摘要
目的探讨病毒性脑炎急性期痫性发作(ASS)患儿脑炎后癫痫(PE)的发生率及影响因素。方法回顾性分析2013年9月至2018年7月郑州大学第一附属医院收治的132例ASS患儿的临床资料,根据最后随访时是否为PE,将患儿分为PE组(62例)和非PE组(70例)。采用多因素Logistic回归方法分析ASS患儿发生PE的危险因素。结果PE发生率为46.97%(62/132例)。PE组精神行为异常[19.4%(12/62例)比2.9%(2/70例)]、反复痫性发作(次数>5)[67.7%(42/62例)比17.1%(12/70例)]、癫痫持续状态(SE)[30.6%(19/62例)比11.4%(8/70例)]、全面性痫样发作[72.6%(45/62例)比88.6%(62/70例)]、气管插管[21.0%(13/62例)比2.9%(2/70例)]、热程[5.5(3.0,11.0)d比3.0(2.0,6.0)d]、重症监护室(ICU)住院时间[13(5,21)d比6(3,8)d]、脑电图痫样异常[49.1%(27/55例)比6.8%(4/59例)]、头颅影像学示皮质下受累[37.3%(22/55例)比20.3%(14/59例)]与非PE组比较差异均有统计学意义(均P<0.05)。多因素Logistic回归分析示,反复痫性发作(次数>5)(OR=5.256,95%CI:1.538~17.961,P=0.008)、SE(OR=6.003,95%CI:1.411~25.539,P=0.015)、脑电图痫样异常(OR=36.693,95%CI:7.031~191.485,P<0.01)、ICU住院时间(OR=1.170,95%CI:1.058~1.298,P=0.002)是ASS患儿发生PE的独立危险因素。结论ASS患儿PE发生率高;急性期反复痫性发作(次数>5)、出现SE、脑电图痫样异常、ICU住院时间长的ASS患儿更易发生PE。
Objective To discuss the incidence rate and influencing factors of postencephalitic epilepsy(PE)in children with viral encephalitis at acute symptomatic seizure(ASS).Methods The data of 132 children with ASS in the First Affiliated Hospital of Zhengzhou University from September 2013 to July 2018 were retrospectively analyzed,and the patients were divided into PE group(62 cases)and non-PE group(70 cases)according to whether they had PE at final follow-up.The risk factors of PE in children with ASS were analyzed using the multivariate Logistic regre-ssion methods.Results The incidence of PE in children with ASS was 46.97%(62/132 cases).There were statistically significant differences in terms of psychological and behavioral abnormalities[19.4%(12/62 cases)vs.2.9%(2/70 cases)],repetitive seizures(more than 5 seizures)[67.7%(42/62 cases)vs.17.1%(12/70 cases)],status epilepticus(SE)[30.6%(19/62 cases)vs.11.4%(8/70 cases)],generalized seizures[72.6%(45/62 cases)vs.88.6%(62/70 cases)],endotracheal intubation[21.0%(13/62 cases)vs.2.9%(2/70 cases)],the duration of fever[5.5(3.0,11.0)d vs.3.0(2.0,6.0)d],the duration in the intensive care unit(ICU)[13(5,21)d vs.6(3,8)d],electroencephalography epileptiform discharges[49.1%(27/55 cases)vs.6.8%(4/59 cases)],presence of subcortical involvement on neuroimaging[37.3%(22/55 cases)vs.20.3%(14/59 cases)]in children with ASS between the PE group and the non-PE group(all P<0.05).The multivariate Logistic regression analysis showed that repetitive seizures(more than 5 seizures)(OR=5.256,95%CI:1.538-17.961,P=0.008),SE(OR=6.003,95%CI:1.411-25.539,P=0.015),electroencephalography epileptiform discharges(OR=36.693,95%CI:7.031-191.485,P<0.01)and the duration in ICU(OR=1.170,95%CI:1.058-1.298,P=0.002)were the risk factors for PE in children with ASS.Conclusions The incidence rate of PE in children with ASS is high.Children with ASS are more likely to develop into PE if they have repetitive seizures(more than 5 seizures),SE,electroencephalography epileptiform discharges,and the longer duration in ICU.
作者
管刘娟
刘鹏
李海英
马威
谢垒
靳培娜
方敩
王怀立
Guan Liujuan;Liu Peng;Li Haiying;Ma Wei;Xie Lei;Jin Peina;Fang Xiao;Wang Huail(Pediatric Intensive Care Unit,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2020年第6期454-457,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
河南省医学科技攻关项目(201701008)
河南省高等学校重点科研项目(17A310037)。
关键词
儿童
病毒性脑炎
痫性发作
脑炎后癫痫
危险因素
Child
Viral encephalitis
Seizures
Postencephalitic epilepsy
Risk factor
