摘要
目的比较上海市中型与重型儿童流行性乙型脑炎(乙脑)流行病学和临床特征,探讨与疾病严重程度和近期预后有关的危险因素。方法收集上海市唯一定点收治儿童乙脑的专科医院2002至2011年10年感染发病的乙脑住院确诊病例的临床资料,进行回顾性分析。乙脑确诊基于血清和(或)脑脊液抗体IgM阳性结果。结果 73例乙脑确诊病例进入分析,男女比例2.3∶1,平均年龄(5.1±3.0)岁,65例(89%)系外来流动儿童,12例(16.4%)明确全程或部分接种过乙脑疫苗,69例(94.5%)居住在郊区或农村。每年7和8月发病,流行初期重型病例多。临床伴随症状依次为:发热(100%)、颈项强直(82.2%)、抽搐(76.7%)、头痛(75.3%)、呕吐(74.0%)和昏迷(47.9%)。6例(8.2%)因呼吸衰竭需要机械通气,3例(4.1%)死亡。50例(68.5%)在出院时完全康复,20例(27.4%)出院时留有不同程度的后遗症。中型、重型患儿在出院时有神经系统异常或死亡分别为13.0%和84.2%(χ2=33.06,P<0.0001),血清肌酸激酶(CK)中位值分别为105和465U·L-1(Z=-3.173,P=0.001)。多因素Logistic回归分析显示:反复抽搐(OR=29.3)、昏迷(OR=253.6)、居住在猪群附近(OR=16.9)以及血清CK>200U·L-1(OR=0.01)为乙脑预后不良的危险因素。结论乙脑的临床分型对指导治疗和判断预后仍有指导意义,血清CK可作为临床分型生化指标加以考虑。加强流动儿童乙脑疫苗接种是减少上海市乙脑发病率和致残率的重要措施。
Objective To understand the epidemiological and clinical features of moderate and severe Japanese encephalitis （JE） in pediatric inpatients in Shanghai and assess the risk factors associated with the severity and prognosis of JE. Methods The clinical data from pediatric JE cases who acquired JE infection in Shanghai during 2002-2011 were retrospectively analyzed. JE was laboratory-confirmed based on the positive JEV-specific immunoglobulin M detection in serum and/or cerebral spinal fluid in clinical cases. Results A total of 73 children confirmed with JE were included in this study, the male-to-female ratio was 2.3 ： 1 and the mean age was 5.1 years; 65 （89%） were migrant children; 12 （ 16.4% ） had reliable records of JE vaccination; 69 （94. 5% ） lived in rural or suburban areas. All JE cases in Shanghai occurred in July and August with more severe cases occurring in early July. All JE cases had fever, followed by neck rigidity （82. 2% ）, seizure （76.7%）, headache （75.3%）, vomiting （74%） and coma （47.9%）. Six （8.2%） cases had secondary respiratory failure, and 3 （4. 1% ） deceased. Twenty （27.4%） had various disability at hospital discharge. The rates of disability or mortality at hospital discharge in moderate and severe JE were 13.0% and 84.2% （X^2 = 33.06 ,P 〈0. 000 1 ）. The median value of serum creatine kinase （CK） was significant higher in severe cases than in moderate cases （465 verse 105 U · L^-1, Z = -3. 173 ,P = 0. 001 ）. The independent risk factors associated with the poor outcomes of JE at hospital discharge included multiple seizures （ OR = 29. 3 ）, coma （ OR = 253.6） ,living near pigs farms （ OR = 16.9） and serum CK 〉 200 U · L^-1（ OR =0. 01 ）. Conclusions The clinical classification of JE severity is useful to guide the appropriate management and predict the prognosis. Elevated serum CK is an important biochemical predictor for severe JE. Multiple seizures, coma, living near pig farms and serum CK 〉 200 U · L-1
出处
《中国循证儿科杂志》
CSCD
2013年第2期92-97,共6页
Chinese Journal of Evidence Based Pediatrics
关键词
流行性乙型脑炎
预后
危险因素
儿童
Japanese encephalitis
Prognosis
Risk factors
Children
