肠道病毒71型感染致儿童中枢神经系统损害相关因素分析

发布时间：2018-05-13 06:34

本文选题：肠道病毒71型 + 中枢神经系统损害　；参考：《青岛大学》2017年硕士论文

【摘要】：背景:EV71是肠道病毒属小RNA病毒科成员之一,是无包膜、无突起的单股正链RNA病毒,主要包括4种结构蛋白、7种非结构蛋白和核糖核酸。EV71感染是全球性传染性疾病,近年来在亚太地区流行呈上升趋势,特别是我国内地地区。EV71感染大多数症状轻微,主要表现为手足口病或者疱疹性咽峡炎,以手、足、口腔、臀部红色斑丘疹或者疱疹为主要特征;少数可导致严重中枢神经系统疾病发生,如脑脊髓炎、脑干脑炎、神经源性肺水肿、急性迟缓性麻痹等,致死率和致残率高,严重影响儿童的生活质量。本研究目的是分析EV71感染导致中枢神经系统损害的相关因素,并明确是否为中枢神经系统损害程度的危险因素。方法:本研究纳入212例手足口病流行期间于青岛大学附属医院和青岛市妇女儿童医院确诊的EV71感染患者,其中男112例(52.83%),女100例(47.17%),年龄范围为0.5-9.7岁,所有研究对象粪便标本经反转录-聚合酶链反应(RT-PCR)技术检测为EV71核酸阳性。根据是否引起中枢神经系统疾病,将研究对象分为脑炎组(n=69)和非脑炎组(n=143),其中脑炎组男35例(50.7%)、女34例(49.3%),平均年龄为4.17±1.81(岁),非脑炎组男76例(53.1%)、女67例(46.9%),平均年龄为4.18±2.09(岁);根据中枢神经系统临床症状表现轻重,将脑炎组分为轻症组(n=63)和重症组(n=6),其中轻症组男32例(50.8%)、女31例(49.2%),平均年龄为4.05±1.66(岁),重症组男3例(50.0%)、女3例(50.0%),平均年龄为5.37±2.87(岁)。符合正态分布的资料用均数±标准差(`x±s)表示,组间比较采用两独立样本t检验;非正态分布数据由中位数和四分位数(P25、P75)来表示,组间比较采用Mann-Whitney U检验;定性资料用百分构成比表示,组间比较采用χ2检验,以95%可信区间(95%CI)和比值比(OR)表示危险度。所有统计学资料采用SPSS17.0软件处理,p0.05为差异具有统计学意义。结果:脑炎组与非脑炎组、轻症组与重症组在性别上差异无统计学意义(χ2=0.109,p=0.741 vs.χ2=0.001,p=0.970);同时脑炎组与非脑炎组、轻症组与重症组在年龄上无统计学差异(t=0.042,p=0.966 vs.t=1.105,p=0.316)。脑炎组白细胞计数明显高于非脑炎组(9.46±4.52 vs.8.27±2.06,t=2.598,p=0.011),且重症组白细胞计数明显高于轻症组(12.62±3.56 vs.9.16±3.39,t=2.374,p=0.02),经Logistic回归分析,发现白细胞计数是中枢神经系统损害发生和中枢神经系统损害程度的危险因素(p=0.003,OR=1.184,95%CI=1.059-1.324 vs.p=0.033,OR=1.343,95%CI=1.024-1.762)。脑炎组CRP明显高于非脑炎组(6.93±4.84 vs.5.07±3.44,t=2.865,p=0.005),重症组CRP明显高于轻症组(10.63±5.19 vs.6.58±4.69,t=2.008,p=0.049),经Logistic回归分析,发现CRP是发生中枢神经系统损害的危险因素(p=0.002,OR=1.121,95%CI=1.042-1.205),但不是中枢神经系统损害程度的危险因素(p=0.063,OR=1.190,95%CI=0.991-1.429)。与非脑炎组相比,脑炎组发热时间较长(P50=3.00 vs.P50=1.50,z=5.134,p=0.000);脑炎组内重症组发热持续时间明显长与轻症组(7.5±2.17 vs.2.88±1.59,t=6.592,p=0.000),经Logistic回归分析,发现发热持续时间是中枢神经系统损害发生和中枢神经系统损害程度的危险因素(p=0.000,OR=1.449,95%CI=1.212-1.734 vs.p=0.004,OR=3.578,95%CI=1.496-8.556)。脑炎组血糖明显高于非脑炎组(P50=5.79 vs.P50=5.16,z=4.941,p=0.000),脑炎组内重症组血糖明显高于轻症组(8.40±0.75 vs.5.96±1.14,t=5.100,p=0.000),经Logistic回归分析,发现血糖水平高低是中枢神经系统损害发生和中枢神经系统损害程度的危险因素(p=0.000,OR=1.973,95%CI=1.491-2.610 vs.p=0.006,OR=6.504,95%CI=1.723-24.559)。另外,脑炎组肌酸激酶同工酶高于非脑炎组(P50=16.0 vs.P50=12.0,z=4.959,p=0.000),经Logistic回归分析,发现肌酸激酶同工酶是中枢神经系统损害发生的危险因素(p=0.003,OR=1.046,95%CI=1.015-1.078);脑炎组内重症组热峰高于轻症组(38.8±0.46 vs.38.2±0.68,t=2.507,p=0.015),经Logistic回归分析,发现热峰高低是中枢神经系统损害程度的危险因素(p=0.036,OR=3.684,95%CI=1.088-12.471)。结论:EV71感染导致中枢神经系统损害与年龄、性别无相关关系;与非脑炎组相比,脑炎组白细胞数、C反应蛋白、发热持续时间、血糖、肌酸激酶同工酶升高或延长;与轻症脑炎组相比,重症脑炎组白细胞计数、发热持续时间、热峰、血糖升高或延长。
[Abstract]:Background : EV71 is one of the members of the small RNA virus of Enterovirus , which is a non - enveloped , non - protruding , single - strand RNA virus , which mainly includes four structural proteins , seven non - structural proteins and ribonucleic acid . The mean age was 4.05 卤 1.66 ( years ) . The mean age was 5.37 卤 2.87 ( years ) . The mean age was 5.37 卤 2.87 ( years ) . The WBC count was significantly higher in the encephalitis group than in the non - encephalitis group ( 9.46 卤 4.52 vs . 8.27 卤 2.06 , t = 2.598 , p = 0 . 011 ) , and the WBC count in the severe group was significantly higher than that in the mild group ( 12.62 卤 3.56 vs . 9.16 卤 3.39 , t = 2.374 , p = 0.02 ) . By Logistic regression analysis , it was found that the white blood cell count was a risk factor for the occurrence of the central nervous system injury and the degree of damage to the central nervous system ( p = 0.003 , OR = 1.184 , 95 % CI = 1.059 - 1.324 vs . p = 0.033 , OR = 1.343 , 95 % CI = 1.024 - 1.762 ) . CRP was significantly higher than that in the non - encephalitis group ( 6.93 卤 4.84 vs . 5.07 卤 3.44 , t = 2.865 , p = 0.005 ) . The CRP in the severe group was significantly higher than that in the mild group ( 10.63 卤 5.19 vs . 6.58 卤 4.69 , t = 2.008 , p = 0.049 ) , but was not a risk factor for the damage to the central nervous system ( p = 0.063 , OR = 1.190 , 95 % CI = 0.991 - 1.429 ) . Compared with non - encephalitis group , the fever duration of the encephalitis group was longer ( P50 = 3.00 vs . P50 = 1.50 , z = 5.134 , p = 0.000 ) ; the duration of fever in the severe group in the encephalitis group was significantly longer than that in the mild group ( 7.5 卤 1.17 vs . 2.88 卤 1 . 59 , t = 6.592 , p = 0.000 ) , and the Logistic regression analysis showed that the duration of fever was the risk factor of the occurrence of the central nervous system injury and the degree of damage to the central nervous system ( p = 0.000 , OR = 1.449 , 95 % CI = 1.212 - 1.734 vs . p = 0.004 , OR = 3.578 , 95 % CI = 1.496 - 8.556 ) . The blood glucose in the encephalitis group was significantly higher than that in the non - encephalitis group ( P50 = 5.79 vs . P50 = 5.16 , z = 4.941 , p = 0.000 ) . The blood glucose levels in the severe group in the encephalitis group were significantly higher than those in the mild group ( 8.40 卤 0.75 vs . 5.96 卤 1.14 , t = 5.100 , p = 0.000 ) . By Logistic regression analysis , it was found that the level of blood glucose was the risk factor of the central nervous system injury and the degree of central nervous system injury ( p = 0.000 , OR = 1.973 , 95 % CI = 1.491 - 2.610 vs . p = 0.006 , OR = 6.504 , 95 % CI = 1.723 - 24.559 ) . In addition , the creatine kinase isoenzyme of the encephalitis group was higher than that of non - encephalitis group ( P50 = 16.0 vs . P50 = 12.0 , z = 4.59 , p = 0.000 ) . After Logistic regression analysis , it was found that creatine kinase isoenzyme was a risk factor for the damage to the central nervous system ( p = 0.003 , OR = 1.046 , 95 % CI = 1.015 - 1.078 ) . The risk factors of the degree of injury of the central nervous system were found by Logistic regression analysis ( p = 0.036 , OR = 3.684 , 95 % CI = 1.088 - 12.471 ) . Conclusion : EV71 infection has no correlation with age and sex . Compared with non - encephalitis group , the number of white blood cells , C - reactive protein , fever duration , blood sugar and creatine kinase isoenzyme of the encephalitis group are increased or prolonged . Compared with the group with mild encephalitis , the white blood cell count , the duration of fever , the hot peak , the blood sugar increase or extend .

【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.1

【参考文献】