轻度胃肠炎伴良性惊厥与胃肠炎合并热性惊厥临床特征比较  

Comparison of clinical features between benign convulsions with mild gastroenteritis and febrile seizures with gastroenteritis

作　　者：丘晓颖 曾永梅 张纪泳[1] 肖菲[1] 郝金斗[1] 李伟艳 王媛媛[1] 陈柚燕 曾凡菲 董国庆[1] QIU Xiaoying;ZENG Yongmei;ZHANG Jiyong;XIAO Fei;HAO Jindou;LI Weiyan;WANG Yuanyuan;CHEN Youyan;ZENG Fanfei;DONG Guoqing(Department of Pediatrics,Shenzhen Maternity and Child Healthcare Hospital,Southern Medical University,Shenzhen 518028,China)

机构地区：[1]南方医科大学深圳妇幼保健院儿科,深圳518028

出　　处：《中国临床新医学》2025年第3期268-273,共6页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：深圳市科技计划项目(编号:JCYJ20220530155006013);深圳市“医疗卫生三名工程”项目(编号:SZSM202311021)。

摘　　要：目的比较轻度胃肠炎伴良性惊厥(CwG)和急性胃肠炎合并热性惊厥(FSwG)患儿的临床特征,为CwG早期评估和管理提供依据。方法回顾性收集南方医科大学深圳妇幼保健院儿科2018年1月至2021年12月因急性(胃)肠炎或腹泻病合并惊厥住院的99例1~72月龄患儿的临床资料,根据惊厥发作前后体温分成CwG组(无发热或体温<38℃,67例)和FSwG组(体温≥38℃,32例),比较两组患儿临床资料及转归。结果两组年龄、性别构成无显著差异,但CwG组发病更集中于>12~24月龄。CwG好发于秋冬季,FSwG好发于冬春季。CwG组惊厥丛集性发作比例显著高于FSwG组(46.27%vs 6.25%,P<0.05)。CwG组惊厥多发生于胃肠炎症状后>24~48 h,明显晚于FSwG组[(1.94±0.92)d vs(1.34±0.74)d,P<0.05]。CwG组C反应蛋白(CRP)、降钙素原(PCT)、前白蛋白(PAB)、HCO-3水平低于FSwG组,丙氨酸氨基转移酶(ALT)、尿酸(UA)、肌酸磷酸酶MB同工酶(CK-MB)水平高于FSwG组,差异有统计学意义(P<0.05)。两组病例急性期脑电图及头颅影像学检查未见明显异常。随访18个月至5年,CwG组失访12例,其余55例中1例再发胃肠炎伴无热惊厥1次;FSwG组失访4例,其余28例中再发热性惊厥5例。结论CwG是好发于1~2岁小儿的良性疾病,秋冬季多见,有丛集性发作倾向,一般预后良好,极少复发。当临床考虑CwG可能性大时,即使急性期存在丛集性发作,脑脊液检查、头颅影像学检查以及抗惊厥治疗也可能是非必要的。Objective To compare the clinical features between benign convulsions with mild gastroenteritis(CwG)and febrile seizure with gastroenteritis(FSwG)in pediatric patients,and to provide the basis for early assessment and management of CwG.Methods The clinical data of 99 pediatric patients aged 1-72 months who were hospitalized in Department of Pediatrics,Shenzhen Maternity and Child Healthcare Hospital,Southern Medical University for acute gastroenteritis or convulsion with diarrhea from January 2018 to December 2021 were retrospectively collected.According to the body temperature before and after convulsion,the pediatric patients were divided into CwG group(no fever or body temperature<38℃,67 cases)and FSwG group(body temperature≥38℃,32 cases).The clinical data and outcomes were compared between the two groups.Results There were no significant differences in age and gender composition between the two groups,but the onset time of the CwG group was more concentrated in the age of>12-24 months.CwG tended to occur in autumn and winter,while FSwG tended to occur in winter and spring.The proportion of seizure clusters in the CwG group was significantly higher than that in the FSwG group(46.27%vs 6.25%,P<0.05).The seizures in the CwG group were more likely to occur at>24-48 hours after gastroenteritis symptoms,and the occurrence of seizures in the CwG group was significantly later than that in the FSwG group[(1.94±0.92)d vs(1.34±0.74)d,P<0.05].The levels of C-reactive protein(CRP),procalcitonin(PCT),prealbumin(PAB)and HCO-3 in the CwG group were lower than those in the FSwG group,while the levels of alanine aminotransferase(ALT),uric acid(UA)and creatine kinase isoenzyme MB(CK-MB)in the CwG group were higher than those in the FSwG group,with statistically significant differences between the two groups(P<0.05).There were no obvious abnormalities in the pediatric patients′acute stage electroencephalogram(EEG)and skull imaging examination in the two groups.After follow-up of 18 months to 5 years,12 cases in the CwG

关 键 词：儿童 急性胃肠炎 惊厥 

分 类 号：R725.7[医药卫生—儿科]