目的:关于高热惊厥(FS)发病机理中病原体相关和宿主相关因素的数据有限。我们设计了一项对照研究,以比较不同呼吸道病毒和发热反应在FS中的作用。
方法:在对1899名6个月-6岁的儿科急诊室患者进行的前瞻性队列研究中,呼吸道病毒多重PCR阳性,我们确定了225例FSs患者。我们首先比较了年龄分层的FSs患者与其他患者中呼吸道病毒的分布。在一项嵌入式病例对照研究中,我们比较了FSs患者与年龄相匹配的对照组的发热反应,季节和相同的呼吸道病毒。
结果:冠状病毒OC43,229E,FS的相对风险最高,与其他呼吸道病毒感染相比,NL63感染[RR:3.2,95%置信区间(CI):1.4-7.2)以及甲型和乙型流感[RR:2.5,95%CI:1.4-4.7]。FSs患者的发热反应更强,为39.2°C(差异:0.8°C,95%CI:0.5-1.2)在急性护理后住院期间比相同呼吸道病毒的对照组晚。
结论:与其他呼吸道病毒相比,流感和冠状病毒引起的与FS相关的急诊室就诊相对更多。此外,FSs患者的发热反应强于相同呼吸道病毒的对照组。结果表明,FSs的病理机制包括可改变的病原体相关和宿主相关因子,这些因子可能具有预防FSs的潜力。
OBJECTIVE: There are limited data on the pathogen-related and host-related factors in the pathogenesis of febrile seizures (FS). We designed a controlled study to compare the role of different respiratory viruses and febrile response in FS.
METHODS: In a prospective cohort study of 1899 pediatric emergency room patients aged 6 months-6 years with a positive respiratory virus multiplex PCR, we identified 225 patients with FSs. We first compared the distribution of respiratory viruses in age-stratified patients with FSs with that in other patients. In an embedded
case-control study, we compared the febrile response in patients with FSs with that in the controls matched for age, season and the same respiratory virus.
RESULTS: The relative risk for FS was the highest for coronavirus OC43, 229E, and NL63 infections [RR: 3.2, 95 % confidence interval (CI): 1.4-7.2) and influenza A and B [RR: 2.5, 95 % CI: 1.4-4.7] as compared to those with other respiratory viral infections. The patients with FSs had a stronger febrile response of 39.2 °C (difference: 0.8 °C, 95 % CI: 0.5-1.2) later during hospitalization after acute care than the controls matched for the same respiratory virus.
CONCLUSIONS: Influenza and coronaviruses caused relatively more FS-related emergency room visits than other respiratory viruses. Furthermore, the febrile response was stronger in the patients with FSs than in the controls matched for the same respiratory virus. The results suggest that the pathomechanism of FSs includes modifiable pathogen-related and host-related factors with possible potential in the prevention of FSs.