소아 장바이러스 뇌수막염의 임상적 특징 및 신경학적 합병증
Clinical Features and Neurologic Complications of Pediatric Enteroviral Meningitis
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목적: 소아에서의 장바이러스 뇌수막염의 임상 특징 및 신경학적합병증을 알아보고, 뇌척수액 백혈구 증가증의 유무와 신경학적 합병증의 발생 유무에 따른 위험인자의 차이를 알아보고자 하였다. 방법: 2009년 3월부터 2015년 2월 사이에 단국대학교병원에 입원한 1개월에서 18세까지의 환아들 중 뇌척수액의 장바이러스 RT-PCR 에서 양성소견을 보인 환아들을 대상으로, 그 의무기록을 후향적으로 연구하였다. 결과: 총 151명이 본 연구에 포함되었다. 94명(62.3%)이 남아였으며, 진단 시 평균 나이는 40.9±47.0개월 이었다. 가장 흔한 입원 계절은 여름으로 나타났다(n=99. 65.6%). 입원 시 증상은 발열, 경구섭취감소, 활동 감소, 그리고 두통 순으로 많이 나타났다. 55명(36.4%)에서 뇌척수액 백혈구 증가증을 보이지 않았고, 신경학적 합병증은 4명(2.6%)에서 관찰되었다. 뇌척수액 백혈구 증가증을 보인 경우 혈액 백혈구 수와 뇌척수액 단백질은 더 높게, 뇌척수액 당 농도는 더 낮게 나타났다(P<0.05). 경련의 발생, 뇌 영상 검사 이상소견의 존재, 그리고진단 이후 발생한 신경발달 이상 등을 신경학적 합병증의 발생으로정의해 보았을 때, 신경학적 합병증을 보인 군에서 경련의 발생 및 의식변화가 더 많았고, 최고 체온이 더 높았으며, 총 발열 기간이 더 길었다(P<0.05). 신경학적 합병증을 보인 환아들은 모두 남아였으며 평균 입원 나이는 더 어렸지만, 통계적으로 유의하진 않았다. 결론: 장바이러스 뇌수막염이 진단된 환아들 중 3분의 1이 넘는 환아들에서 뇌척수액 백혈구 증가증이 동반되지 않았으며, 대부분은 예후가 좋았지만, 뇌전증 지속증, 의식변화를 보인 수막뇌염, 재발성 경련 등의 신경학적 합병증이 드물게 나타났다. 신경학적 합병증을 보인군에서 경련과 의식변화가 더 많았고, 총 발열기간이 더 길었으며, 최고 체온 및 뇌척수액 단백질과 백혈구의 수치가 더 높았다.
Abstract
Purpose: To explore clinical features and neurologic complications of pediatric enteroviral meningitis, and to evaluate risk factors according to the presence of cerebrospinal fluid (CSF) pleocytosis and neurologic complications. Methods: Retrospective review of medical records of patients aged between 1 month and 18 years who were found positive for CSF enterovirus reverse transcription polymerase chain reaction in Dankook University Hospital from March 2009 to February 2015. Results: A total of 151 children was enrolled in the study. Ninety four patients were males and the age at diagnosis was 40.9±47.0 months. Most common season of admission was summer (n=99, 65.6%). Most frequent presenting symptom was fever followed by poor oral intake, decreased activity, and headache. Fifty five (36.4%) patients had no CSF pleocytosis. Complications were observed in 4 (2.6%). Mean blood white blood cell, CSF protein levels were higher, and CSF glucose levels were lower in group with pleocytosis (P<0.05). There were more seizure development and mental changes, higher peak body temperature, longer fever duration, and longer duration from symptom onset to CSF tapping in group with complications (P<0.05). All were boys and mean age at admission was younger in group with complications, without statistically significant difference. Conclusion: Relatively high proportion of children with enteroviral meningitis showed no pleocytosis. Complications such as meningoencephalitis, refractory status epilepticus, or recurrent seizure rarely occurred, although most had good clinical outcomes.
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