急性中枢神经系统病毒感染患儿近期预后的危险因素

Risk factors influencing short - term prognosis of acute central nervous system viral infection in children

目的：探讨影响急性中枢神经系统（CNS）病毒感染患儿近期不良预后的危险因素，为指导临床治疗提供依据。方法选择2010年1月至2013年6月在福建医科大学附属第一医院儿科临床诊断为急性CNS 病毒感染的住院患儿为研究对象，根据出院时格拉斯哥预后评分结果将患儿分为预后良好组和预后不良组，对2组患儿临床资料与其近期预后间关系进行单因素分析和二分类 Logistic 回归模型多因素分析。结果301例患儿纳入研究，近期预后良好组278例（92.36％），预后不良组23例（7.64％）。单因素分析显示，入院前病程、发热总时间、脑脊液白细胞计数、血钙值、早期意识障碍、多次惊厥发作、惊厥性癫持续状态、脑膜刺激征阳性、肌力异常、脑电图（EEG）重度异常、颅脑影像学（计算机断层扫描和/或磁共振成像）异常在2组间比较差异均有统计学意义（P 均约0.05）；多因素分析筛选出4个独立危险因素：早期意识障碍（0R ＝4.885，95％ CI：1.523～15.670，P ＝0.008）、多次惊厥发作（0R ＝6.352，95％ CI：1.905～21.178，P ＝0.003）、EEG 重度异常（0R ＝4.269，95％ CI：1.708～10.666，P ＝0.002）、颅脑影像学异常（0R ＝9.740，95％ CI：2.360～40.192， P ＝0.002）。结论早期意识障碍、多次惊厥发作、EEG 重度异常、颅脑影像学异常是小儿急性 CNS 病毒感染近期不良预后的危险因素。

Objective To study the risk factors for children with acute central nervous system（CNS）viral in-fection,so that pediatrician may identify children with poor prognosis at early stages of the disease,and provide them with a theoretical basis for clinical treatment. Methods The clinical data of a cohort patients of acute CNS viral infec-tion who were hospitalized at the First Affiliated Hospital of Fujian Medical University between January 2010 and June 2013 were retrospectively collected and analyzed. According to Glasgow outcome scale on discharge,children were di-vided into good prognosis group and poor prognosis group. Clinical data and outcomes were analyzed by using univariate analysis and binary Logistic regression multivariate analysis. Results Three hundred and one cases were enrolled,278 （92. 36% ）patients were assigned to the good prognosis group,and 23（7. 64% ）patients were assigned to the poor prognosis group. By univariate analysis,the patients in the poor prognosis group had longer duration of sickness before admission,longer time of fever,lower white blood cell count in cerebrospinal fluid,a relatively lower calcium level,con-scious disturbance at the early stage,multiple seizures,convulsive status epilepticus,meningeal irritation sign,muscle weakness,severe changes in electroencephalogram（EEG）,and abnormal neuroimaging findings（computed tomography or magnetic resonance imaging,or both）had significant differences between the good prognosis group and the poor short - term outcome groups（all P ＆lt; 0. 05）. By binary Logistic regression multivariate analysis,factors indicating a poor prognosis during the early stage were conscious disturbance at the early stage（0R = 4. 885,95% CI：1. 523 - 15. 670, P = 0. 008）,multiple seizures（0R = 6. 352,95% CI：1. 905 - 21. 178,P = 0. 003）,severe changes in EEG（ 0R =4. 269,95% CI：1. 708 - 10. 666,P = 0. 002）,and abnormal neuroimaging findings（ 0R = 9. 740,95% CI：2. 360 -40. 192,P = 0. 002）. Conclusions Conscious disturbance at the early stage,multiple seizures,severe changes in EEG and abnormal neuroimaging findings are risk factors for acute viral infection of CNS in children.