128例合并神经系统症状流行性感冒患儿的临床特征

Clinical characteristics of 128 children with influenza complicated with nervous system symptoms

目的探讨合并神经系统症状流行性感冒(流感)患儿的临床特点。方法回顾性分析2019年1月至12月首都医科大学附属北京地坛医院收治的流感合并神经系统症状的128例患儿,对其临床资料、实验室检查指标及头颅影像学资料、转归及预后进行分析;根据诊断,将其分为热性惊厥(FS)组(108例)、流感相关脑病/脑炎(IAE)组(14例)和癫痫发作组(6例)。本研究中计量资料均不符合正态分布,以[M(P25,P75)]表示,组间比较采用Kruskal-Wallis检验。计数资料采用[例(%)]表示,组间比较采用Fisher’s确切概率法。结果128例流感合并神经系统症状患儿主要的临床表现为发热、抽搐。FS组、IAE组及癫痫发作组患儿在发病年龄(H=10.678、P=0.005)、性别(P=0.018)、神经系统基础疾病(P=0.049)、意识障碍(P<0.001)、抽搐(P<0.001)和癫痫持续状态(P<0.001)差异均有统计学意义;IAE组患儿门冬氨酸氨基转移酶(AST)和肌酸激酶同工酶(CK-MB)较其他两组升高,3组间差异有统计学意义(H=6.198、P=0.045,H=11.201、P=0.004)。FS组和癫痫发作组患儿均预后良好,IAE组死亡4例(28.6%),遗留神经系统后遗症者2例(14.3%)。结论流感儿童的神经系统症状主要为热性惊厥,有癫痫基础的可能出现癫痫发作,预后均良好,少数患儿会出现意识障碍,进展为IAE,有神经系统后遗症及死亡风险。

Objective To investigate the clinical characteristics of influenza in children with neurological symptoms.Methods Total of 128 children with influenza complicated with neurological symptoms admitted to Beijing Ditan Hospital,Capital Medical University from January to December 2019 were analyzed,retrospectively.Clinical data,laboratory and cranial imaging data,outcomes and prognosis were analyzed,respectively.According to the diagnosis,108(84.4%)cases were divided into febrile seizures(FS)group,14(10.9%)cases were collected into influenza-associated encephalopathy/encephalitis(IAE)group and 6(4.7%)cases were collected into epileptic seizure group.Measurement data without normal distribution were represented as M(P25,P75),comparison between groups was performed by Kruskal-Wallis test.Count data were represented by[cases(%)],and comparison between groups was performed using Fisher’s exact probability method.Results The main clinical manifestations were fever and convulsion in 128 children with influenza and nervous system symptoms.There were significant differences in age(H=10.678,P=0.005),gender(P=0.018),neurological underlying diseases(P=0.049),disorders of consciousness(P<0.001),convulsions(P<0.001)and epileptic status(P<0.001)among FS group,IAE group and epileptic group.Aspartate aminotransferase(AST)and creatine kinase isoenzyme(CK-MB)of cases in IAE group were significantly higher than those of the other two groups,and the difference among the three groups were statistically significant(H=6.198,P=0.045;H=11.201,P=0.004).The prognosis of children in FS group and epileptic seizure group were good.Among IAE group,4(28.6%)cases died and 2(14.3%)cases had neurological sequelae.Conclusions Neurologic symptoms of in children with influenza are mainly febrile convulsion,epileptic seizure,and the prognosis is good.A few children can appear disturbance of consciousness,and progress as IAE,which may occur neurological sequelae and the risk of death.