| 沈淑媛,周进芳,秦运霞,王小伟,吴 睿.视频脑电图联合PEWS评分、NSE、CD4+/CD8+比值对病毒性脑炎患儿病情评估及预后预测的临床价值[J].,2023,(18):3449-3454 |
| 视频脑电图联合PEWS评分、NSE、CD4+/CD8+比值对病毒性脑炎患儿病情评估及预后预测的临床价值 |
| Clinical Value of Video Electroencephalogram, Pediatric Early Warning Score, NSE and CD4+/CD8+ Ratio in Evaluating the Condition and Predicting the Prognosis of Children with Viral Encephalitis |
| 投稿时间：2023-03-11 修订日期：2023-03-31 |
| DOI：10.13241/j.cnki.pmb.2023.18.009 |
| 中文关键词: 儿童 病毒性脑炎 视频脑电图 PEWS NSE CD4+/CD8+比值 病情严重程度 预后 预测价值 |
| 英文关键词: Children Viral encephalitis Video electroencephalogram PEWS NSE CD4+/CD8+ ratio Severity of the disease Prognosis Predictive value |
| 基金项目:江苏省人社厅"六大人才"项目（2014-WSN-062） |
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| 中文摘要: |
| 摘要 目的：探讨视频脑电图（VEEG）联合儿童早期预警评分（PEWS）、神经元特异性烯醇化酶（NSE）、CD4+/CD8+比值对病毒性脑炎患儿病情评估及预后预测的价值。方法：选择2020年3月至2022年3月南京医科大学附属儿童医院收治的152例病毒性脑炎患儿，根据病情严重程度将患儿分为重症组（67例）和轻症组（85例），另选择72例无神经系统损伤住院患儿为对照组。治疗2周后，根据儿童格拉斯哥预后量表（CGOS）将其分为预后良好组（4~5级，89例）与预后不良组（1~3级，63例）。所有研究对象均接受PEWS测评和VEEG检查，检测血清NSE水平，计算CD4+/CD8+比值。采用单因素和多因素Logistic回归分析影响病毒性脑炎患儿预后的因素。采用受试者工作特征（ROC）曲线分析PEWS、VEEG 及血清NSE、CD4+/CD8+比值预测病毒性脑炎患儿预后的价值。结果：重症组PEWS、VEEG重度异常比例及血清NSE水平高于轻症组和对照组，CD4+/CD8+比值低于轻症组和对照组（P＜0.05）；轻症组PEWS、VEEG重度异常比例及血清NSE水平高于对照组，CD4+/CD8+比值低于对照组（P＜0.05）。预后不良组PEWS、VEEG重度异常比例、血清NSE水平高于预后良好组，CD4+/CD8+比值低于预后良好组（P＜0.05）。多因素Logistic回归分析结果显示，持续惊厥、高PEWS、VEEG重度异常、血清NSE水平升高是病毒性脑炎患儿预后不良的危险因素，CD4+/CD8+比值升高是保护因素（P＜0.05）。联合PEWS、VEEG 及血清NSE、CD4+/CD8+比值预测病毒性脑炎患儿预后曲线下面积为0.859，高于各指标单独预测。结论：病毒性脑炎患儿高PEWS、VEEG重度异常、血清NSE水平升高、CD4+/CD8+比值降低，与病情加重和预后不良有关，联合以上四项指标辅助预测病毒性脑炎患儿预后的价值较高。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the value of video electroencephalogram (VEEG) combined with pediatric early warning score (PEWS), neurospecific enolase (NSE) and CD4+/CD8+ ratio in evaluating the condition and predicting the prognosis of children with viral encephalitis. Methods: 152 children with viral encephalitis who were admitted to the Children's Hospital of Nanjing Medical University from March 2020 to March 2022 were selected, and they were divided into severe group (67 cases) and mild group (85 cases) according to the severity of the disease, another 72 hospitalized children without nervous system injury were selected as the control group. 2 weeks after treatment, they were divided into good prognosis group (4~5 grades, 89 cases) and poor prognosis group (1~3 grades, 63 cases) according to the Glasgow Outcome Scale for children(CGOS). All subjects received PEWS evaluation and VEEG examination, serum NSE level was detected, and CD4+/CD8+ ratio was calculated. The factors affecting the prognosis of children with viral encephalitis were analyzed by univariate and multivariate logistic regression. The ROC curve was used to analyze the prognostic value of PEWS, VEEG, serum NSE, CD4+/CD8+ratio in children with viral encephalitis. Results: PEWS, the proportion of VEEG severe abnormality and the serum NSE level in the severe group were higher than those in the mild group and control group, and the CD4+/CD8+ ratio was lower than that in the mild group and control group (P＜0.05). PEWS, the proportion of VEEG severe abnormality and the serum NSE level in the mild group were higher than those in the control group, and the CD4+/CD8+ ratio was lower than that in the control group (P＜0.05). PEWS, the proportion of VEEG severe abnormality and serum NSE level in the poor prognosis group were higher than those in the good prognosis group, and the CD4+/CD8+ ratio was lower than that in the good prognosis group (P＜0.05). Multivariate Logistic regression analysis showed that continuous convulsion, high PEWS, VEEG severe abnormality and increased serum NSE level were risk factors for poor prognosis in children with viral encephalitis, and increased CD4+/CD8+ ratio was protective factor (P＜0.05). Combined with PEWS, VEEG, serum NSE and CD4+/CD8+ ratio, the prognostic area under curve of viral encephalitis was 0.859, which was higher than that predicted by each indicator alone. Conclusion: High PEWS, VEEG severe abnormality, increased serum NSE level, and decreased CD4+/CD8+ ratio in children with viral encephalitis are associated with aggravation of the disease and poor prognosis. Combining the above four indicators is of high value to assist in predicting the prognosis of children with viral encephalitis. |
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