轮状病毒肠炎惊厥的临床特点及惊厥多发危险因素分析

Analysis of clinical features of convulsion in rotavirus enteritis and the risk factors for multiple convulsion

目的分析轮状病毒肠炎伴发惊厥患儿的临床特征及惊厥多发的危险因素。方法回顾性分析西安市儿童医院2018年1月至2021年3月收治的轮状病毒肠炎伴发惊厥患儿的临床资料,根据惊厥时有无发热分为热性惊厥(FS)组和无热惊厥(AFS)组。结果入组274例轮状病毒肠炎伴惊厥的患儿中,FS组男∶女为2.26∶1,AFS组男∶女为1∶1.1;AFS组中位呕吐次数较FS组多[4(2,6)次/d比2(1,5)次/d,P<0.01]。FS组以惊厥1次为主(80.68%),AFS组大多惊厥≥2次(62.90%);FS组惊厥多发生于病程第1天(60.23%),而AFS组惊厥主要发生在病程的第2~3天(79.57%);而两组在惊厥持续时间及总病程方面比较差异无统计学意义(P>0.05)。FS组中超敏C反应蛋白中位数、降钙素原中位数均高于AFS组[5.52(1.45,15.50)mg/L比0.98(0.50,3.17)mg/L、0.17(0.07,0.46)μg/L比0.06(0.05,0.15)μg/L];AFS组中丙氨酸氨基转移酶、天冬氨酸氨基转移酶、尿酸、肌酸激酶同工酶的中位数均高于FS组[28.00(21.00,34.25)U/L比25.00(19.00,31.00)U/L、53.00(45.00,62.00)U/L比50.00(40.00,58.00)U/L、390.00(296.00,474.25)μmol/L比331.00(250.00,399.75)μmol/L、67.00(49.75,94.25)U/L比59.50(37.25,78.75)U/L],差异有统计学意义(P<0.05)。惊厥≥3次组年龄中位数、尿酸水平中位数高于惊厥≤2次组[21(18,26)个月比18(15,21)个月、411.00(296.50,496.50)μmol/L比364.00(278.00,440.50)μmol/L],而血清Na+中位数、Cl-平均值均低于惊厥≤2次组[135.50(133.75,137.25)mmol/L比136.60(134.50,138.20)mmol/L、(103.76±3.26)mmol/L比(105.08±4.26)mmol/L],差异有统计学意义(P<0.05);轮状病毒肠炎并惊厥的患儿中年龄≥18个月龄(OR=3.359,P=0.002,95%CI 1.544~7.307)、血清Cl-<104.8 mmol/L(OR=2.17,P=0.019,95%CI 1.138~4.138)的患儿病程中发生惊厥≥3次的风险增加。结论轮状病毒肠炎FS多发生于病程第1天,大多惊厥1次,常有超敏C反应蛋白、降钙素原升高;而AFS多发生于病程的第2~3天,惊厥多≥2次,常有丙氨酸氨基转移酶、天冬氨酸氨基转移酶及尿酸升高;年龄≥18个月龄及血清Cl-<104.8 mmol/L的患儿,其病程中惊厥≥3次的风险增加。

Objective To analyze the clinical features of convulsion in rotavirus enteritis and the risk factors of multiple convulsion.Methods The clinical data of children with rotavirus enteritis complicated with convulsion admitted to Xi'an Children's Hospital from January 2018 to March 2021 were retrospectively analyzed.According to whether there was fever during convulsion,they were divided into febrile seizure(FS)group and afebrile seizure(AFS)group.Results A total of 274 children with rotavirus enteritis accompanied by convulsion were enrolled.The male to female ratio was 2.26∶1 in the FS group,while the male to female ratio was 1∶1.1 in the AFS group.The median number of vomiting in the AFS group was higher than that in the FS group:4(2,6)times per day vs.2(1,5)times per day,P<0.01.One convulsion was dominant in the FS group(80.68%),and more than two convulsions in the AFS group(62.90%).In the FS group,60.23%of convulsions occurred on the first day of the course of disease,while in the AFS group,79.57%of convulsions mainly occurred on the second and third day of the course of disease.There was no statistical difference in duration of convulsion and overall course of disease between the two groups(P>0.05).The median of hypersensitive C-reactive protein(CRP)and procalcitonin(PCT)in FS group were higher than those in AFS group:5.52(1.45,15.50)mg/L vs.0.98(0.50,3.17)mg/L,0.17(0.07,0.46)μg/L vs.0.06(0.05,0.15)μg/L.The median of alanine aminotransferase(ALT),aspartate aminotransferase(AST),uric acid(UA)and creatine kinase isoenzyme(CK-MB)in the AFS group were higher than those in the FS group:28.00(21.00,34.25)U/L vs.25.00(19.00,31.00)U/L,53.00(45.00,62.00)U/L vs.50.00(40.00,58.00)U/L,390.00(296.00,474.25)μmol/L vs.331.00(250.00,399.75)μmol/L,67.00(49.75,94.25)U/L vs.59.50(37.25,78.75)U/L,the differences were statistically significant(P<0.05).The median age and the median of UA levels in≥3 convulsions group were higher than those in≤2 convulsions group:21(18,26)months vs.18(15,21)months,411.00(296.50,496.50)μmol/L vs.364.00(278.00,440.50)μmol/L,while the median of serum Na+,the mean value of serum Cl-in the≥3 convulsions group were lower than those in the≤2 convulsions group:135.50(133.75,137.25)mmol/L vs.136.60(134.50,138.20)mmol/L,(103.76±3.26)mmol/L vs.(105.08±4.26)mmol/L,the differences were statistically significant(P<0.05).The age≥18 months in children with rotavirus enteritis and convulsion(OR=3.359,P=0.002,95%CI 1.544-7.307)and the serum Cl-<104.8 mmol/L(OR=2.17,P=0.019,95%CI 1.138-4.138)had an increased risk of convulsions≥3 times during the course of rotavirus enteritis.Conclusions Rotavirus enteritis FS mostly occurred on the first day of the course of disease,most of them had convulsion once,hs-CRP and PCT were relatively high.In AFS,convulsions were more than 2 times,and occurred on the 2nd and 3rd day of the course of disease.ALT,AST and UA were relatively high.Children with age≥18 months and serum Cl-<104.8 mmol/L had an increased risk of convulsions≥3 times during the course of the disease.