病毒性脑炎近期与远期预后分析
发布时间：2018-02-12 16:47
本文关键词： 病毒性脑炎 格拉斯哥预后评分 回归分析 出处：《山西医科大学》2014年硕士论文 论文类型：学位论文
【摘要】：目的：比较病毒性脑炎(viral encephalitis，VE)患者近期与远期预后，根据临床资料从临床症状、脑电图、脑脊液检查、神经影像学、治疗等方面选取研究变量，并探讨影响预后的危险因素。 方法：收集2010年4月至2013年6月山西医科大学第一附属医院神经内科住院治疗的病毒性脑炎患者临床资料105例，依据格拉斯哥预后量表(Glasgow outcomescale，GOS)分级，将出院时患者分为近期预后良好组(78例)，近期预后不良组(27例)；对出院半年后研究对象进行远期随访，排除失访7例，并依据以上分组标准，分为远期预后良好组(78例)与远期预后不良组(20例)，选取14个因素，应用SPSS13.0统计软件进行单因素相关分析，对有统计学意义的因素进入Logistic回归分析。 结果：近期预后良好组有9例(12%)评为远期预后不良组，近期预后不良组有11例(50%)评为远期预后良好组。单因素分析显示发热与开始阿昔洛韦治疗时间差、脑电图、格拉斯哥昏迷量表(Glasgow coma scale，GCS)评分、癫痫及血清钠浓度与病毒性脑炎患者近期及远期预后均有相关性(P0.05)，经多因素Logistic回归分析显示GCS评分≤8分(OR=46.431，，P=0.003)与血清钠浓度㩳135mmol/L(OR=8.842，P=0.004)为VE近期预后的危险因素，远期预后的危险因素包括发热与开始阿昔洛韦治疗时间差≥7天(OR=7.347，P=0.010)与3次癫痫发作(OR=12.795，P=0.004)。 结论：病毒性脑炎经过积极合理的治疗，大多数患者预后良好，故临床上对疑诊病毒性脑炎的患者均应及时应用抗病毒药物。病毒性脑炎的预后是由多因素共同作用影响，且出院时近期预后危险因素不能预测远期预后。发热与开始阿昔洛韦治疗时间差≥7天与大于3次癫痫发作是影响远期预后的重要危险因素。
[Abstract]:Objective: to compare the short-term and long-term prognosis of patients with viral encephalitis (VEV), and to select the study variables from clinical symptoms, electroencephalogram, cerebrospinal fluid examination, neuroimaging and treatment, and to explore the risk factors affecting the prognosis. Methods: the clinical data of 105 patients with viral encephalitis treated in Department of Neurology, first affiliated Hospital of Shanxi Medical University from April 2010 to June 2013 were collected and classified according to Glasgow outcome scale (Glasgow outescale scale). At the time of discharge, the patients were divided into two groups: 78 patients with good short-term prognosis and 27 patients with poor short-term prognosis. The study subjects were followed-up for six months after discharge, 7 cases were excluded, and according to the above grouping criteria, There were 78 patients with good long-term prognosis (n = 78) and 20 patients with poor long-term prognosis (n = 20). Fourteen factors were selected and univariate correlation analysis was carried out with SPSS13.0 statistical software. The factors with statistical significance were analyzed by Logistic regression analysis. Results: there were 9 cases with good prognosis (n = 12) and 11 cases with bad prognosis (n = 11) with a good long-term prognosis. Univariate analysis showed that the time between fever and the beginning of acyclovir treatment was different, electroencephalogram (EEG). Glasgow coma scale scale (Glasgow coma scale) score, epilepsy and serum sodium concentration were correlated with the short-term and long-term prognosis of patients with viral encephalitis (P 0.05). The multivariate Logistic regression analysis showed that the GCS score 鈮
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