振幅整合脑电图联合甲状腺激素、格拉斯哥昏迷评分评价重症脑炎患儿脑功能预后研究

The value of amplitude integrated electroencephalogram combined with thyroid hormone and Glasgow comascore in evaluat­ing the prognosis of brain function in children with severe encephalitis

目的 探讨振幅整合脑电图(aEEG)联合游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、格拉斯哥昏迷(GCS)评分评价重症脑炎患儿脑功能预后价值。方法 回顾性分析自2019年8月至2021年8月收治的72例重症脑炎患儿的临床资料,在患儿出院时根据大脑及整体表现分类量表结果分为预后良好组(n=28)和预后不良组(n=44)。选取同期体检的32例健康儿童作为健康组,观察3组aEEG评分、FT3、FT4、TSH及GCS评分,各个指标与重症脑炎患儿脑功能预后采用Pearson分析相关性,采用受试者工作特征(ROC)曲线评估各指标及联合检测情况。结果 预后不良组与预后良好组aEEG评分高于健康组,且预后不良组高于预后良好组,差异均有统计学意义(P<0.05);预后不良组与预后良好组FT3、FT3/FT4及GCS评分均低于健康组,且预后不良组低于预后良好组,差异均有统计学意义(P<0.05)。aEEG评分与脑炎患儿脑功能预后呈负相关(r=-0.547,P<0.001),FT3、FT3/FT4及GCS评分与脑炎患儿脑功能预后呈正相关(r=0.341、0.462、0.387,P<0.001)。最佳界限以aEEG评分(8.17分),FT3(4.23 pmonl/L)、FT3/FT4(0.28)、GCS评分(9.66分)可获得最大ROC曲线下面积(AUC)。联合检测AUC均大于单项检测,差异有统计学意义(P<0.001)。联合检测敏感度为73.6%、特异度为96.4%。结论 aEEG联合甲状腺激素中FT3、FT3/FT4及GCS评分对重症脑炎患儿脑功能预后具有一定的应用价值,联合检测能更全面评估重症脑炎患儿脑功能预后,有利于临床及时制定干预方案。

Objective To investigate the prognosis of brain function in children with severe encephalitis by amplitude integrated electroencephalogram(aEEG)combined with free triiodothyronine(FT3),free thyroxin(FT4),thyroid-stimulating hormone(TSH)and Glasgow coma Scale(GCS)scores in thyroxine.Methods A retrospective study was performed on 72 children with severe encephalitis admitted to our hospital from August 2019 to August 2021.Children were divided intothe good prognosis group(n=28)andthe poor prognosis group(n=44)by pediatric brain and global performance classification scale at discharge after treatment.Thirty-two healthy children were selected as the healthy group during the same period.The aEEG score,FT3,FT4,TSH and GCS scores were observed in the three groups.Pearson analysis was used to analyze the correlation between indexes and the prognosis of brain function in children with severe encephalitis.The receiver operator characteristic curve(ROC)was used to evaluate the predictive ability of combined detection of each index for the prognosis of brain function in children with severe encephalitis.Results The aEEG score of poor prognosis group and good prognosis group was higher than that in healthy group,and the AEEG score of poor prognosis group was higher than that in good prognosis group,The scores of FT3,FT3/FT4 and GCS scores in the poor prognosis group and the good prognosis group were lower than those in the healthy group,and the poor prognosis group was lower than that in the good prognosis group,the difference was statistically significant(P<0.05).aEEG score was negatively correlated with the prognosis of brain function in children with encephalitis(r=-0.547,P<0.001),FT3,FT3/FT4 and GCS scores were positively correlated with the prognosis of brain function in children with encephalitis(r=0.341、0.462、0.387,P<0.001).According to the ROC curve,the maximum area under the ROC curve can be obtained by aEEG score(8.17 points),FT3(4.23 pmonl/L),FT3/FT4(0.28)and GCS score(9.66 points),and the area under curveis larger than the single detection area(P<0.001).The sensitivity is 73.6%and the specificity is 96.4%.Conclusions The aEEG combined with FT3,FT3/FT4 and GCS scores in thyroid hormone has certain application value in the prognosis of brain function in children with severe encephalitis.Combined detection can more comprehensively evaluate the prognosis of brain function in children with severe encephalitis,which is conducive to timely clinical intervention program and improve its prognosis.