儿童肠道病毒性脑炎的临床特点及预后分析

Clinical characteristics and prognosis of enteroviral encephalitis in children

目的探讨儿童肠道病毒性脑炎(EVE)的临床特点以及对患儿预后的影响。方法选取2018年1月-2019年1月南阳市中心医院儿科就诊EVE患儿259例(其中6个月~3岁53例,>3~6岁91例,>6~15岁115例),在所有患儿入院确诊后,对其进行综合治疗,根据儿童格拉斯哥预后量表(CGOS)分为预后良好组(n=177)和预后不良组(n=82)。收集患儿的临床资料,包括性别、年龄、发病症状、实验室检查[白细胞(WBC)、C反应蛋白(CRP)、肝功能指标、心肌酶指标]、病原学检查、脑电图检查、随访6个月,并观察其预后情况等;Logistic多因素分析预后危险因素。结果肠道病毒性脑炎患儿表现为发热、头痛、呕吐、WBC总数>10×10^(9)/L、CRP上升,部分患儿可伴肝功能异常或脑电图轻中度异常。不同年龄患儿发热、头痛、呕吐症状比较差异有统计学意义(P<0.05)。Logistic多因素分析显示,发热时间、精神性行为异常、意识状态异常、惊厥、脑MRI异常、肺部感染、呼吸衰竭、应激性高血糖是肠道病毒性脑炎患儿不良预后的危险因素,差异有统计学意义(P<0.05)。结论应根据患儿的临床特点对其进行早期诊断和治疗,并针对影响预后的危险因素采取措施进行预防或治疗,以提高患儿的生存质量。

Objective To investigate the clinical characteristics and prognosis of enteroviral encephalitis(EVE)in children.Methods From January 2018 to January 2019,259 children with EVE(including 53 cases of 6 months to 3 years old,91 cases of>3 to 6 years old,and 115 cases of>6 to 15 years old)were selected from the Pediatric Department of NanyangCentral Hospital.All children were treated with comprehensive treatment after admission to hospital.According to theChildren’s Glasgow Outcome Scale(CGOS),they were divided into two groups:good prognosis group(n=177)and poorprognosis group(n=82).The clinical data of the children were collected,including sex,age,symptoms,laboratoryexamination[white blood cell(WBC),C reactive protein(CRP),liver function index,myocardial enzyme index],etiological examination,electroencephalogram(EEG)examination,follow-up for 6 months,and the prognosis was observed.The prognostic risk factors were analyzed by Logistic multivariate analysis.Results Children with enterovirus encephalitisshowed fever,headache,vomiting,total WBC>10×10^(9)/L,and CRP increased.Some children may be associated withabnormal liver function or mild to moderate EEG.Fever,headache,and vomiting were statistically significant in children ofdifferent ages(P<0.05).Logistic multivariate analysis,fever time,abnormal mental behavior,abnormal state ofconsciousness,convulsions,abnormal brain MRI,pulmonary infection,respiratory failure,and stress hyperglycemia arerisk factors for poor prognosis in children with enterovirus encephalitis(P<0.05).Conclusion Early diagnosis andtreatment should be carried out according to the clinical characteristics of the children,and measures should be taken toprevent or treat the risk factors that affect the prognosis in order to improve the quality of life of the children.