341例儿童病毒性中枢神经系统感染临床特征及预后不良相关危险因素分析

Clinical features and risk factors of poor prognosis for 341 children with viral infections in the central nervous system

目的了解儿童病毒性中枢神经系统(central nervous system,CNS)感染的临床特征以及预后不良相关危险因素,为儿童病毒性CNS感染的早期防治提供参考依据。方法回顾性收集广东省妇幼保健院2013年1月—2017年6月收治的的341例在临床上诊断为病毒性CNS感染的儿童患者。收集患儿临床资料及脑脊液常规、生物化学、病毒检测结果,患儿入院的首次血常规、降钙素原、C反应蛋白检测结果,以及脑电图、头颅CT、头颅核磁共振成像(magnetic resonance imaging,MRI)检查结果。根据格拉斯哥预后量表(Glasgow outcome scale,GOS)评分,将患儿分为预后良好组(n=214)和预后不良组(n=96),采用单因素及多因素logistic回归模型分析,探讨影响预后的相关危险因素。结果儿童病毒性CNS感染首发症状以发热及皮疹最常见。单因素分析结果显示皮疹、抽搐、头痛头晕、脑脊液糖异常、脑脊液蛋白质升高、外周血血小板下降、头颅MRI异常、脑电图异常、头颅CT异常、巨细胞病毒(cytomegalovirus,CMV)阳性、单纯疱疹病毒I型(herpes simplex virus-1,HSV-1)阳性、发病至入院时间、发病至腰椎穿刺时间,与儿童病毒性CNS感染预后不良有相关性(P<0.05)。多因素logistic回归分析显示,头颅MRI检查异常和发病至腰穿时间与儿童病毒性CNS感染预后不良有相关性(P<0.05)。结论发热及皮疹是儿童病毒性CNS感染最常见的首发症状;头颅MRI异常、发病至腰椎穿刺时间是儿童病毒性CNS感染近期预后不良的两个重要因素。

Objective To study the clinical features and risk factors of poor prognosis for 341 children with viral infections in the central nervous system(CNS).Methods A total of 341 cases of children with viral CNS infection in the Women and Children Hospital of Guangdong Province from January 2013 to June 2017 were retrospectively collected.Cerebrospinal fluid test results were collected,including CSF routine,biochemical and viral tests,as well as the first blood routine,procalcitonin and C-reactive protein test results of the hospitalized children,and electroencephalogram,craniocerebral CT and craniocerebral magnetic resonance imaging(MRI)examination results.According to the Glasgow outcome score(GOS),patients were divided into a group of good prognosis(n=214)and a group of poor prognosis(n=96).Univariate and multivariate logistic regression models were used to analyze the risk factors affecting the prognosis.Results Fever and rash were the most common first symptoms in children with viral CNS infection.Univariate analysis showed that the rash,convulsions,headache and dizziness,abnormal cerebrospinal fluid glucose,cerebrospinal fluid protein increased,peripheral blood thrombocytopenia,abnormal craniocerebral MRI,abnormal electroencephalogram,abnormal craniocerebral CT,positive CMV,positive HSV-1,time from onset to admission,and time from onset to lumbar puncture,were associated with poor prognosis of viral CNS infection in children(P<0.05).Multivariate logistic regression analysis showed that abnormal craniocerebral MRI and the time from onset to lumbar puncture were associated with poor prognosis of children with viral CNS infection(P<0.05).Conclusions Fever and rash are the most common first symptoms of viral CNS infection in children.Abnormal craniocerebral MRI and the time from onset to lumbar puncture are two important factors for poor prognosis in the short term of viral CNS infection.