小儿重症病毒性脑炎临床特点、预后及其相关因素分析

Clinical features,prognosis,and related factors of severe viral encephalitis in children

目的了解重症病毒性脑炎(SVE)患儿的临床特点及预后,探讨影响其预后的相关因素。方法回顾性分析2014年1月—2016年1月湖南省儿童医院神经内科及重症监护病房收治的102例SVE患儿临床资料,根据预后将患儿分为预后良好组[24例,儿童格拉斯哥预后评分量表(CGOS)评级4~5级]和预后不良组(78例,CGOS评级1~3级),比较两组患儿临床资料,分析影响SVE患儿预后的危险因素。结果预后良好组中,痊愈15例,9例有轻度后遗症;预后不良组中,14例死亡,25例留有严重后遗症,39例有中度后遗症。预后良好组患儿发热持续时间、住院时间均短于预后不良组,差异具有统计学意义(均P<0.05)。多因素非条件logistic回归分析显示:惊厥持续状态、呼吸衰竭、发热持续时间长(>5 d)、脑电图重度异常、头颅MRI累及病变超过2处或累及幕下以及应激性高血糖为SVE预后不良因素,其OR值分别为13.468、4.580、2.378、10.196、3.012、6.316。结论SVE严重威胁儿童的生存质量,伴有惊厥持续状态、呼吸衰竭、发热持续时间长、脑电图重度异常、头颅MRI累及病变超过2处或累及幕下以及应激性高血糖是影响儿童SVE预后的危险因素。

Objective To understand the clinical features and prognosis of children with severe viral encephalitis(SVE),evaluate the related factors affecting prognosis.Methods Clinical data of 102 children with SVE in pedia-tric neurological ward and pediatric intensive care unit in Hunan Children’s Hospital between January 2014 and January 2016 were analyzed retrospectively.According to prognosis,children were divided into good prognosis group(n=24,children’s Glasgow outcome scale[CGOS]:4-5)and poor prognosis group(n=78,CGOS:1-3),clinical data of two groups of children were compared,risk factors affecting the prognosis of SVE children were analyzed.Results In good prognosis group,15 cases were cured and 9 had mild sequelae;in poor prognosis group,14 cases died,25 had severe sequelae,and 39 had moderate sequelae.The duration of fever and length of hospital stay in good prognosis group were both shorter than poor prognosis group,difference was statistically significant(both P<0.05).Multivariate unconditioned logistic regression analysis showed that adverse factors for prognosis of SVE were as follows:convulsive status,respiratory failure,longer fever period(>5 days),severely abnormal electroencephalogram(EEG),head magnetic resonance imaging(MRI)lesions involving more than two sites or lesions involving the infratentorial,and stress hyperglycemia,odds ratio(OR)were 13.468,4.580,2.378,10.196,3.012,and 6.316 respectively.Conclusion SVE is a serious threat to quality of children’s life,convulsive status,respiratory failure,longer fever period,severely abnormal EEG,head MRI lesions involving more than two sites or lesions involving the infratentorial,and stress hyperglycemia are risk factors for prognosis of SVE in children.