轻度胃肠炎伴热性惊厥患儿肠道菌群失调与脑损伤的相关性

探讨热性惊厥患儿肠道菌群失调与脑损伤的相关性，为该类患儿的治疗提供参考。

选取2020年10月至2021年10月我院收治的108例热性惊厥患儿为研究对象，根据患儿临床表现分为轻度胃肠炎伴热性惊厥组（57例）和单纯型高热惊厥组（51例）；根据是否发生脑损伤分为脑损伤组（27例）与无脑损伤组（81例）。入院时采集患儿粪便标本进行轮状病毒检测以及大肠埃希菌、肠球菌、乳杆菌和双歧杆菌培养。采集患儿空腹静脉血，采用酶联免疫双抗体夹心法检测血清S-100β蛋白、碱性髓鞘蛋白（myelin basic protein，MBP）、神经元特异性烯醇化酶（neuron-specific enolase，NSE）水平。采用多因素Logistic回归分析影响热性惊厥患儿脑损伤的危险因素，然后采用Pearson法分析肠道菌群与脑损伤的相关性。

轻度胃肠炎伴热性惊厥组患儿轮状病毒阳性28例（49.12%），单纯型高热惊厥组患儿轮状病毒阳性15例（29.41%），差异有统计学意义（χ² = 4.364，P＜0.05）。轻度胃肠炎伴热性惊厥组患儿粪便中大肠埃希菌、肠球菌、乳杆菌、双歧杆菌数量均低于单纯型高热惊厥组（均P＜0.05）。轻度胃肠炎伴热性惊厥组患儿血清S-100β蛋白、MBP、NSE水平均高于单纯型高热惊厥组（均P＜0.05）。单因素分析显示，脑损伤组患儿首次发热体温以及粪便中大肠埃希菌、肠球菌、乳杆菌、双歧杆菌数量低于无脑损伤组患儿，而血清S-100β蛋白、MBP、NSE水平高于无脑损伤组患儿（均P＜0.05）。多因素Logistic回归分析显示，大肠埃希菌数量降低（OR = 2.063，95% CI：1.252～2.919）、肠球菌数量降低（OR = 1.912，95% CI：1.252～2.919）、乳杆菌数量降低（OR = 2.032，95% CI：1.083～3.812）、双歧杆菌数量降低（OR = 2.044，95% CI：1.235～9.593）、血清S-100β蛋白水平升高（OR = 3.442，95% CI：1.235～9.593）、血清MBP水平升高（OR = 3.149，95% CI：1.222～8.115）、血清NSE水平升高（OR = 2.815，95% CI：1.752～4.524）是影响热性惊厥患儿脑损伤的独立危险因素（均P＜0.05）。Pearson相关性分析结果显示，血清S-100β蛋白、MBP、NSE水平与粪便中大肠埃希菌、肠球菌、乳杆菌、双歧杆菌数量呈负相关（均P＜0.05）。

轮状病毒感染，肠道菌群失衡，有益菌数量降低与轻度胃肠炎伴热性惊厥患儿发病和脑损伤密切相关，调节轻度胃肠炎伴热性惊厥患儿肠道菌群对该病的防治具有积极意义。

The correlation between intestinal microbial imbalance and brain injury in children with mild gastroenteritis and febrile convulsion

ObjectiveTo explore the correlation between intestinal microbial imbalance and brain injury in children with febrile convulsion (FC), and provide a reference for the treatment. MethodsA total of 108 children with febrile seizures (FS) who were admitted to our hospital from October 2020 to October 2021 were selected and divided into mild gastroenteritis with FS group (57 cases) and simple FS group (51 cases) according to their clinical manifestations. According to whether brain injury occurred or not, they were divided into brain injury group (27 cases) and brain injury-free group (81 cases). At admission, fecal specimens were collected from the children for fecal rotavirus detection and culturing of Escherichia coli, Enterococcus, Lactobacillus and Bifidobacterium. Venous blood was collected for detection of S-100β protein, basic myelin protein (MBP) and neuron-specific enolase (NSE). Multivariate Logistic regression was used to analyze the risk factors for brain injury in children with febrile seizures, and Pearson's method was used to analyze the correlation between gut microbes and brain injury. ResultsTwenty-eight (49.12%) children with mild gastroenteritis and FC were positive for rotavirus, and 15 (29.41%) children in the simple FS group were positive for rotavirus, with statistically significant difference (χ2 = 4.364, P＜0.05). The counts of Escherichia coli, Enterococcus, Lactobacillus and Bifidobacterium in feces of children in mild gastroenteritis with FS group were lower than those in simple FS group (all P＜0.05). The levels of serum S-100β protein, MBP and NSE in mild gastroenteritis with FS group were higher than those in the simple FS group (all P＜0.05). Univariate analysis showed that the body temperature at first onset of fever and counts of Escherichia coli, Enterococcus, Lactobacillus and Bifidobacterium of the children in the brain injury group were lower than those of the children without brain injury, while the levels of serum S-100β protein, MBP and NSE were higher than those of the children without brain injury (all P＜0.05). Logistic regression analysis showed that decreased counts of Escherichia coli (OR = 2.063, 95% CI: 1.252 - 2.919), Enterococcus (OR = 1.912, 95% CI: 1.252 - 2.919), Lactobacillus (OR = 2.032, 95% CI: 1.083 - 3.812) and Bifidobacterium (OR = 2.044, 95% CI: 1.235 - 9.593), as well as increased serum S-100β protein (OR = 3.442, 95% CI: 1.235 - 9.593), serum MBP (OR = 3.149, 95% CI: 1.222 - 8.115) and serum NSE (OR = 2.815, 95% CI: 1.752 - 4.524) were independent risk factors for brain injury in children with FS (all P＜0.05). Pearson correlation analysis showed that serum S-100β protein, MBP and NSE were negatively correlated with the counts of Escherichia coli, Enterococcus, Lactobacillus and Bifidobacterium in feces (all P＜0.05). ConclusionRotavirus infection, intestinal microbial imbalance and reduced count of probiotics are closely related to the morbidity and brain damage in children with mild gastroenteritis and febrile convulsion. Regulation of intestinal flora in children with mild gastroenteritis and febrile convulsion is of positive significance for improving the prevention and treatment of febrile convulsion.