视频脑电图监测对小儿中枢神经系统感染性疾病鉴别诊断价值及对患儿预后预测价值  

Value of Video Electroencephalogram Monitoring in Differential Diagnosis of Infectious Diseases of Central Nervous System in Children and Its Predictive Value for Prognosis

作　　者：王梓潺 朱洪涛[1] WANG Zichan;ZHU Hongtao(Department Three of Pediatrics,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院儿内三科,乌鲁木齐830054

出　　处：《医学综述》2023年第11期2279-2283,2288,共6页Medical Recapitulate

摘　　要：目的探讨视频脑电图(VEEG)监测对小儿中枢神经系统感染性疾病鉴别诊断价值及对患儿预后的预测价值。方法选取2020年5月至2021年5月新疆医科大学第一附属医院收治的92例疑似中枢神经系统感染患儿为研究对象,患儿入院后均接受临床病理学诊断、24 h VEEG监测。以临床病理学诊断结果为金标准,采用Kappa分析法评估VEEG监测结果与临床病理学诊断结果的一致性。根据临床病理诊断结果将患儿分为感染组、未感染组,比较两组患儿VEEG差异。对感染组VEEG异常患儿进行6个月的跟踪随访,根据认知功能评价、后遗症发生情况将患儿分为预后良好组、预后不良组,绘制受试者工作特征(ROC)曲线评估VEEG监测对小儿中枢神经系统感染性疾病的诊断价值,采用线性趋势检验法评估VEEG异常程度对患儿预后的预测价值。结果在92例疑似中枢神经系统感染患儿中,经临床病理学诊断,62例确诊中枢神经系统感染性疾病,其中病毒脑膜炎15例、化脓性脑膜炎24例、脑微循环障碍23例;经VEEG监测,60例确诊中枢神经系统感染性疾病,VEEG监测结果与临床病理学诊断结果的一致性良好(Kappa=0.951,P<0.001)。感染组患儿VEEG监测结果均显示异常,其中轻度异常占43.55%(27/62),中度异常占35.48%(22/62),重度异常占20.97%(13/62),未感染组患儿仅2例出现脑电图轻度异常,占6.67%(2/30),感染组VEEG监测结果异常占比明显高于未感染组(χ^(2)=83.183,P<0.001)。根据临床脑电图进行诊断,结果显示,以δ波广泛持续增多为主的VEEG重度异常患儿均表现为病毒性脑炎,以背景波形变慢为主的VEEG轻度异常、以广泛持续δ波为主的VEEG重度异常患者表现为病毒性脑炎、化脓性脑膜炎或脑微循环障碍,上述三种疾病VEEG改变缺乏特异性。随访6个月,感染组VEEG轻度异常、中度异常、重度异常患儿预后不良发生率分别为22.22%(6/27)、59.09%(13/22)、76.Objective To explore the value of video electroencephalogram(VEEG)monitoring in the differential diagnosis of infectious diseases of the central nervous system in children and in predicting the prognosis of the children.Methods A total of 92 children with suspected central nervous system infection admitted to the First Affiliated Hospital of Xinjiang Medical University from May 2020 to May 2021 were included in the study.All the children received clinicopathological diagnosis and 24-hour VEEG monitoring after admission.The consistency between VEEG monitoring results and clinicopathological diagnosis results was evaluated by Kappa analysis method with clinicopathological diagnosis results as the gold standard.According to the clinical pathological diagnosis,the children were divided into an infection group and a non-infection group,and the differences of VEEG between the two groups were compared.The children with abnormal VEEG in the infection group were followed up for 6 months.According to the evaluation of cognitive function and the occurrence of sequelae,the children were divided into a good prognosis group and a poor prognosis group.The receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of VEEG monitoring in children with central nervous system infectious diseases,and the linear trend test was used to evaluate the predictive value of VEEG abnormal degree on the prognosis of the children.Results Among the 92 children suspected of central nervous system infection,62 cases were diagnosed as central nervous system infectious diseases by clinicopathological diagnosis,including 15 cases of viral meningitis,24 cases of purulent meningitis,and 23 cases of cerebral microcirculation disorders;through VEEG monitoring,60 cases of central nervous system infectious diseases were confirmed,which showed that the VEEG monitoring results were in good consistency with the clinicopathological diagnosis results(Kappa=0.951,P<0.001).The VEEG monitoring results of children in the infection group

关 键 词：小儿中枢神经系统感染性疾病 视频脑电图 鉴别诊断 

分 类 号：R445.9[医药卫生—影像医学与核医学]