儿童肺炎支原体脑炎的临床特征及预后不良危险因素分析

背景近年儿童肺炎支原体脑炎(MPIE)发病趋势有所增加，临床表现异质性和诊断手段局限性使得临床医生认识不足。目的 分析儿童MPIE的临床特征并探讨患儿预后不良的独立危险因素，为降低MPIE神经后遗症的发生率和病死率提供理论依据。方法 回顾性分析2020年1月至2022年6月于河北省儿童医院神经内科住院治疗的101例MPIE患儿的临床资料，采用格拉斯哥预后分级(GOS)评估患儿出院时情况，分为预后良好组(73例)和预后不良组(28例)。分析两组MPIE患儿的临床特征，包括一般资料(性别、年龄等)、临床症状及体征、辅助检查结果[肺炎支原体(MP)、脑脊液、脑电图、影像学及免疫学等相关实验室检查指标]及治疗情况并进行比较。采用多因素Logistic回归分析探讨儿童MPIE预后不良的独立危险因素。结果 MPIE患儿预后良好率为72.3%(73/101)，预后不良率为27.7%(28/101)。患儿多急性起病，学龄期儿童为主，全年散发，冬春季占比较高，最常见的症状是发热，神经系统表现以言语障碍和运动障碍等局灶性损害较多见，部分出现癫痫发作，甚至发展为难治性癫痫持续状态。脑脊液肺炎支原体-聚合酶链...

Clinical Characteristics and Risk Factors for Unfavourble Prognosis of Mycoplasma Pneumoniae Encephalitis in Children

BackgroundThe incidence of Mycoplasma pneumoniae encephalitis (MPIE) in children has increased in recent years, but it is under-recognized by clinicians due to its heterogenous clinical presentations and limited diagnostic tools.ObjectiveTo analyze the clinical characteristics of children with MPIE and to explore the independent risk factors for unfavourble prognosis, so as to provide a theoretical basis for reducing the incidence of neurological sequelae and mortality of MPIE in children.MethodsThe clinical data of 101 children with MPIE who were hospitalized in Department of Neurology, Children's Hospital of Hebei Province from January 2020 to June 2022 were retrospectively analyzed. The Glasgow Outcome Scale (GOS) was used to assess the children's condition at discharge, by which they were divided into favourble prognosis group and unfavourble prognosis group. Clinical characteristics including demographics (age, gender, etc.) , clinical symptoms and signs, as well as auxiliary examination results〔laboratory tests related to Mycoplasma pneumoniae (MP) , cerebrospinal fluid (CSF) , electroencephalogram (EEG) and imaging, and immunological indicators〕and treatment were analyzed, and then compared between the two groups. Multivariate Logistic regression analysis was used to explore the independent risk factors for unfavourble prognosis of MPIE.ResultsThe prevalence of favourble and unfavourble prognosis was 72.3% (73/101) and 27.7% (28/101) , respectively. Most of the children were of school age, and MPIE in them was mainly manifested by occurring sporadically throughout the year but with a relatively high incidence in winter and spring, acute onset, with fever as the most common symptom, lalopathy and dyskinesia and other focal lesions as the common neurological manifestations. Epilepsy was found in some cases, which may even develop into refractory status epilepticus. The prevalence of MP in CSF detected by PCR was 26.7% (27/101) . The EEG mainly showed slowing of background alpha rhythm. Brain MRI mainly showed long T1 and T2 signals in the involved region, and the abnormal rates of both were 68.3% (69/101) and 44.6% (45/101) , respectively. By tests for cellular immunity and humoral immunity, or the blood or CSF test in some children, anti-NMDAR, myelin oligodendrocyte glycoprotein and other immune encephalitis and demyelinating related antibodies could be detected. There were significant differences between favourble and unfavourble prognosis groups in the prevalence of psychobehavioral abnormality, disturbance of consciousness, epileptic seizures, status epilepticus, focal neurological dysfunction, EEG abnormalities, brain MRI abnormalities, hormone therapy and intravenous immunoglobulin therapy, as well as average level of white blood cell count in CSF (P<0.05) . Multivariate Logistic regression analysis showed that focal neurological dysfunction〔OR=6.292, 95%CI (1.188, 33.327) , P=0.035〕, status epilepticus〔OR=18.031, 95%CI (1.231, 264.082) , P=0.031〕, abnormal EEG〔OR=7.379, 95%CI (1.077, 50.548) , P=0.042〕, abnormal brain MRI〔OR=5.757, 95%CI (1.105, 30.003) , P=0.038〕, and requiring hormone therapy〔OR=12.441, 95%CI (1.082, 143.114) , P=0.043〕were independent risk factors for unfavourble prognosis in children with MPIE.ConclusionFocal neurological dysfunction, status epilepticus, abnormal EEG and brain MRI changes and the need for glucocorticoid therapy may be independent risk factors for unfavourble prognosis in children with MPIE, and clinicians should pay high attention to these factors to early identify them, so that the incidence of neurological sequelae and mortality of MPIE could be reduced.