摘要
目的探讨中枢神经系统炎性脱髓鞘病(IDDCNS)儿童复发特征及影响因素。方法对20例IDDCNS复发者和50例病史在0.5 a以上的IDDCNS无复发者进行病例对照研究,对二组病例的年龄、性别、发病前诱因、临床症状、激素治疗反应、首次发病后遗症等资料进行单因素和多因素分析。结果1.复发特征:IDDCNS近期内复发几率高,0.5 a内复发者占75.0%。复发组多发性硬化(MS)18例,视神经脊髓炎、非完全型横贯性脊髓炎各1例;无复发组主要为急性播散性脑脊髓炎病例(39例)。2.单因素分析:发病年龄、性别、惊厥、瘫痪、意识障碍、共济失调、病情自然缓解、首次发病后遗症8种因素与IDDCNS复发无明显相关关系;发病前病毒感染或预防接种及临床表现有发热、视觉障碍、多灶症状、病理征阳性、皮质激素治疗反应良好6种因素对IDDCNS复发有明显影响。3.多因素分析:影响复发的独立危险因素为视觉障碍(OR=42.50)、病理征阳性(OR=8.666);影响复发的独立保护因素为神经系统多灶症状(OR=0.068)。结论儿童IDDCNS多于0.5 a内复发,复发后诊断以MS为主;首次IDDCNS中出现视觉障碍、病理征阳性复发几率增加,存在神经系统多灶症状复发几率降低。
Objective To explore influential factors and features of relapse of presenting with an initial episode of acute central nervous system inflammatory demyelinating disease （IDDCNS） in children. Methods By group - control study,20 relapsing patients with IDDCNS compared with 50 single episoding patients with IDDCNS whose case history longer than 0.5 year, whose age at onset, gender, preceding infection or immunization, neurologic syndromes at presentation,therapeutic response, and final neurologic outcome after initial episode were analyzed by mono - factor analysis and multi - factor nonconditional Logistic regression model. Results 1. The risk of relapse increased in the near future,75.0% relapsed before 6 months. There were 18 cases diagnosed multiple sclerosis （MS） ,1 case neurooptic myelitis and 1 case immaturity myelitis in relapsing patients. There were 39 cases diagnosed acute disseminated encephalomyelitis in single episoding patients. 2. Mono - factor analysis ： 8 factors were not statistically significant, including age at onset, gender, seizure, palsy, conscious disturbance, ataxia, natural relief, sequelae after the first attack; 6 factors were statistically significant, including infectious or vaccination agents before episode, fever, visual disorder, multiple neurological signs, positive pathologic reflex, with marked improvement to cortical hormone. 3. In the multi -factor stepwise regression analysis, visual disorder（ OR = 42.50 ） and positive pathologic reflex （ OR = 8. 666 ） were the independent influencing factors, multiple neurological signs（ OR = 0. 068 ） was independent protecting factor. Conclusions The rate of relapse in IDDCNS is lower than abroad and most relapse before 0.5 year, the main diagnosis of relapsing case is MS. When visual disorder and positive pathologic reflex presenting in the fist episode of IDDCNS , the opportunity of relapse will increase, and will decrease when multiple neurological signs presenting.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2009年第6期458-460,共3页
Journal of Applied Clinical Pediatrics
关键词
炎性脱髓鞘疾病
中枢神经系统
复发因素
儿童
inflammatory demyelination
central nervous system
relapse factors
child
