脑电图联合血清胶质纤维酸性蛋白对病毒性脑炎患儿早期诊断及预后评估的价值分析

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目的:探讨脑电图(EEG)联合血清胶质纤维酸性蛋白(GFAP)对病毒性脑炎(VE)患儿早期诊断及预后评估的价值。方法:选取2016年1月至2019年12月杭州市第七人民医院收治的63例VE患者为观察组,另外选取同期怀疑患中枢神经系统疾病后诊断为健康者80例作为对照组,记录两组性别构成、年龄、体质量、体质量指数(BMI)等一般资料,采用酶联免疫吸附法(ELISA)检测血清GFAP水平。比较两组一般资料、EEG异常结果、血清GFAP水平的差异;分析EEG联合血清GFAP对VE的诊断价值;绘制受试者工作特征(ROC)曲线评估血清GFAP对VE的诊断价值。结果:两组性别构成、年龄、体质量、BMI比较差异无统计学意义(n P>0.05);EEG诊断VE结果显示,观察组中有11例漏诊,对照组中有10例误诊,EEG诊断VE的灵敏度、特异度、准确度分别为82.54%、87.50%、85.31%;观察组血清GFAP水平高于对照组[(460.19 ± 126.53) ng/L比(217.36 ± 53.17) ng/L],差异有统计学意义(n t =15.525,n P<0.05)。ROC曲线分析显示,血清GFAP诊断VE的曲线下面积(AUC)为0.907,截断值为238.37 ng/L;EEG联合血清GFAP诊断VE的灵敏度、特异度、准确度分别为93.65%、83.75%、88.11%;12个月随访结果显示,63例VE患者中20例存在后遗症,不良预后发生率为31.75%(20/63)。预后良好组、预后不良组EEG、GFAP异常情况比较差异均有统计学意义(n P0.05). The results of EEG diagnosis for VE showed that 11 of 63 cases were missed and 10 of 80 cases in the control group were misdiagnosed, and the sensitivity, specificity and accuracy of EEG diagnosis for VE were 82.54%, 87.50% and 85.31%, respectively. Compared with that of the control group, the level of serum GFAP of the observation group was higher: (460.19 ± 126.53) ng/L vs. (217.36 ± 53.17) ng/L,n t =15.525, n P<0.05. ROC curve showed that area under curve (AUC) of serum GFAP for VE diagnosis was 0.907 and cutoff value was 238.37 ng/L. The sensitivity, specificity and accuracy of EEG combined with serum GFAP in diagnosing VE were 93.65%, 83.75% and 88.11%, respectively, and the sensitivity and accuracy of EEG combined with serum GFAP were higher than those of EEG and GFAP alone. The results of 12-month follow-up showed that 20 of 63 VE patients had sequel (poor prognosis group), 43 patients had good prognosis (good prognosis group), and the incidence of adverse prognosis was 31.75%(20/63). There were significant differences in EEG and GFAP between the good prognosis group and poor prognosis group (n P<0.05).n Conclusions:The sensitivity and accuracy of EEG combined with serum GFAP in the diagnosis of VE are good, which may be used for the early diagnosis and prognosis evaluation of VE.
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