcome Scale, 24 patients （41.38%） had poor prognosis, including 20 cases of intellectual and psychomotor retardation （83.33%）, 3 cases of language disorders （12.50%）, 1 case of hearing impairment （4.17%）, 3 cases of limb dysfunction （12.50%）, 3 cases of mortalities （12.50%）. Single factor analysis suggested status epilepticus in acute [CM（155.3mm]phase had more chance to poor prognosis,but this was not confirmed by logistic regression analysis. The risk factors of post viral encephalitic epilepsy in pediatric patients comprise the mental/behavior disorder, repetitive seizures, status epilepticus, and detection of clinical seizures during VEEG monitoring. The risk factors of poor prognosis remain unclear.

关 键 词：病毒性脑炎 癫痫 儿童 危险因素 预后 

分 类 号：R725.1[医药卫生—儿科]