Li Chunmei, Liu Zhenkui, Lu Yanhui, Shi Wei, Gao Jiaojiao, Cao Yanling, Liu Junfen, Ma Junshuai
Department of Pediatrics, the First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei, China.
Department of Nephrology, the First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Aug;35(8):860-864. doi: 10.3760/cma.j.cn121430-20220627-00606.
To investigate the association between serum zinc levels and convulsive brain injury in infants with mild gastroenteritis complicated with benign infantile seizures (BICE) and febrile seizures (FC).
A case-control study method was conducted. 120 children with mild gastroenteritis and convulsion admitted to the First Affiliated Hospital of Hebei North University from January 2020 to January 2022 were enrolled as the research subjects. They were divided into BICE group and FC group according to the type of convulsion. The serum zinc level, the frequency and duration of convulsion, and the occurrence of convulsive brain injury in the two groups were recorded. Multivariate Logistic regression analysis was used to screen the risk factors for convulsive brain injury. The Spearman correlation method was used to analyze the association between serum zinc levels, clinical characteristics of convulsion and convulsive brain injury.
A total of 120 children were enrolled, of which 81 developed to BICE and 39 developed to FC during hospitalization. The serum zinc level of children in the FC group was significantly lower than that in the BICE group (μmol/L: 39.24±6.50 vs. 48.65±7.21, P < 0.01). In the BICE group and FC group, the serum zinc level in children with more than 2 convulsions was significantly lower than that in the children with one convulsion (μmol/L: 37.65±6.50 vs. 53.17±7.55 in the BICE group, and 30.27±5.58 vs. 44.16±7.57 in the FC group, both P < 0.01). Serum zinc level in children with convulsion duration ≥ 5 minutes was significantly lower than that in the children with convulsion duration < 5 minutes (μmol/L: 38.75±6.74 vs. 51.21±7.58 in the BICE group, and 31.08±5.46 vs. 45.19±7.25 in the FC group, both P < 0.01). Moreover, the serum zinc level of children with different convulsion frequency and duration in the FC group was significantly lower than that in the BICE group (all P < 0.01). Among the 120 children, 9 cases of convulsive brain injury occurred, and the incidence rate was 7.50%. The incidence of convulsive brain injury in the BICE group was 1.23% (1/81), which was significantly lower than 20.51% in the FC group (8/39, P < 0.01). The serum zinc level of children with convulsive brain injury was significantly lower than that of children with non-brain injury (μmol/L: 28.50±5.00 vs. 60.22±7.31, P < 0.01), and the number of convulsion was significantly higher than that of non-cerebral injury (≥ 2 convulsions: 100.00% vs. 1.80%, P < 0.01), and the duration of convulsion in children with brain injury was significantly longer than that of non-brain-injured children (convulsion duration ≥ 5 minutes: 100.00% vs. 11.71%, P < 0.01). Multivariate Logistic regression analysis showed that decreased serum zinc level [odds ratio (OR) = 2.147, 95% confidence interval (95%CI) was 1.354-3.403], increased number of convulsion (OR = 3.452, 95%CI was 1.266-9.417), and prolonged convulsion duration (OR = 3.117, 95%CI was 1.326-7.327) were independent risk factor for convulsive brain injury in children with mild gastroenteritis and convulsion (all P < 0.05). Spearman correlation analysis showed that serum zinc level, convulsion ≥ 2 times, duration of convulsion ≥ 5 minutes and convulsion ≥ 2 times + convulsion duration ≥ 5 minutes were significantly negatively correlated with the occurrence of convulsive brain injury in FC children (r values were -0.546, -0.517, -0.522, and -0.528, all P < 0.01). There was no significant correlation between serum zinc level, convulsion ≥ 2 times, convulsion duration ≥ 5 minutes and convulsion ≥ 2 times+convulsion duration ≥ 5 minutes and convulsive brain injury in BICE children (r values were -0.281, -0.129, -0.201, -0.243, all P > 0.05).
Serum zinc level is related to the characteristics of convulsive symptoms in children with mild gastroenteritis complicated with FC, and has a strong negative correlation with the occurrence of convulsive brain injury. Active targeted intervention and treatment may help reduce the incidence of brain injury in children.
探讨血清锌水平与轻度胃肠炎合并良性婴儿惊厥（BICE）和热性惊厥（FC）患儿惊厥性脑损伤之间的关联。
采用病例对照研究方法。选取2020年1月至2022年1月在河北北方学院附属第一医院收治的120例轻度胃肠炎伴惊厥患儿作为研究对象。根据惊厥类型分为BICE组和FC组。记录两组患儿的血清锌水平、惊厥发作频率和持续时间以及惊厥性脑损伤的发生情况。采用多因素Logistic回归分析筛选惊厥性脑损伤的危险因素。采用Spearman相关分析血清锌水平、惊厥临床特征与惊厥性脑损伤之间的关联。
共纳入120例患儿，其中住院期间81例发展为BICE，39例发展为FC。FC组患儿血清锌水平显著低于BICE组（μmol/L：39.24±6.50 vs. 48.65±7.21，P<0.01）。在BICE组和FC组中，惊厥发作2次以上患儿的血清锌水平显著低于惊厥发作1次的患儿（BICE组：μmol/L：37.65±6.50 vs. 53.17±7.55，FC组：30.27±5.58 vs. 44.16±7.57，均P<0.01）。惊厥持续时间≥5分钟患儿的血清锌水平显著低于惊厥持续时间<5分钟的患儿（BICE组：μmol/L：38.75±6.74 vs. 51.21±7.58，FC组：31.08±5.46 vs. 45.19±7.25，均P<0.01）。此外FC组中不同惊厥发作频率和持续时间患儿的血清锌水平均显著低于BICE组（均P<0.01）。120例患儿中，发生惊厥性脑损伤9例，发生率为7.50%。BICE组惊厥性脑损伤发生率为1.23%（1/81），显著低于FC组的20.51%（8/39，P<0.01）。惊厥性脑损伤患儿的血清锌水平显著低于无脑部损伤患儿（μmol/L：28.50±5.00 vs. 60.22±7.31，P<0.01），惊厥发作次数显著高于无脑部损伤患儿（≥2次惊厥：100.00% vs. 1.80%，P<0.01），脑损伤患儿的惊厥持续时间显著长于无脑部损伤患儿（惊厥持续时间≥5分钟：100.00% vs. 11.71%，P<0.01）。多因素Logistic回归分析显示，血清锌水平降低[比值比（OR）=2.147，95%置信区间（95%CI）为1.354 - 3.403]、惊厥发作次数增加（OR = 3.452，95%CI为1.266 - 9.417）和惊厥持续时间延长（OR = 3.117，95%CI为1.326 - 7.327）是轻度胃肠炎伴惊厥患儿惊厥性脑损伤的独立危险因素（均P<0.05）。Spearman相关分析显示，血清锌水平、惊厥≥2次、惊厥持续时间≥5分钟以及惊厥≥2次+惊厥持续时间≥5分钟与FC患儿惊厥性脑损伤的发生均呈显著负相关（r值分别为-0.546、-0.517、-0.522和-0.528，均P<0.01）。血清锌水平、惊厥≥2次、惊厥持续时间≥5分钟以及惊厥≥2次+惊厥持续时间≥5分钟与BICE患儿惊厥性脑损伤无显著相关性（r值分别为-0.281、-0.129、-0.201、-0.243，均P>0.05）。
血清锌水平与轻度胃肠炎合并FC患儿的惊厥症状特征有关，与惊厥性脑损伤的发生呈强负相关。积极进行针对性干预和治疗可能有助于降低患儿脑损伤的发生率。
