病毒性脑炎近期与远期预后分析

The analysis of recent and long-term prognosis in patients with viral encephalitis

目的比较病毒性脑炎(VE)患者近期与远期预后,并探讨影响预后的危险因素。方法收集2009年4月至2013年6月105例VE患者临床资料,依据格拉斯哥预后量表(GOS)分级,将出院时患者分为近期预后良好组(78例),近期预后不良组(27例),对105例研究对象排除失访后进行远期随访,分为远期预后良好组(69例)与远期预后不良组(16例),选取14个因素进行单因素相关分析,对有统计学意义的因素进入Logistic回归分析。结果近期预后良好组有8例(12%)评为远期预后不良组,近期预后不良组有11例(58%)评为远期预后良好组。单因素分析显示发热与开始阿昔洛韦治疗时间差、脑电图、格拉斯哥昏迷量表(GCS)评分、癫痫及血清钠浓度与VE患者近期及远期预后均有关,多因素分析显示GCS评分≤8分(OR=46.431,P=0.003;OR=20.896,P=0.026)与血钠浓度<135 mmol/L(OR=8.842,P=0.004;OR=4.39,P=0.091)两个因素均为近期、远期预后的危险因素,远期预后的危险因素还包括>3次癫痫发作(OR=12.712,P=0.001)。结论 VE的预后由多因素共同作用影响,且出院时近期预后危险因素不能完全预测远期预后。GCS评分≤8分与血钠浓度<135 mmol/L是同时影响近期与远期预后的重要危险因素。

Objective To examine patients outcome at hospital discharge compared with that at long-term follow-up visits, and to assess the related factors which affect the prognosis outcome of viral encephalitis （VE）. Methods A clinical study was performed about 105 cases with viral encephalitis between April,2009 and June, 2013. The patients were assessed and their outcomes were graded with a Glasgow outcome scale（GOS） at hospital discharge and at follow-up appointments, and they were divided into good prognosis group and poor prognosis group respectively. Fourteen related risk factors were chosen and multifactor Logistic regression analysis was made. Results Eight patients who experienced improvement at hospital discharge,experienced deterioration in their outcome grade at long-term follow-up. 11 patients who experienced deterioration at long-term follow-up, had a good prognosis at hospital discharge, univariate analysis showed, decreased serum sodium, abnormal electroencephalogram, seizures, the time interval between the initial fever and acyclovir therapy, and Glasgow coma score （ GCS ） with short-term prognosis, but Multivariate analysis showed that GCS ≤ 8 （ OR = 46.431, P = 0. 003 ; OR = 20. 896, P = 0. 026）, and the level of serum sodium 〈 135 mmol/L （ OR = 8. 842, P = 0. 004 ; OR = 4. 39, P = 0. 091 ） were risk factors of the recent and long-term prognosis, and 〉 3 witnessed seizures （ OR = 12. 712, P = 0. 001 ） was risk factor of the long-term prognosis. Conclusions The prognosis of viral encephalitis relates with many factors, neurological assessment of viral encephalitis survivors at hospital discharge does not predict long-term outcome. GCS≤8, and the level of serum sodium 〈 135 mmol/L are risk factors for a poor outcome at hospital discharge and at long-term follow-up visits.