儿童急性播散性脑脊髓炎的神经电生理特点分析  

Neuroelectrophysiological Characteristics of Pediatric Acute Disseminated Encephalomyelitis

作　　者：刘静[1] 靳梅[1,2] 王永刚 张梅杰 孙素真[1,2] LIU Jing;JIN Mei;WANG Yong-gang;ZHANG Mei-jie;SUN Su-zhen(The Children Hospital of Hebei Province,Shijiazhuang 050000,China;The Key Laboratory of Pediatric Epilepsy and Neurological Disorders of Hebei Province,Shijiazhuang 050000,China)

机构地区：[1]河北省儿童医院,石家庄050000 [2]河北省小儿癫间与神经疾病重点实验室,石家庄050000

出　　处：《中国临床神经科学》2025年第1期50-56,共7页Chinese Journal of Clinical Neurosciences

基　　金：2019年河北省医学科学研究重点课题计划(编号:20190806)。

摘　　要：目的 探讨急性播散性脑脊髓炎(ADEM)患儿的脑诱发电位特点,并进一步分析脑诱发电位在ADEM早期诊断中的价值。方法 回顾分析2017年11月至2021年12月收治的34例诊断为ADEM患儿(ADEM组)的临床资料;另选择同期因“头痛、行为异常”就诊,诊断为偏头痛、儿童情绪障碍患儿为对照组。以影像学异常为金标准,评价单项检测与联合应用电生理指标:脑干听觉诱发电位(BAEPs)、视觉诱发电位(VEPs)及体感诱发电位(SEPs)诊断ADEM的敏感度、特异度、阳性预测值、阴性预测值、准确度以及Kappa值(κ值)。结果 ADEM组中BAEPs表现为Ⅲ、Ⅴ波潜伏期延长,VEPs为P100潜伏期延长,SEPs为N20和P25波形分化差。BAEPs单独应用的敏感度、特异度、准确度分别为64.71%、96.67%、79.69%,与影像学异常呈中度一致性(κ=0.60);VEPs单独应用的敏感度、特异度、准确度分别为70.59%、93.33%、81.25%,与影像学异常呈中度一致性(κ=0.63);SEPs单独应用的敏感度、特异度、准确度分别为50%、96.67%、71.88%,与影像学异常间的一致性较差(κ=0.45);BAEPs+VEPs+SEPs联合应用的敏感度、特异度、准确度分别为94.12%、86.67%、90.63%,与影像学异常呈高度一致(κ=0.81)。BAEPs单独应用诊断的阳性率为64.71%,VEPs单独应用诊断的阳性率为70.59%,SEPs单独应用诊断的阳性率为50%,BAEPs+VEPs+SEPs联合应用诊断的阳性率为94.12%,联合应用与单独应用BAEPs、VEPs、SEPs比较,差异均有统计学意义(均P<0.05)。结论 脑诱发电位异常高风险提示存在中枢神经系统传导通路受损,BAEPs+VEPs+SEPs联合应用在早期协助诊断ADEM中具有重要临床应用价值。Aim To identify the characteristics of brain evoked potentials(BAEPs,VEPs and SEPs)in children with acute disseminated encephalomyelitis(ADEM),and further analyze the value of brain evoked potentials in the early diagnosis of ADEM.Methods The clinical data of 34 patients with ADEM admitted to the department of neurology from November 2017 to December 2021 were retrospectively analyzed.Patients diagnosed with migraine and emotional disorders were selected as the control group.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Kappa value(κvalue)of single detection and combination of electrophysiological indicators in the diagnosis of ADEM were evaluated using magnetic resonance imaging(MRI)abnormalities as the gold standard.Results In ADEM group,BAEPs showed prolonged latency ofⅢandⅤwaves,VEPs showed prolonged latency of P100 waves,and SEPs showed poor waveform differentiation of N20 and P25 waves.MRI used as the diagnostic criterion,the sensitivity,specificity,and accuracy(κwas 0.81)of multimodal EPs were highly consistent with those of MRI,and the validity could be ranked in the following order with respect to the diagnosis of ADEM:multimodal EPs>single VEPs>single BAEPs>single SEPs.Of 34 patients with ADEM,abnormalities in multimodal EPs were 94.12%,while abnormalities in single VEPs,BAEPs and SEPs were 70.59%,64.71%and 50%,respectively.There were significant differences between single VEPs-BAEPs-SEPs and multimodal EPs(P<0.05).Conclusion The combined application of multimodal EPs was superior to BAEPs,VEPs,or SEPs alone in detecting the existence of central nerve demyelination,which indicated these modalities will be applicable in the early diagnosis of ADEM.

关 键 词：急性播散性脑脊髓炎 儿童 脑干听觉诱发电位 视觉诱发电位 体感诱发电位 

分 类 号：R744.53[医药卫生—神经病学与精神病学]