摘要
目的 探究复杂性热性惊厥(CFS)患儿丙二醛、神经胶质纤维酸性蛋白(GFAP)、神经元特异性烯醇化酶(NSE)表达水平及其对脑损伤的预测价值.方法 回顾性选取2017年10月至2022年12月在巴彦淖尔市医院治疗的热性惊厥患儿100例作为研究对象,其中CFS患儿45例纳入观察组,单纯性热性惊厥患儿55例纳入对照组.观察组患儿进行6个月的随访,根据患儿是否发生神经系统异常表现将其分为预后良好患儿34例和预后不良患儿11例.比较观察组和对照组患儿、不同预后CFS患儿的血清丙二醛、GFAP、NSE水平、惊厥次数及惊厥持续时间,同时分析丙二醛、NSE、GFAP水平与脑损伤的关系.采用多因素Logistic回归分析影响CFS患儿脑损伤的因素;采用受试者操作特征(ROC)曲线分析丙二醛、GFAP、NSE水平预测CFS患儿脑损伤的价值.结果 观察组患儿血清丙二醛、GFAP、NSE水平分别为(5.66±1.43)ng/mL、(47.32±11.34)μmol/L、(22.47±5.14)ng/mL,均显著高于对照组[(1.42±0.61)ng/mL、(27.42±8.29)μmol/L、(14.16±3.79)ng/mL],差异均有统计学意义(P＜0.05).观察组患儿惊厥次数为(2.79±0.86)次,多于对照组[(1.33±0.22)次],惊厥持续时间为(14.21±3.67)min,长于对照组[(4.32±1.33)min],差异均有统计学意义(P＜0.05).经Pearson相关性分析,观察组患儿血清丙二醛、GFAP、NSE水平与惊厥次数和惊厥持续时间均呈正相关(P＜0.05).预后良好患儿血清丙二醛、GFAP、NSE水平均低于预后不良患儿,差异均有统计学意义(P＜0.05).经Logistic回归分析,丙二醛、GFAP、NSE表达均为影响CFS患儿发生脑损伤的独立危险因素(P＜0.05).经ROC曲线分析,丙二醛、GFAP、NSE水平表达和三者联合对CFS患儿发生脑损伤均有较高的预测价值,且联合预测的预测价值最高,曲线下面积(AUC)值分别为0.883、0.785、0.845、0.959.结论 丙二醛、GFAP、NSE表达水平的升高参与CFS患儿的发病过程,且与脑损伤程度密切相关,三者联合预测发病后脑损伤效能较好,值得临床推广.
Abstract
Objective To explore the expression levels of malondialdehyde,glial fibrillary acidic protein(GFAP),and neuron specific enolase(NSE)in children with complex febrile seizure(CFS)and their predictive value for brain injury.Methods One hundred children with febrile seizure who were treated in Bayannur City Hospital from October 2017 to December 2022 were selected,45 children with CFS as the obser-vation group,and 55 children with simple febrile seizure as the control group.The observation group of children was followed up for 6 months,and they were divided into 34 children with good prognosis and 11 children with poor prognosis based on whether they had neurological abnormal ex-pression.The levels of serum malondialdehyde MDA,GFAP,NSE in the observation group and the control group children,as well as CFS chil-dren with different prognoses were compared,frequency and duration of seizure between two groups were compared,and the relationship between malondialdehyde,NSE,GFAP levels and brain injury was analyzed.The factors affecting brain injury in children with CFS were analyzed using multivariate Logistic regression analysis.The predictive value of brain injury in children with CFS using levels of malondialdehyde,GFAP,and NSE was analyzed using receiver operating characteristic(ROC)curves.Results The serum levels of malondialdehyde,GFAP,and NSE in the observation group were(5.66±1.43)ng/mL,(47.32±11.34)μmol/L,and(22.47±5.14)ng/mL,respectively,which were significantly higher than those in the control group[(1.42±0.61)ng/mL,(27.42±8.29)μmol/L,and(14.16±3.79)ng/mL],and the differences were statistically significant(P＜0.05).The number of seizures in the observation group was(2.79±0.86)times,which was higher than that in the control group[(1.33±0.22)times],and the duration of seizures was(14.21±3.67)minutes,which was longer than that in the control group[(4.32±1.33)minutes],the differences were statistically significant(P＜0.05).According to Pearson correlation analysis,the levels of malondialdehyde,GFAP,and NSE in the observation group were positively correlated with the frequency and duration of seizure(P＜0.05).The levels of malondialdehyde,GFAP,and NSE in children with good prognosis were lower than those in children with poor prognosis,and the differences were statistically significant(P＜0.05).Through Logistic regression analysis,malondialdehyde,GFAP,and NSE expression were all independent risk factors for brain injury in children with complex febrile seizure(P＜0.05).According to ROC curve analysis,the expression levels of malondialdehyde,GFAP,NSE,and their combination had high predictive value for the occurrence of brain injury in children with com-plex febrile seizure,and the combined prediction had the highest predictive value,with area under the curve(AUC)values of 0.883,0.785,0.845,and 0.959,respectively.Conclusion The increased expression levels of malondialdehyde,GFAP,and NSE are involved in the patho-genesis of CFS in children,and are closely related to the degree of brain injury.The combined prediction of brain injury after onset by the three is effective and worthy of clinical promotion.
基金项目
内蒙古自治区卫生计生科研计划(201703103)
维普
万方数据