脑电图及神经影像学在小儿热性惊厥中的临床应用价值

Clinical value of electroencephalogram and neuroimaging in children with febrile seizures

摘要:

目的：探讨脑电图（electroencephalogram，EEG）及神经影像学（computed tomography，CT或magnetic resonance imaging，MRI）检查在小儿热性惊厥（febrile seizures，FS）中的临床应用价值。方法：①根据临床特征将FS分为单纯性热性惊厥（simple febrile seizures，SFS）和复杂性热性惊厥（complex febrile seizures，CFS）；根据随访结果，分为FS继发癫痫组与FS未继发癫痫组；②426例FS儿童于发作后2周内行首次EEG，并根据病情定期随访，92例行CT，310例行MRI，采用卡方检验和logistic回归分析，分析总结EEG、CT或MRI与FS类型、临床特征以及是否继发癫痫的关系。结果：①FS儿童首次EEG异常71例，随访后异常138例，两者比较有明显差异（P=0.000）；其中SFS组和CFS组分别由22例、49例增至26例、112例，复查前、后比较，SFS组无明显差异（P=0.102），CFS组有明显差异（P=0.008）；②根据随访结果，EEG异常率在SFS组（26/426）与CFS组（112/426）间、FS继发癫痫组（97/127）与FS未继发癫痫组（41/299）间比较存在明显差异（P=0.001，P=0.001）；③CT、MRI异常率在SFS组（CT，8/92；MRI，9/310）与CFS组（CT，5/92；MRI，28/310）间、FS继发癫痫组（CT，3/16；MRI，16/110）与FS未继发癫痫组（CT，10/76；MRI，21/200）间比较均无明显差异（P=0.574，P=0.755，P=0.559，P=0.293）；④CT/MRI与EEG检查异常率之间无相关性（P=0.836，P=0.557）。结论：①对CFS儿童定期随访EEG有较大的临床应用价值，但对SFS儿童其价值有限；②CT/MRI对发育正常的FS儿童的临床应用价值有限，不需要常规进行。

Abstract:

Objective：To explore the clinical value of electroencephalograms（EEG） and neuroimaging（CT or MRI） in children with febrile seizures（FS）. Methods：①According to clinical features，the children with FS were classified as simple febrile seizures（SFS） and complex febrile seizures（CFS）. According to the follow-up results，the children with FS were classified as children with epilepsy group and children without epilepsy group. ②The initial EEGs were recoreded within two weeks after onset in 426 children with FS. And EEGs were followed up regularly. A total of 92 children with FS underwent CT and 310 underwent MRI. Chi-square test and Lo－gistic regression analysis were used to analyze the relationship between EEG，CT/MRI and types of FS，clinical features，and sec－ondary epilepsy. Results：①The abnormal cases of initial EEGs and follow-up EEGs were 71 and 138 respectively，with significant differences（P=0.000）. The abnormal cases of EEG in SFS group and CFS group ranged from 22 to 26，from 49 to 112 respectively. Compared with follow-up results before and after，there was no significant difference in SFS group（P=0.102），and the difference was significant in CFS group（P=0.008）. ②In the follow-up results，the abnormal rate of EEGs were significant different in SFS group （26/426） and CFS group（112/426），children with epilepsy group（97/127） and in children without epilepsy group（41/299）（P=0.001，P=0.001）. ③The abnormal rate of CT/MRI were not significant different in SFS group（CT，8/92；MRI，9/310），CFS group（CT，5/92；MRI，28/310），children with epilepsy group（CT，3/16；MRI，16/110） and in children without epilepsy group（CT，10/76；MRI，21/200）（P=0.574，P=0.755，P=0.559，P=0.293）. ④The abnormali－ties of CT/MRI were not correlated with the abnormalities of EEG（P=0.836，P=0.557）. Conclusion：①EEG，especially the regular follow-up of EEG，has a greater clinical value for chil－dren with CFS，and is of limited value for children with SFS. ②CT/MRI has limited clinical value in neurologically normal chil－dren with FS，and the routine examination is not justified.