小儿危重病例评分联合脑脊液...发生风险预测作用的初步研究_魏荣胜.pdf

现代生物医学进展Progress in Modern Biomedicine Vol.23NO.2JAN.2023doi:10.13241/ki.pmb.2023.02.024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*魏荣胜徐卫华陈婷张云栋张奇武（复旦大学附属儿科医院安徽医院/安徽省儿童医院急诊科 安徽 合肥 230000）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 14 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（P0.05），视频脑电图（VEEG）重度异常构成比大于预后良好组（P0.05），预后不良组 PCIS 评分低于预后良好组（P0.05）。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，P0.05），PCIS 评分（较高）是 SVE 患儿预后不良的保护因素（OR=0.769，P0.05）。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。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；预后中图分类号：R512.3文献标识码：A文章编号：1673-6273（2023）02-330-06A Preliminary Study on the Predictive Effect of Pediatric Critical IllnessScore Combined with Cerebrospinal Fluid Procalcitonin and Interleukin-6on the Risk of Poor Prognosis in Children with Severe Viral Encephalitis*WEI Rong-sheng,XU Wei-hua,CHEN Ting,ZHANG Yun-dong,ZHANG Qi-wu(Department of Emergency,Anhui Hospital Affiliated Pediatric Hospital of Fudan University/Anhui Childrens Hospital,Hefei,Anhui,230000,China)ABSTRACT Objective:To explore the predictive value of pediatric critical illness score(PCIS)combined with cerebrospinal fluidprocalcitonin(PCT)and interleukin-6(IL-6)for poor prognosis in children with severe viral encephalitis(SVE).Methods:The clinicalmedical records of 104 children with SVE who were admitted to our hospital from January 2020 to December 2021 were retrospectivelyanalyzed.According to the Glasgow prognosis scale for children(CGOS),the children were divided into poor prognosis group(CGOSrating 14 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 regres-sion 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 cellcount,PCT and IL-6 in the poor prognosis group were higher than those in the good prognosis group(P0.05),the proportion of severeabnormalities of video-electroencephalogram(VEEG)was higher than that in the good prognosis group(P0.05),and the PCIS score inthe poor prognosis group was lower than that in the good prognosis group(P0.05).The results of multivariate Logistic regression analysisshowed 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,P0.05),and thePCIS score(higher)was the protective factor for poor prognosis in children with SVE(OR=0.769,P0.05).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 and0.78 respectively,which were higher than that of single index detection.Conclusion:PCIS score,cerebrospinal fluid PCT and IL-6 are all*基金项目：安徽省重点研究与开发计划项目（201804a0702018）作者简介：魏荣胜（1984-），男，硕士，主治医师，主要从事小儿神经重症与急救方向的研究，E-mail:W通讯作者：徐卫华（1977-），男，硕士，主任医师，主要从事小儿急诊急救与危重症方向的研究，E-mail:（收稿日期：2022-05-30 接受日期：2022-06-26）330现代生物医学进展Progress in Modern Biomedicine Vol.23NO.2JAN.2023influence factors of the prognosis of children with SVE.Joint detection is helpful to predict the risk of poor prognosis of children,so as toguide clinical development of targeted diagnosis and treatment programs to improve the prognosis of children.Key words:Severe viral encephalitis;Pediatric critical illness score;Procalcitonin;Interleukin-6;PrognosisChinese Library Classification(CLC):R512.3Document code:AArticle ID:1673-6273(2023)02-330-06前言重症病毒性脑炎（severe viral encephalitis，SVE）病情危重，疾病进展快，患儿预后差，50%70%的患儿均存在不同程度的后遗症，超过 20%的患儿可致残，严重者可致死亡1,2。早期预测患儿预后，是临床制定针对性诊疗方案的关键。根据发热、意识改变、头痛、癫痫等临床表现评估患儿预后误差较大，且存在主观性，目前临床常以多指标联合的方式诊断疾病和预测预后3。小儿危重病例评分（pediatric critical illness score，PCIS）是临床常用于评估重症患儿病情危重程度的指标4，研究发现5，PCIS评分越低的患者，病情越危重，预后也更差。SVE 是由病毒感染引起的脑实质炎症，炎症反应在疾病的发生发展过程中发挥重要作用6。降钙素原（procalcitonin，PCT）是由甲状腺 C 细胞产生的降钙素原前体物质，生理状态下体内含量较低，细菌及病毒感染时表达上调，是反映炎症反应活跃程度的因子，可作为检测炎症性疾病病情进展的指标7。白细胞介素-6（inter-leukin-6，IL-6）是由淋巴细胞、中性粒细胞、巨噬细胞等炎症细胞在感染、免疫失衡等刺激下产生的促炎因子，广泛介导机体炎症反应，IL-6 与炎症性疾病病情严重程度密切相关8。本研究采用 PCIS 评估 SVE 患儿病情严重性，并检测脑脊液 PCT 和IL-6 水平，旨在探讨三指标联合对 SVE 患儿预后