Frequency of sub-clinical cerebral edema in children with diabetic ketoacidosis
Frequency of sub-clinical cerebral edema in children with diabetic ketoacidosis
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DOI：
10.1111/j.1399-543x.2006.00156.x
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发表时间：
2006-04-01
影响因子：
3.4
通讯作者：
Kuppermann, N
中科院分区：
文献类型：
--
作者：
Glaser, NS;Wootton-Gorges, SL;Kuppermann, N
约1%的糖尿病酮症酸中毒（DKA）患儿会出现症状性脑水肿。然而，无症状或亚临床脑水肿被认为发生更频繁。一些小型研究发现，大多数或所有DKA儿童的脑室变窄表明脑水肿，但其他研究未检测到脑室尺寸变窄。在这项研究中，我们使用磁共振成像（MRI）测量了DKA儿童在治疗期间和从DKA事件中恢复后的侧脑室前角的尾状核间宽度。我们确定了心室狭窄的频率，并比较了有和没有心室狭窄的儿童的临床和生化数据。41名儿童完成了研究方案。在DKA治疗期间，侧脑室明显变小（平均宽度，9.3 ± 0.3 mm vs.从DKA恢复后10.2 ± 0.3 mm，p < 0.001）。DKA治疗期间脑室狭窄的儿童（22名儿童，54%）比无狭窄的儿童更可能出现精神状态异常[治疗期间格拉斯哥昏迷量表（GCS）评分低于15分的12/22 vs. 4/19，p = 0.03]。多元逻辑回归分析显示，较低的初始PCO 2水平与心室狭窄显著相关[比值比（OR）= 0.88，95%置信区间（95% CI）= 0.78-0.99，p = 0.047]。在多变量分析中，没有其他变量与心室狭窄相关。我们的结论是，侧脑室狭窄是明显的，在刚刚超过一半的儿童接受治疗的DKA。虽然脑室狭窄的儿童没有表现出足以诊断为“症状性脑水肿”的神经系统异常，但经常发生轻度精神状态异常，这表明DKA儿童脑水肿的临床证据可能比以前报道的更常见。
Symptomatic cerebral edema occurs in approximately 1% of children with diabetic ketoacidosis (DKA). However, asymptomatic or subclinical cerebral edema is thought to occur more frequently. Some small studies have found narrowing of the cerebral ventricles indicating cerebral edema in most or all children with DKA, but other studies have not detected narrowing in ventricle size. In this study, we measured the intercaudate width of the frontal horns of the lateral ventricles using magnetic resonance imaging (MRI) in children with DKA during treatment and after recovery from the DKA episode. We determined the frequency of ventricular narrowing and compared clinical and biochemical data for children with and without ventricular narrowing. Forty-one children completed the study protocol. The lateral ventricles were significantly smaller during DKA treatment (mean width, 9.3 +/- 0.3 vs. 10.2 +/- 0.3 mm after recovery from DKA, p < 0.001). Children with ventricular narrowing during DKA treatment (22 children, 54%) were more likely to have mental status abnormalities than those without narrowing [12/22 vs. 4/19 with Glasgow Coma Scale (GCS) scores below 15 during therapy, p = 0.03]. Multiple logistic regression analysis revealed that a lower initial PCO2 level was significantly associated with ventricular narrowing [odds ratio (OR) = 0.88, 95% confidence interval (95% CI) = 0.78-0.99, p = 0.047). No other variables analyzed were associated with ventricular narrowing in the multivariate analysis. We conclude that narrowing of the lateral ventricles is evident in just over half of children being treated for DKA. Although children with ventricular narrowing did not exhibit neurological abnormalities sufficient for a diagnosis of 'symptomatic cerebral edema', mild mental status abnormalities occurred frequently, suggesting that clinical evidence of cerebral edema in children with DKA may be more common than previously reported.