儿童局灶性脑动脉病的临床特点及预后影响因素分析  

Analysis of clinical features and prognostic factors of focal cerebral arteriopathy in children

作　　者：卓秀伟[1] 于泽谋 孟令丙 周季 张炜华[1] 任长红[1] 巩帅[1] 代丽芳[1] 杨欣英[1] 张珅[1] 刘明[1] 程华[1] 田小娟 李久伟[1] Zhuo Xiuwei;Yu Zemou;Meng Lingbing;Zhou Ji;Zhang Weihua;Ren Changhong;Gong Shuai;Dai Lifang;Yang Xinying;Zhang Shen;Liu Ming;Cheng Hua;Tian Xiaojuan;Li Jiuwei(Department of Neurology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Cardiology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院神经内科,北京100045 [2]北京清华长庚医院心脏内科、清华大学临床医学院,北京102218

出　　处：《中华儿科杂志》2025年第2期174-179,共6页Chinese Journal of Pediatrics

摘　　要：目的总结儿童局灶性脑动脉病(FCA)的临床特点并分析其预后的影响因素。方法回顾性队列研究。收集2015年9月至2024年8月首都医科大学附属北京儿童医院神经内科住院的40例FCA患儿的临床资料,在2024年10月通过门诊或互联网进行集中随访,根据儿童卒中结局量表(PSOM)评价患儿转归并分为神经功能正常组及神经功能异常组。采用Mann-WhitneyU检验、Fisher确切概率法分析组间差异,采用单因素Logistic回归分析寻找FCA患儿神经功能结局的影响因素。结果40例FCA患儿中男、女各20例,起病年龄9.2(6.8,12.5)岁。12例(30%)患儿有卒中前1年内水痘病史。40例患儿中,23例(58%)以短暂性脑缺血发作或反复波动症状起病,3例(8%)在发病第1个月内表现为进展性脑卒中,受累血管部位以大脑中动脉的M1段为最常见[16例(40%)],8例(20%)患儿存在动脉闭塞。36例进行腰椎穿刺的患儿中6例脑脊液白细胞升高。23例患儿完成了磁共振血管壁成像(VWI),均存在动脉管壁环形强化。28例(70%)接受抗血小板或抗凝治疗,16例(40%)接受激素治疗。入院时美国国立卫生研究院儿童卒中量表(PedNIHSS)评分为6.0(2.0,8.8)分,出院时降至0.5(0,3.0)分。随访时间为1.6(0.8,4.9)年,1例失访,完成随访的39例患儿中神经功能正常组23例(59%)、神经功能异常组16例(41%)。1例曾有复发,表现为短暂性脑缺血发作。29例患儿影像学复查,23例末次磁共振动脉血管成像(MRA)示原有的动脉狭窄保持稳定或好转,其中6例病程早期动脉狭窄曾短暂恶化(病程2个月内);6例末次复查MRA提示动脉狭窄进展,其中1例为进展性脑动脉病。神经功能异常组头痛、意识改变及失语的比例,入院及出院PedNISS评分均高于神经功能正常组(均P<0.05)。单因素Logistic回归分析发现,仅有入院时PedNISS评分>6分是神经功能异常的影响因素(OR=20.58,95%CI 3.93~107.70,P<0.001)。结论儿童FCA多以波动性Objective To summarize the clinical characteristics of focal cerebral arteriopathy(FCA)in children,and to analyze its influencing factor of prognosis.Methods A retrospective cohort study was conducted.Clinical data from 40 children with FCA who were hospitalized at the Department of Neurology,Beijing Children′s Hospital,Capital Medical University,from September 2015 to August 2024 were collected.A centralized follow-up was conducted in October 2024 via outpatient clinics or the internet.The pediatric stroke outcome measure(PSOM)was used to evaluate their outcomes.Based on the PSOM,the children were further divided into a group with normal neurological function and another group with abnormal neurological function.Differences between groups were analyzed using the Mann-Whitney U test and Fisher exact test.Univariate Logistic regression analysis was performed to identify the influencing factors for neurological outcomes in children with FCA.Results A total of 40 children were included,with 20 males and 20 females,and the onset age of 9.2(6.8,12.5)years.Among them,12 cases(30%)had a history of varicella within 1 year before onset.There were 23 cases(58%)presenting with transient ischemic attack(TIA)or recurrent fluctuating symptoms of onset,while 3 cases(8%)developed progressive stroke within the first month of onset.The M1 segment of the middle cerebral artery was the most commonly affected vascular site,with a total of 16 cases(40%).Arterial occlusion occurred in 8 cases(20%).Lumbar puncture was completed in 36 children,and white blood cell counts in cerebrospinal fluid was increased in 6 cases.All 23 patients who completed magnetic resonance vessel wall imaging(VWI)showed circular enhancement of the arterial wall.A total of 28 patients(70%)received antiplatelet or anticoagulation therapy,and 16 patients(40%)received hormone therapy.At admission,the pediatric National Institute of Health Stroke Scale(PedNIHSS)score was 6.0(2.0,8.8)points,which decreased to 0.5(0,3.0)points at discharge.The follow-up duration was

关 键 词：儿童 局灶性脑动脉病 卒中 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]