摘要
目的总结儿童流行性感冒相关性脑病(IAE)的临床和影像特征,探讨IAE影像学评分与患儿生存时间的相关性,提高IAE诊断的准确性和及时性。方法回顾性分析深圳市儿童医院流感相关性脑病死亡病例的临床数据、实验室检查、头颅CT等资料,并对比分析既往报道大宗病例。根据白细胞、血糖等6项实验室指标的升高、正常、降低对患儿进行分组,采用Mann-Whitney U检验比较升高组、正常组两组间生存时间差异,Kruskal-Wallis H检验比较升高组、正常组、降低组三组间生存时间差异。建立影像评分方法,以受累部位数和并发症累计积分,采用Spearman相关分析评价IAE患儿的影像学评分与其生存时间的相关性。结果共15例流感相关性脑病死亡病例,发病平均年龄(4.57±2.44)岁。常见症状为高热(86.6%)、呕吐(53.3%)、惊厥(66.6%)、意识障碍(93.3%)。白细胞、血糖等6项实验室指标升高、正常、降低组间的生存时间差异均无统计学意义(P>0.01)。13例患儿行头颅CT扫描,表现为双侧大脑半球弥漫性肿胀11例,累及脑干7例,累及小脑4例,累及丘脑/基底节区5例;出现小脑扁桃体疝2例,合并蛛网膜下腔出血4例。影像学评分为0~6分,评分中位数为3分。影像学评分与死亡时间具有相关性(r=0.698,P<0.01)。深圳地区病例与其他报道病例主要差异为各前驱症状发生率不同,发热及呕吐发生率较高,而上呼吸道感染发生率较低。结论儿童流感相关性脑病的前驱症状和神经症状分别以发热、呕吐和惊厥、意识障碍为主。对高热、呕吐、意识障碍的患儿,若头颅CT显示累及多部位的弥漫性脑水肿,特别是丘脑及脑干对称性肿胀时,需警惕IAE可能;其影像学评分与患儿生存时间之间存在较好的相关性,影像评分越高的患儿生存时间越短,有助于临床判断病情严重程度。
Objective To summarize the clinical and imaging characteristics of influenza associated encephalopathy(IAE)in children,and explore the correlation between IAE imaging score and survival time in order to improve the accuracy and timeliness of IAE diagnosis.Methods The clinical data,laboratory examinations,and head CT of death cases of influenza-related encephalopathy in Shenzhen Children’s Hospital were retrospectively analyzed,and a large number of previously reported cases were compared.The children were divided into groups according to the increase,normal and decrease of six laboratory indexes such as leukocyte and blood glucose.The Mann-Whitney U test was used to compare the difference of survival time between the increase group and the normal group,and the Kruskal-Wallis test was used to compare the difference of survival time between the increase group,the normal group and the decrease group.The imaging scoring method was established by the number of affected parts and the cumulative score of complications.The correlation between the imaging score and survival time of children with IAE was evaluated by Spearman correlation analysis.Results There were 15 deaths from influenza-related encephalopathy,with an average age of(4.57±2.44)years old.The clinical symptoms are high fever(86.6%),vomiting(53.3%),convulsions(66.6%),and disturbance of consciousness(93.3%).There was no significant difference in survival time between the groups with elevated,normal and decreased six laboratory indexes such as leukocyte and blood glucose(P>0.01).CT scan of 13 children showed diffuse swelling of bilateral cerebral hemispheres in 11 cases,involving brain stem in 7 cases,cerebellum in 4 cases and thalamus/basal ganglia in 5 cases.Cerebellar tonsillar hernia occurred in 2 cases and subarachnoid hemorrhage in 4 cases.The imaging scores were in accordance with the normal distribution and scores of each case were 0-6 points,with a median of 3 points.The imaging score was correlated with the time of death(r=0.698,P<0.01).The main d
作者
罗意
庄义江
范绮梦
张少君
赵一霖
曾洪武
LUO Yi;ZHANG Yijiang;FAN Qimeng(Departmentof Radiology,Shenzhen Children’s Hospital,Shenzhe,Guangdong Province 518000,P.R.China)
出处
《临床放射学杂志》
北大核心
2022年第7期1336-1341,共6页
Journal of Clinical Radiology
基金
深圳市医疗卫生三名工程项目(编号:SZSM202011005)。
