日本儿童急性脑病国家研究（2020年4月至2023年10月）：来自第三项研究的见解

IF 1.3 4区医学 Q4 CLINICAL NEUROLOGY

Brain & Development Pub Date : 2025-06-25 DOI:10.1016/j.braindev.2025.104387

Taku Omata , Hiroshi Sakuma , Hiroaki Nagase , Yuichi Abe , Ichiro Kuki , Akihisa Okumura , Yoshihiro Maegaki , Kei Murayama , Yasunari Sakai , Ai Hoshino , Masashi Mizuguchi , Jun-ichi Takanashi

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引用次数: 0

摘要

日本以前的急性脑病国家研究是在2007-2010年和2014-2017年进行的。在第三项研究（2020年4月1日至2023年10月31日）中，跨越2019冠状病毒病（COVID-19）爆发，我们比较了结果，以评估儿科病毒感染和治疗实践的趋势。方法对日本儿科学会所属430家医院进行问卷调查，共收到241份问卷，1197例病例。对151家机构进行二次调查，收到110份回复（72.8%），确定了622名符合条件的患者（604名接受治疗，544名接受结果分析）。收集患者背景、证候分类、致病病毒、治疗和预后等资料。结果622例病例中，1岁儿童发病率最高，其中男孩占54.6%，病例数在COVID-19和流感暴发期间达到高峰。临床综合征发生率为：急性脑病伴两期癫痫发作，弥散晚期减低，占35.1%；临床轻度脑炎/脑病伴可逆性脾损害，17.8%；失血性休克和脑病综合征（HSES）， 6.9%；急性脑炎伴难治性反复部分性发作，3.7%；急性暴发性脑水肿（AFCE）， 2.2%；急性坏死性脑病，1.6%；无法分类的占31.4%。值得注意的是，HSES/AFCE的综合比率从2014-2017年的1.9%上升到9.1%，这可能是由于诊断增强和COVID-19的影响。致病菌为麻疹（16.1%）、严重急性呼吸综合征冠状病毒2型（15.9%）和流感（7.7%）。治疗包括类固醇脉冲治疗（68.9%）、线粒体鸡尾酒治疗（42.5%）和靶向温度管理（31.0%）。结论本研究提供了COVID-19暴发期间儿科急性脑病的全面概述，显示了HSES/AFCE的发病率增加，并提出了目前的治疗方法。

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National study on pediatric acute encephalopathy in Japan (April 2020 to October 2023): Insights from the third study

Background

Previous national studies of acute encephalopathy in Japan were conducted in 2007–2010 and 2014–2017. In this third study (April 1, 2020–October 31, 2023), spanning the coronavirus disease 2019 (COVID-19) outbreak, we compared results to assess trends in pediatric viral infections and therapeutic practices.

Methods

Questionnaires were sent to 430 hospitals of the Japanese Pediatric Society, yielding 241 responses and 1197 cases. A secondary survey to 151 facilities received 110 responses (72.8 %), identifying 622 eligible patients (604 for treatment, 544 for outcome analysis). Data on patient background, syndrome classification, causative virus, treatment, and prognosis were collected.

Results

Among 622 cases (54.6 % boys), the highest incidence was in 1-year-olds, with case numbers peaking during COVID-19 and influenza outbreaks. The frequency of clinical syndromes was: acute encephalopathy with biphasic seizures and late reduced diffusion, 35.1 %; clinically mild encephalitis/encephalopathy with a reversible splenial lesion, 17.8 %; hemorrhagic shock and encephalopathy syndrome (HSES), 6.9 %; acute encephalitis with refractory, repetitive partial seizures, 3.7 %; acute fulminant cerebral edema (AFCE), 2.2 %; acute necrotizing encephalopathy, 1.6 %; and unclassifiable, 31.4 %. Notably, the combined HSES/AFCE rate increased from 1.9 % in the 2014–2017 survey to 9.1 %, likely due to enhanced diagnosis and COVID-19 impact. Pathogens were exanthem subitum (16.1 %), severe acute respiratory syndrome coronavirus 2 (15.9 %), and influenza (7.7 %). Treatments included steroid pulse therapy (68.9 %), mitochondrial cocktails (42.5 %), and targeted temperature management (31.0 %).

Conclusion

This study provides a comprehensive overview of pediatric acute encephalopathy during COVID-19 outbreaks, shows increases in the incidence of HSES/AFCE, and presents current treatment.

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来源期刊

Brain & Development 医学-临床神经学

CiteScore

3.60

自引率

0.00%

发文量

153

审稿时长

50 days

期刊介绍： Brain and Development (ISSN 0387-7604) is the Official Journal of the Japanese Society of Child Neurology, and is aimed to promote clinical child neurology and developmental neuroscience. The journal is devoted to publishing Review Articles, Full Length Original Papers, Case Reports and Letters to the Editor in the field of Child Neurology and related sciences. Proceedings of meetings, and professional announcements will be published at the Editor''s discretion. Letters concerning articles published in Brain and Development and other relevant issues are also welcome.