山东省平邑县轻度胃肠炎伴婴幼儿良性惊厥轮状病毒感染调查

发布时间：2018-11-24 10:40

【摘要】：目的:探讨轻度胃肠炎伴婴幼儿良性惊厥(benign infantile convulsions associated with mild gastroenteritis,BICE)与轮状病毒的关联性,并比较分析伴轮状病毒感染病例和非轮状病毒感染病例临床表现及实验室检查之间的异同。方法:以2008年1月至2016年10月就诊于我院儿科的278例BICE患儿为研究对象,根据粪便人轮状病毒(human rotavirus,HRV)抗原检测结果,分为HRV阳性组与阴性组。回顾分析全部患儿的临床资料,比较两组患儿在发病季节、发病年龄、性别、临床表现、血常规、肝功能、电解质之间的异同,尤其是惊厥方面的差异。出院后随访6~48个月,回顾分析预后。结果:278例入选患儿,其中HRV阳性组42例(15.1%),阴性组236例(84.9%)。HRV阳性组男20例(47.6%),女22例(52.4%)。年龄分布在9~28个月,平均(16.5±4.2)个月。秋冬季发病31例(73.8.%),春夏季发病11例(26.2%)。伴发热20例(47.6%),不发热22例(52.4%)。腹泻伴呕吐22例(52.4%),腹泻18例(42.8%),呕吐2例(4.8%)。全面性发作37例(88.1%),部分性发作5例(11.9%)。首次惊厥发作于第1天3例(7.1%),第2天10例(23.8%),第3天25例(59.6%),第4天3例(7.1%),第5天1例(2.4%)。惊厥发作1次4例(9.5%),发作2次24例(57.2%),发作3次9例(21.4%),发作4次3例(7.1%),发作≥5次2例(4.8%)。42例患儿共发生惊厥101次,平均2.40次,惊厥持续时间≤1分钟32次(31.7%),1~5分钟68次(67.3%),≥5分钟1次(1.0%)。HRV阴性组男110例(46.6%),女126例(53.4%);年龄分布在8~34个月,平均(17.8±5.1)个月。秋冬季发病176例(74.6%),春夏季发病60例(25.4%)。伴发热45例(19.1%),不发热191例(80.9%)。腹泻伴呕吐118例(50.0%),腹泻110例(46.4%),呕吐8例(3.6%)。全面性发作215例(91.1%),部分性发作21例(8.9%)。首次惊厥发作于第1天11例(4.7%),第2天62例(26.3%),第3天137例(58.0%),第4天20例(8.5%),第5天6例(2.5%)。惊厥发作1次25例(10.6%),发作2次132例(55.9%),发作3次52例(22.0%),发作4次15例(6.4%),发作≥5次12例(5.1%)。236例患儿共发生惊厥571次,平均2.42次,惊厥持续时间≤1分钟170次(29.8%),1~5分钟396次(69.4%),≥5分钟5次(0.8%)。比较两组间的临床特点发现,HRV阳性组较阴性组更易出现发热,且差异有统计学意义(P0.05);而在发病季节、发病年龄、性别、呕吐、腹泻、惊厥等分布的差异无统计学意义(P0.05)。在实验室检查方面,HRV阳性组较阴性组血清钠、钙含量降低,且差异有统计学意义(P0.05),其余各项指标差异无统计学意义。所有患儿出院后随访均未出现神经系统后遗症,其中6例(2.16%)出现复发,1例(0.36%)出现反复无热惊厥,转化为癫痫。结论:轮状病毒可引起BICE;伴轮状病毒感染组较非轮状病毒感染组更易出现发热,并可伴有一定程度的血钠、血钙浓度降低,但尚未达到引起惊厥的低钠血症和低钙血症。BICE惊厥出现于病程的第1~5天,以第3天最多见,大部分表现为反复惊厥发作或成簇样发作。本病预后良好,无神经系统后遗症,但极少数患儿存在复发情况。
[Abstract]:Objective: to investigate the association between mild gastroenteritis with benign convulsion (benign infantile convulsions associated with mild gastroenteritis,BICE) and rotavirus. The clinical manifestations and laboratory findings of rotavirus infection and non rotavirus infection were compared and analyzed. Methods: 278 children with BICE from January 2008 to October 2016 were divided into HRV positive group and negative group according to the results of stool human rotavirus (human rotavirus,HRV) antigen detection. The clinical data of all the children were retrospectively analyzed and the differences in onset season, age, sex, clinical manifestation, blood routine, liver function and electrolyte, especially in convulsion were compared between the two groups. The patients were followed up for 6 ~ 48 months after discharge and the prognosis was analyzed retrospectively. Results: there were 42 cases (15.1%) in HRV positive group, 236 cases (84.9%) in). HRV positive group, 20 cases (47.6%) in male and 22 cases (52.4%) in female. The age distribution ranged from 9 to 28 months, with an average of (16.5 卤4.2) months. There were 31 cases (73.8%) in autumn and winter and 11 cases (26.2%) in spring and summer. There were 20 cases (47.6%) with fever and 22 cases (52.4%) with no fever. There were 22 cases (52.4%) of diarrhea with vomiting, 18 cases (42.8%) of diarrhea and 2 cases (4.8%) of vomiting. There were 37 cases (88.1%) of comprehensive seizure and 5 cases (11.9%) of partial attack. The first seizure occurred on the first day (7.1%), the second day in 10 cases (23.8%), the third day in 25 cases (59.6%), the fourth day in 3 cases (7.1%) and the fifth day in 1 case (2.4%). Seizures occurred once in 4 cases (9.5%), twice in 24 cases (57.2%), 3 times in 9 cases (21.4%), 4 times in 3 cases (7.1%). Seizures 鈮，

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