儿童MOGAD中急性症状性癫痫发作及继发癫痫的相关因素分析  

Related factors of acute symptomatic seizures and epilepsy in children with myelin oligodendrocyte glycoprotein antibody-associated disease

作　　者：李尚茹 常旭婷 张捷[1] 滕新岭 吴晔[1] Li Shangru;Chang Xuting;Zhang Jie;Teng Xinling;Wu Ye(Department of Pediatrics,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院儿科,北京100034

出　　处：《中华儿科杂志》2024年第7期655-660,共6页Chinese Journal of Pediatrics

摘　　要：目的了解髓鞘少突胶质细胞糖蛋白抗体相关疾病(MOGAD)中急性症状性癫痫发作(ASS)和继发癫痫的相关因素。方法采用双向队列研究, 纳入2013年1月至2023年6月北京大学第一医院儿科就诊的74例MOGAD患儿进行长期随访。收集患儿人口学信息、临床发作信息、治疗情况、ASS和继发癫痫情况。按临床发作表型进行分类, 并根据患儿病程中是否存在ASS分为有ASS组和无ASS组。采用χ^(2)检验、Fisher确切检验、Mann WhitneyU检验等分析两组患儿的症状及辅助检查特点与ASS发生的相关性, 采用多因素Logistic回归分析进行多因素分析。结果 74例MOGAD患儿起病年龄6.58(3.80, 9.67)岁, 其中女38例、男36例, 末次随访时病程2.67(1.10, 4.12)年, 共计239次急性临床发作。39.2%(29/74)患儿病程中出现ASS。239次急性临床发作中发生ASS 70次(29.3%)。239次急性临床发作病程中常见的表型为急性播散性脑脊髓炎(ADEM)67次(28.0%)、视神经炎37次(15.5%)和大脑皮质脑炎31次(13.0%), ADEM和大脑皮质脑炎表型ASS发生率分别为28.4%(19/67)和100.0%(31/31)。剔除单纯累及视神经或脊髓的急性临床发作49次后, 多因素分析提示临床发作期间头颅磁共振成像大脑皮质受累为ASS发生的独立危险因素(β=-1.49, OR=0.23)。随访中5例(6.8%)患儿继发癫痫, 均有多次MOGAD急性临床发作, 均曾出现ASS。结论 MOGAD患儿临床发作期间头颅磁共振成像大脑皮质受累为发生ASS的独立危险因素。继发癫痫的患儿既往均有ASS且均有多次MOGAD临床发作。ObjectiveTo investigate the risk factors of acute symptomatic seizures(ASS)and epilepsy in children with myelin oligodendrocyte glycoprotein antibody-associated disease(MOGAD).MethodsA ambispective cohort study was used including 74 children with MOGAD who were admitted to the Department of Pediatrics of Peking University First Hospital from January 2013 to June 2023 and were followed up.Demographic information,clinical information,treatment status,ASS and epilepsy status were collected.The clinical phenotypes were classified.According to the presence or absence of ASS in the course of disease,the children and the course of disease were divided into groups with and without ASS.Chi-square test,Fisher exact test and Mann Whitney U test were used to analyze the correlation between symptoms and auxiliary examination characteristics and the occurrence of ASS in the two groups of children.Multivariate Logistic regression analysis was used for multivariate analysis.ResultsThe onset age of the 74 children with MOGAD was 6.58(3.80,9.67)years,including 38 females(51.4%)and 36 males(48.6%).The duration of the final follow-up was 2.67(1.10,4.12)years,with a total of 239 times acute clinical episodes.ASS occurred in 39.2%(29/74)children during the course of disease and in 29.3%(70/239)of attacks.The common phenotypes were ADEM(67 times(28.0%)),optic neuritis(37 times(15.4%))and cerebral cortical encephalitis(31 times(13.0%))in 239 times acute clinical episodes.The incidence of ASS in ADEM and cerebral cortical encephalitis phenotype was 28.4%(19/67)and 100.0%(31/31),respectively.Multivariate analysis showed that cortical involvement on magnetic resonance imaging during clinical attacks was an independent risk factor for ASS(β=-1.49,OR=0.23)after excluding attacks involving only optic nerve or spinal cord(49 episodes).During the follow-up,5 children(6.8%)had epilepsy,and all children with epilepsy had multiple clinical attacks of MOGAD and previous ASS.ConclusionsCortical involvement on magnetic resonance imaging during clini

关 键 词：儿童 髓鞘少突胶质细胞糖蛋白抗体相关疾病 癫痫发作 癫痫 

分 类 号：R742.1[医药卫生—神经病学与精神病学]