病毒性脑炎患儿的临床特点及预后影响因素研究  

Clinical Features of Children with Viral Encephalitis and the Influencing Factors of Prognosis

作　　者：隋英[1] 郭静[2] SUI Ying;GUO Jing(Department of Pediatrics,the People′s Hospital of Dezhou,Dezhou 253014,China)

机构地区：[1]山东省德州市人民医院儿科,253014 [2]山东省立医院血液内科

出　　处：《实用心脑肺血管病杂志》2016年第12期38-42,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的分析病毒性脑炎(VE)患儿的临床特点及预后影响因素。方法选取德州市人民医院儿科2011年3月-2015年2月收治的VE患儿92例,根据儿童格拉斯哥预后量表(CGOS)评分分为预后不良组(CGOS评分1~3分,n=24)和预后良好组(CGOS评分4~5分,n=68),比较两组患儿性别、年龄、既往上呼吸道感染病史、发热至治疗时间、治疗情况(抗病毒治疗、激素治疗)、临床症状(头痛、发热、意识障碍、精神行为异常、恶心呕吐、癫痫)、病情严重程度、影像学检查结果〔脑电图异常、磁共振成像(MRI)检查结果异常、颅脑CT检查结果异常、肌力异常〕、实验室检查指标(外周血白细胞计数、血钠、血钾、脑脊液蛋白含量)、CGOS评分、病变部位(颞叶、额叶、脑干)、病灶数目(单个、多个),分析VE患儿预后影响因素。结果 VE患儿临床症状以头痛、发热、精神行为异常、恶心呕吐为主。两组患儿性别、年龄、既往上呼吸道感染史阳性率、采用激素治疗者所占比例、发热发生率、恶心呕吐发生率、颅脑CT检查结果异常率、外周血白细胞计数、血钾及脑脊液蛋白含量比较,差异无统计学意义(P>0.05);预后不良组患儿发热至治疗时间长于预后良好组,采用抗病毒治疗者所占比例、头痛发生率、血钠、CGOS评分低于预后良好组,意识障碍发生率、精神行为异常发生率、癫痫发生率、重症患儿所占比例、脑电图异常率、MRI检查结果异常率、肌力异常发生率、病变部位为颞叶及脑干者所占比例、病灶数目为多个者所占比例高于预后良好组(P<0.05)。多因素logistic回归分析结果显示,发热至治疗时间〔OR=7.344,95%CI(1.601,33.662)〕、意识障碍〔OR=1.569,95%CI(1.092,2.395)〕、病情严重程度〔OR=1.465,95%CI(1.039,3.214)〕、MRI检查结果异常〔OR=16.262,95%CI(2.865,38.226)〕、血钠〔OR=13.547,95%CI(2.741,48.664)〕、CGOS评分〔OR=20.431,95%CI(3.805,82.4Objective To analyze the clinical features and influencing factors of prognosis of children with viral encephalitis. Methods From March 2011 to February 2015,a total of 92 children with viral encephalitis were selected in the Department of Pediatrics,the People’s Hospital of Dezhou;according to Children’s Glasgow Outcome Scale( CGOS),all of the children were divided into A group( with CGOS score within 1 to 3,n = 24) and B group( within CGOS score within 4 to 5,n= 68). Gender, age, previous history of upper respiratory infection, duration between fever and treatment, therapeutic methods( including anti-virus therapy and hormonotherapy), clinical symptoms( including headache,fever, conscious disturbance,mental and behavior disorder,nausea and vomiting and epilepsy),disease severity,imaging examination results( including abnormal results of EEG examination, MRI examination, craniocerebral CT examination and myodynamia examination), laboratory examination results( including peripheral blood WBC, blood sodium, blood potassium and cerebrospinal fluid protein content),CGOS score,leison regions( including temporal lobe,frontal lobe and brainstem) and number of nidus( single or multiple) were compared between the two groups,and influencing factors of prognosis of children with viral encephalitis were analyzed. Results Headache,fever,mental and behavior disorder,nausea and vomiting were the major clinical symptoms of children with viral encephalitis. No statistically significant differences of gender,age,positive rate of previous history of upper respiratory infection,proportion of children treated with hormonotherapy,incidence of fever,nausea or vomiting,abnormal rate of craniocerebral CT examination results,peripheral blood WBC,blood potassium or cerebrospinal fluid protein content was found between the two groups( P > 0. 05);duration between fever and treatment of A group was statistically significantly longer than that of B group,proportion of children treated with anti-virus therapy,incidence of headache,blood so

关 键 词：脑炎 病毒性 疾病特征 预后 危险因素 

分 类 号：R512.3[医药卫生—内科学]