血生化和脑脊液检测在儿童流感相关坏死性脑病早期预警中的价值

Value of blood biochemical and cerebrospinal fluid detection in early warning of influenza-associated necrotizing encephalopathy in children

目的儿童流感相关坏死性脑病(influenza-associated necrotizing encephalopathy,IANE)是一种严重的流感并发症,目前缺乏早期诊断预警指标,本文探讨血生化和脑脊液检测在儿童IANE早期预警中的作用,为IANE早期诊断提供预测参考。方法回顾分析2016年1月—2020年12月在我院接受诊治的确诊流感并发神经系统并发症的患儿。40例流感相关性脑病(influenza-associated encephalopathy,IAE)和32例IANE患儿纳入研究。采用受试者工作特征曲线(ROC)分析来确定所选变量的预警价值。结果与IAE组相比,IANE组丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酐激酶(CK)、乳酸脱氢酶(LDH)、脑脊液乳酸脱氢酶(CSF LDH)、脑脊液蛋白(CSF PRO)均升高,两组差别有统计学意义(P<0.05)。用于区分IAE和IANE的LDH、CSF LDH和CSF PRO的曲线下面积(AUC)分别为0.876、0.853和0.831。LDH>535 U/L预测IANE的敏感度为89.7%,特异度为86.5%。CSF LDH>67 U/L预测IANE的敏感度为82.8%,特异度为73.3%。CSF PRO>0.49 g/L预测IANE的敏感度为73.7%,特异度为76.6%。IANE患儿死亡10例(43.3%),IAE患儿死亡0例(P<0.05)。结论IANE组LDH、CSF LDH和CSF PRO明显升高,可作为IANE的早期预警指标。对此类患儿要密切评估,早期预测及干预,减少后遗症及病死率,改善预后。

Objective Influenza-associated necrotizing encephalopathy(IANE)in children is a serious complication of influenza.At present,there is a lack of indicators for early diagnosis and early warning.In this paper,the role of blood biochemical and cerebrospinal fluid detection in early warning of IANE in children is discussed,so as to provide a predictive reference for early diagnosis of IANE.Methods A retrospective analysis was conducted on children diagnosed with influenza and with neurological complications who were treated in our hospital from January 2016 to December 2020.Forty children with influenza-associated encephalopathy(IAE)and 32 children with IANE were included.Receiver operating characteristic curve(ROC)analysis was used to determine the predictive value of the selected variables.Results Compared with IAE group,the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine kinase(CK),lactate dehydrogenase(LDH),cerebrospinal fluid lactate dehydrogenase(CSF LDH)and cerebrospinal fluid protein(CSF PRO)were all increased in IANE group,and the differences between the two groups were statistically significant(P<0.05).The area under curve(AUC)of LDH,CSF LDH and CSF PRO used to distinguish IAE from IANE were 0.876,0.853 and 0.831,respectively.The sensitivity and specificity of LDH>535 U/L for predicting IANE were 89.7% and 86.5% respectively.The sensitivity and specificity of CSF LDH>67 U/L for predicting IANE were 82.8% and 73.3% respectively.The sensitivity and specificity of CSF PRO>0.49 g/L in predicting IANE were 73.7% and 76.6%.There were 10 deaths of IANE(43.3%)and 0 death of IAE(P<0.05).Conclusion The levels of LDH,CSF LDH and CSF PRO were significantly increased in IANE group,which could be used as early warning indicators for IANE.For such children,close evaluation,early prediction and intervention should be made to reduce sequelae and fatality rate and to improve prognosis.