Long-term outcome of acute central nervous system infection in children
Long-term outcome of acute central nervous system infection in children
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DOI：
10.1002/ped4.12054
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发表时间：
2018-09-01
影响因子：
2.2
通讯作者：
Liu, Gang
中科院分区：
文献类型：
--
作者：
Chen, Tianming;Liu, Gang
中枢神经系统感染是儿童的一种严重疾病。关于各种病因引起的中枢神经系统感染儿童的长期结局知之甚少。本研究的目的是调查儿童急性中枢神经系统感染的长期结局，并检查可能的预后因素。139人有资格接受后续评价。出院后3.8-4.7年对父母进行了结构化访谈。使用儿科版本的格拉斯哥结局量表-扩展确定所有患者的总体结局。急性发作的临床特征检索从medical records.ResultsThe结果是有利的109 139例（78%），38（27%）轻度受损，6（4%）中度受损，14（10%）严重受损，两个（1%）处于植物人状态。有8人死亡。最常见的症状是注意力不集中（16%）、癫痫（12%）、肢体瘫痪（12%）、记忆障碍（10%）、言语障碍（9%）、易怒（9%）。癫痫的显著危险因素包括反复发作或癫痫持续状态、脑电图中存在纯尖峰、神经影像学上脑实质异常和单纯疱疹病毒脑炎（HSVE）。多变量分析确定了三个因素，独立与不良结局：昏迷，脑实质异常的神经影像学和HSVE.InterpretationMost急性中枢神经系统感染的儿童经历了一个良好的结果出院后3.8-4.7年。轻度至重度残疾的比例很高。昏迷、神经影像学检查和HSVE显示的脑实质异常可能预示不良的长期预后。
ImportanceCentral nervous system infection is a severe illness in children. Little is known about the long-term outcome in children with central nervous system infection of various etiologies.ObjectiveThe aims of this study were to investigate the long-term outcomes of childhood acute central nervous system infection and to examine possible prognostic factors.MethodsOf 172 children who were treated for acute central nervous system infection from January 2009 through December 2009, 139 were eligible for follow-up evaluations. A structured interview was conducted with the parents 3.8-4.7 years after hospital discharge. The global outcome was determined in all patients using the Pediatric Version of the Glasgow Outcome Scale-Extended. Clinical features of the acute episode were retrieved from medical records.ResultsThe outcome was favorable in 109 of 139 patients (78%), 38 (27%) were mildly impaired, six (4%) were moderately impaired, 14 (10%) were severely impaired and two (1%) were in a vegetative state. There were eight deaths. The most frequent symptoms were difficulty concentrating (16%), epilepsy (12%), limb paralysis (12%), memory impairment (10%), speech disorders (9%), irritability (9%). Significant risk factors for epilepsy included the presence of recurrent seizures or status epilepticus, the existence of pure spikes in the electroencephalogram, brain parenchyma abnormalities on neuroimaging and herpes simplex virus encephalitis (HSVE). A multivariate analysis identified three factors that were independently associated with poor outcome: coma, brain parenchyma abnormalities on neuroimaging and HSVE.InterpretationMost children with acute central nervous system infection experienced a favorable outcome 3.8-4.7 years after discharge from the hospital. Minor to severe disability persists in a high proportion of cases. Coma, brain parenchymal abnormalities on neuroimaging and HSVE may predict poor long-term outcome.