소아환자에서 바이러스뇌염의 예측인자 및 예후인자
Predictive and Prognostic Factors of Viral Encephalitis in Pediatric Patients
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목적: 뇌염은 바이러스 등의 감염원이나 면역반응이 뇌 실질을 직접적인 침범하여 염증이 발생하는 것으로 소아청소년 연령에서의 발병률은 성인보다 많은 비율을 차지한다. 본 연구에서는 발열을 동반한 일시적인 의식의 변화 또는 발작을 보인 환자들을 대상으로 바이러스 뇌염의 예측인자를 확인하고 바이러스 뇌염의 예후인자를 알아보고자 하였다. 방법: 2008년 1월부터 2013년 5월까지 삼성서울병원 소아청소년과를 방문한 발열을 동반한 일시적인 의식의 변화 또는 발작을 보인81명을 대상으로 후향적 의무기록을 조사하여 이들의 임상양상과 검사소견 등을 비교 분석하였다. 결과: 총 81명 중 남자는 49명, 여자는 32명이었다. 발병시 평균 연령은 4.9±4.3세(범위 0-14세) 였으며, VIRAL ENC (임상적으로 바이러스 뇌염으로 진단된 환자군)은 66명(81%), C-FS (바이러스 뇌염과유사한 증상을 보인 복합열성경련 환자군)은 15명(19%) 이었다. 뇌파소견 중 부분 또는 편측의 이상소견을 가진 경우(P<0.001)가 예측인자로 통계적으로 의의가 있었다. 결론: 응급실 방문 초기에 뇌염 또는 뇌염과 유사한 증상을 동반한환자의 경우 뇌파의 이상소견이 바이러스성 뇌염을 예측할 수 있어발열 중 의식저하를 보이거나, 발작 후 의식의 회복이 지연되는 환자에서 뇌파를 조기에 시행하고 추적검사를 시행하는 것이 바이러스 뇌염을 조기에 진단하는 것에 도움이 될 것으로 사료된다.
Abstract
Purpose: Encephalitis is an inflammation affecting brain parenchyma. At the time of presentation, it may be difficult to differentiate between viral encephalitis and altered mental status or seizures during febrile illness. The aim of the present study is to identify the predictive factors and to determine the prognostic factors of viral encephalitis in children presenting as seizure with fever. Methods: From the retrospective review of the medical records, children with seizures or altered mental status during febrile illness who presented to Samsung Medical Center between January 2008 and May 2013 were included in the study. Results: 81 patients were enrolled in this study (female:male=32:49). The mean age at admission was 4.9±4.3 years (range 0-14 years old). The patients were categorized into two groups according to the clinical diagnosis: (1) Viral encephalitis (VIRAL ENC, n=66), (2) Complex febrile seizures imitating viral encephalitis(C-FS, n=15). The predictive factors of viral encephalitis were focal and/or lateralized abnormalities in electroencephalography (EEG) (P<0.001). Conclusions: EEG can be helpful to predict the viral encephalitis, in pediatric patient who shows delayed restoration of consciousness after seizure during febrile illness.
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