| 魏荣胜,徐卫华,陈 婷,张云栋,张奇武.小儿危重病例评分联合脑脊液降钙素原、白细胞介素-6对重症病毒性脑炎患儿预后不良发生风险预测作用的初步研究[J].,2023,(2):330-335 |
| 小儿危重病例评分联合脑脊液降钙素原、白细胞介素-6对重症病毒性脑炎患儿预后不良发生风险预测作用的初步研究 |
| A Preliminary Study on the Predictive Effect of Pediatric Critical Illness Score Combined with Cerebrospinal Fluid Procalcitonin and Interleukin-6 on the Risk of Poor Prognosis in Children with Severe Viral Encephalitis |
| 投稿时间：2022-05-30 修订日期：2022-06-26 |
| DOI：10.13241/j.cnki.pmb.2023.02.024 |
| 中文关键词: 重症病毒性脑炎 小儿危重病例评分 降钙素原 白细胞介素-6 预后 |
| 英文关键词: Severe viral encephalitis Pediatric critical illness score Procalcitonin Interleukin-6 Prognosis |
| 基金项目:安徽省重点研究与开发计划项目（201804a0702018） |
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| 中文摘要: |
| 摘要 目的：探讨小儿危重病例评分（PCIS）联合脑脊液降钙素原（PCT）、白细胞介素-6（IL-6）对重症病毒性脑炎（SVE）患儿预后不良的预测价值。方法：回顾性分析2020年1月至2021年12月我院收治的104例SVE患儿的临床病历资料，根据儿童格拉斯哥预后量表（CGOS）将患儿分为预后不良组（CGOS评级1~4级，n=39）和预后良好组（CGOS评级5级，n=65）。采用PCIS对患儿病情严重程度进行评估，采用酶联免疫吸附法检测患儿脑脊液PCT和IL-6水平。采用多因素logistic回归分析SVE患儿预后不良的影响因素，绘制受试者工作特征（ROC）曲线评估PCIS联合脑脊液PCT及IL-6对预后不良的预测价值。结果：预后不良组意识障碍、惊厥、合并脏器损伤发生率、脑脊液白细胞计数、PCT、IL-6水平高于预后良好组（P<0.05），视频脑电图（VEEG）重度异常构成比大于预后良好组（P<0.05），预后不良组PCIS评分低于预后良好组（P<0.05）。多因素logistic回归分析结果显示：合并脏器损伤、VEEG重度异常、脑脊液白细胞计数（较高）、PCT（较高）和IL-6水平（较高）是SVE患儿预后不良的危险因素（OR=1.449、3.732、1.355、1.483、1.388，P<0.05），PCIS评分（较高）是SVE患儿预后不良的保护因素（OR=0.769，P<0.05）。PCIS评分、脑脊液PCT和IL-6预测预后不良的曲线下面积（AUC）为0.869，灵敏度、特异性分别为0.85、0.78，均高于单一指标检测。结论：PCIS、脑脊液PCT及IL-6均是SVE患儿预后的影响因素，联合检测有助于预测患儿预后不良发生风险，从而指导临床制定针对性诊疗方案以改善患儿预后。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the predictive value of pediatric critical illness score (PCIS) combined with cerebrospinal fluid procalcitonin (PCT) and interleukin-6 (IL-6) for poor prognosis in children with severe viral encephalitis (SVE). Methods: The clinical medical records of 104 children with SVE who were admitted to our hospital from January 2020 to December 2021 were retrospectively analyzed. According to the Glasgow prognosis scale for children (CGOS), the children were divided into poor prognosis group (CGOS rating 1~4 grade, n=39) and good prognosis group (CGOS rating 5 grade, n=65). PCIS was used to evaluate the severity of the disease, and enzyme-linked immunosorbent assay was used to detect the levels of cerebrospinal fluid PCT and IL-6. Multivariate Logistic regression was used to analyze the influencing factors of poor prognosis in children with SVE, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of PCIS combined with cerebrospinal fluid PCT and IL-6 for poor prognosis. Results: The incidence of consciousness disturbance, convulsion, complicated with organ injury, the levels of cerebrospinal fluid white blood cell count, PCT and IL-6 in the poor prognosis group were higher than those in the good prognosis group (P<0.05), the proportion of severe abnormalities of video-electroencephalogram (VEEG) was higher than that in the good prognosis group(P<0.05), and the PCIS score in the poor prognosis group was lower than that in the good prognosis group(P<0.05). The results of multivariate Logistic regression analysis showed that the risk factors for poor prognosis in children with SVE were complicated with organ injury, severe abnormality of VEEG, cerebrospinal fluid white blood cell count (high), PCT (high) and IL-6 levels (high) (OR=1.449, 3.732, 1.355, 1.483, 1.388, P<0.05), and the PCIS score (higher) was the protective factor for poor prognosis in children with SVE (OR=0.769, P<0.05). The area under curve (AUC) of PCIS score, cerebrospinal fluid PCT and IL-6 in predicting poor prognosis was 0.869, and the sensitivity and specificity were 0.85 and 0.78 respectively, which were higher than that of single index detection. Conclusion: PCIS score, cerebrospinal fluid PCT and IL-6 are all influence factors of the prognosis of children with SVE. Joint detection is helpful to predict the risk of poor prognosis of children, so as to guide clinical development of targeted diagnosis and treatment programs to improve the prognosis of children. |
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