儿童小脑性共济失调的病因及胃肠道术后感染后急性小脑性共济失调的临床特征分析  

Etiology of cerebellar ataxia in children and clinical characteristics of acute post-infectious cerebellar ataxia after gastrointestinal surgery

作　　者：张建昭[1] 孙静[1] 李冬青[1] 刘钊[1] 马才惠 李冠男[1] 杨健[1] Zhang Jianzhao;Sun Jing;Li Dongqing;Liu Zhao;Ma Caihui;Li Guannan;Yang Jian(Department of Neurology,Children's Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院神经内科,北京100020

出　　处：《北京医学》2024年第6期466-469,473,共5页Beijing Medical Journal

摘　　要：目的 探讨儿童小脑性共济失调(cerebellar ataxia, CA)的病因及胃肠道术后感染后急性小脑性共济失调(acute post-infectious cerebellar ataxia, APCA)的临床特征。方法 选取2007年1月至2023年1月首都儿科研究所附属儿童医院神经内科CA患儿428例,分析CA的病因及胃肠道术后APCA的临床特征。结果 428例患儿中,男251例,女177例,年龄0.8~13岁,平均(4.3±2.1)岁。主要病因为APCA(349例,81.54%)、急性小脑炎(15例,3.50%)、遗传代谢性CA(13例,3.04%)等。349例APCA患儿中,存在胃肠道手术史的患儿181例,其他病因的CA无手术史。有胃肠道手术史的APCA患儿发病时间与手术间隔时间为0.8~2.6年。与无胃肠道手术史的APCA患儿相比,有胃肠道手术史的APCA患儿男性占比较高、年龄较小、共济失调持续天数较短、免疫治疗占比较低、复发率较高,差异均有统计学意义(P<0.05)。APCA患儿存在1~3次复发者56例(13.08%),其中42例(75.00%,42/56)有胃肠道手术史。结论 CA病因较多,临床诊疗过程中应做好鉴别诊断。APCA为最常见病因,有胃肠道手术史的APCA患儿容易出现病情复发,但预后良好。Objective To explore the etiology of cerebellar ataxia(CA)in children and the clinical characteristics of acute post-infectious cerebellar ataxia(APCA)after gastrointestinal surgery.Methods A total of 428 children with in Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2007 to January 2023 were selected,and the etiology of CA and clinical characteristics of APCA after gastrointestinal surgery were analyzed.Results Among the 428 cases,there were 251 males and 177 females,aged from 0.8 years to 13 years,with an average of(4.3±2.1)years.The main etiology were APCA(349 cases,81.54%),acute cerebellar encephalitis(15 cases,3.50%),and hereditary metabolic CA(13 cases,3.04%).Among the 349 cases of APCA,181 patients had a history of gastrointestinal surgery,while there were no cases of CA with other causes with a history of gastrointestinal surgery.The onset time of APCA after gastrointestinal surgery ranged from 0.8 to 2.6 years after the surgery.Compared with APCA patients without a history of gastrointestinal surgery,patients with a history of gastrointestinal surgery had a higher proportion of males,a younger age,a shorter duration of ataxia,a lower proportion of immunotherapy,and a higher recurrence rate,and the differences were statistically significant(P<0.05).There were 56 cases of recurrence(13.08%)among the APCA patients,of which 42 cases(75.00%)had a history of gastrointestinal surgery.Conclusions There are many etiology of CA,so differential diagnosis should be made in clinical diagnosis and treatment.APCA is the most common etiology.Children with a history of gastrointestinal surgery are more likely to have recurrent disease,but the prognosis is good.

关 键 词：小脑性共济失调 感染后急性小脑性共济失调 儿童 病因 胃肠道 手术 

分 类 号：R744.7[医药卫生—神经病学与精神病学]