炎症指标对新型冠状病毒奥密克戎变异株感染患儿惊厥发作的预测价值

Predictive value of inflammatory markers for convulsions in children infected with the severe acute respiratory syndrome coronavirus 2 Omicron variant

目的探讨炎症指标对新型冠状病毒奥密克戎变异株感染患儿惊厥发作的预测价值。方法选择2022年12月至2023年1月于福建省儿童医院各病区住院的奥密克戎变异株感染患儿共263例,根据有无惊厥发作,将纳入患儿分成惊厥组(93例)和非惊厥组(170例)。采用χ^(2)检验、独立样本t检验比较两组患儿的临床特征、实验室检查指标等。采用二元logistic回归分析炎症指标与惊厥发作的关系,采用受试者操作特征曲线(ROC曲线)评估血清淀粉样蛋白A(SAA)和白细胞介素-6(IL-6)预测患儿惊厥发作的效能。结果惊厥组患儿有基础疾病和热性惊厥病史者的占比分别为29.03%(27/93)和40.86%(38/93),分别高于非惊厥组的18.24%(31/170)和5.29%(9/170),差异均有统计学意义(χ^(2)=8.71、16.92,均P<0.05)。惊厥组的降钙素原、血清铁蛋白、IL-6、SAA、天冬氨酸转氨酶、肌酸激酶、肌酸激酶同工酶、纤维蛋白原均高于非惊厥组,差异均有统计学意义(t=-2.00、-1.54、-2.71、-5.04、-1.30、-2.03、-1.38、1.57,均P<0.05);红细胞沉降率、C反应蛋白、淋巴细胞计数、血尿素氮、血肌酐均低于非惊厥组,差异均有统计学意义(t=3.31、2.05、4.21、2.37、1.85,均P<0.05)。SAA和IL-6为奥密克戎变异株感染患儿惊厥发作的独立危险因素(均P<0.01)。ROC曲线分析显示,SAA和IL-6联合预测的曲线下面积为0.833(P<0.01),灵敏度为0.724,特异度为0.843,其中SAA预测奥密克戎变异株感染患儿惊厥发作的最佳临界值为141.40 mg/L,IL-6为85.05 ng/L。结论SAA联合IL-6可作为奥密克戎变异株感染患儿惊厥发作的早期预警指标,为临床及时诊治提供参考。

Objective To explore the predictive value of inflammatory markers for convulsions in children infected with the severe acute respiratory syndrome coronavirus 2 Omicron variant.Methods A total of 263 children infected with the Omicron variant admitted to various wards of Fujian Children′s Hospital from December 2022 to January 2023 were included in this study.Based on the presence or absence of convulsions,the children were divided into convulsions group(93 cases)and non-convulsions group(170 cases).Chi-square test and independent samples t-test were used to compare the clinical characteristics and laboratory indicators of the two groups.Binary logistic regression analysis was conducted to determine the relationship between inflammatory markers and convulsions,and receiver operator characteristic(ROC)curve was used to evaluate the efficacy of serum amyloid A(SAA)and interleukin-6(IL-6)for predicting convulsions occurrence in children.Results The convulsions group had proportions of 29.03%(27/93)with underlying medical conditions and 40.86%(38/93)with a history of febrile convulsions,which were both higher than the non-convulsions group′s proportions of 18.24%(31/170)and 5.29%(9/170),respectively.These differences were both statistically significant(χ^(2)=8.71 and 16.92,respectively,both P<0.05).In the convulsions group,levels of procalcitonin,serum ferritin,IL-6,SAA,aspartate aminotransferase,creatine kinase,creatine kinase-isoenzymes and fibrinogen were all significantly higher than those in the non-convulsions group.These differences were all statistically significant(t=-2.00,-1.54,-2.71,-5.04,-1.30,-2.03,-1.38 and 1.57,respectively,all P<0.05).Erythrocyte sedimentation rate,C-reactive protein,lymphocyte count,blood urea nitrogen and serum creatinine in the convulsions group were all lower than those in the non-convulsions group,with statistically significant differences(t=3.31,2.05,4.21,2.37 and 1.85,respectively,all P<0.05).SAA and IL-6 were identified as independent risk factors for convulsions in children infected with Omicron variant(both P<0.01).The ROC curve analysis showed that the area under the curve of predictive value of combined SAA and IL-6 was 0.833(P<0.01),with a sensitivity of 0.724 and specificity of 0.843.The optimal cutoff values for SAA and IL-6 in predicting convulsions in children infected with the Omicron variant were 141.40 mg/L and 85.05 ng/L,respectively.Conclusions The combination of SAA and IL-6 could serve as early predictive indicators for convulsions in children infected with the Omicron variant,which could provide valuable insights for timely clinical diagnosis and treatment.