急性单纯疱疹病毒性脑炎及脑膜炎患者临床特征及预后分析

发布时间：2018-01-24 19:04

本文关键词： 脑炎单纯疱疹脑膜炎病毒性症状和体征预后危险因素　出处：《中国全科医学》2017年08期 　论文类型：期刊论文

【摘要】：目的了解成年人急性单纯疱疹病毒(HSV)性脑炎及脑膜炎的临床表现、脑脊液(CSF)及神经影像学检查表现,探讨患者临床不良预后的危险因素。方法选取2009—2015年于南京大学医学院附属鼓楼医院急诊科治疗的HSV性脑炎或脑膜炎患者80例为研究对象,其中脑炎20例,脑膜炎60例。记录患者性别、年龄、临床表现;经腰椎穿刺留取CSF,检测白细胞计数、淋巴细胞分数、粒细胞分数、红细胞计数、蛋白、葡萄糖水平;记录神经影像学及脑电图(EEG)检查结果;出院时采用Glasgow预后评分评价患者临床预后。结果 7例患者颅脑CT有异常改变,其中2例单侧颞叶或颞额区异常密度影,1例左侧岛叶皮质亚急性梗死,1例左侧颞骨内侧高密度影,3例为非特异性改变。14例患者颅脑MRI有异常改变,其中5例单侧颞叶或颞额叶区异常,1例双侧颞额叶区异常,1例左侧岛叶皮质点状出血和亚急性梗死,1例双侧额叶皮质弥散性高密度影,6例为非特异性改变。9例患者EEG有异常改变,其中3例额叶区或颞叶区波形异常,6例为非特异性改变。10例患者出现不良临床预后,其中2例为植物状态,7例为严重功能缺损,1例为中度功能缺损。HSV性脑炎与脑膜炎患者年龄、头痛、意识状态改变、癫痫、局灶性神经缺损、颈强直、CT异常、MRI异常、EEG异常比例,以及住院时间、不良临床预后发生率比较,差异均有统计学意义(P0.05)。多因素Logistic回归分析显示,合并疾病〔β=2.701,SE=0.804,OR=14.895,95%CI(3.081,72.013)〕、HSV性脑炎〔β=3.766,SE=0.750,OR=43.207,95%CI(9.934,187.917)〕是患者发生不良临床预后的危险因素(P0.05)。结论 HSV性脑炎和脑膜炎的临床症状、神经影像学检查、EEG及临床预后存在明显差异,合并疾病和HSV性脑炎患者是不良临床预后的危险因素。
[Abstract]:Objective to investigate the clinical manifestations of acute herpes simplex virus (HSV) encephalitis and meningitis in adults, cerebrospinal fluid (CSF) and neuroimaging findings. Methods 80 patients with HSV encephalitis or meningitis treated in the emergency department of Gulou Hospital affiliated to Medical College of Nanjing University from 2009 to 2015 were selected as subjects. . There were 20 cases of encephalitis and 60 cases of meningitis. CSF was obtained by lumbar puncture, and leukocyte count, lymphocyte fraction, granulocyte fraction, erythrocyte count, protein and glucose level were measured. The results of neuroimaging and electroencephalogram (EGG) were recorded. Results 7 patients had abnormal CT changes, 2 of them had abnormal density images of unilateral temporal lobe or temporal frontal area. One case with subacute infarction of left insular cortex, one case with left medial hyperdense temporal bone, 3 cases with nonspecific changes. There were abnormal changes in craniocerebral MRI in 14 cases, of which 5 cases were abnormal in unilateral temporal lobe or temporal frontal lobe. One case with bilateral temporomandibular cortex abnormality, one case with left insular cortex point hemorrhage and one case with subacute infarction, 6 cases with non-specific changes of bilateral frontal cortex, 9 cases with abnormal changes of EEG. Among them, 3 cases had abnormal waveform in frontal or temporal lobe, 6 cases were nonspecific changes. 10 cases had poor clinical prognosis, among them 2 cases were vegetative and 7 cases were serious functional defect. A case of moderate functional defect. HSV encephalitis and meningitis, age, headache, state of consciousness, epilepsy, focal nerve defect, cervical ankylosis CT abnormal MRI abnormal EEG abnormal proportion. There were significant differences in the incidence of poor clinical prognosis and duration of hospitalization (P 0.05). Multivariate Logistic regression analysis showed that the patients were complicated with diseases (尾 2.701). SEU 0.804 Oran 14.89595% CIQ 3.081 ~ 72.013 ~ + HSV encephalitis (尾 -3.766SE-0.750). Orang 43.207 and 95 CII 9.934. Conclusion HSV encephalitis and meningitis are the clinical symptoms and neuroimaging examination of patients with HSV encephalitis and meningitis. Patients with EEG and HSV encephalitis were risk factors for poor clinical prognosis.
【作者单位】：南京大学医学院附属鼓楼医院急诊科;
【基金】：江苏省医学会急性感染性疾病研究项目(2015JZKY01)
【分类号】：R512.3
【正文快照】： 全球范围内,严重的中枢神经系统(CNS)感染有较高的发病率,其中病毒是最常见的病原体,已知有超过100多种病毒能够引起CNS感染[1]。美国流行病学研究表明,13.8%的病毒性脑炎住院患者病原体为单纯疱疹病毒(HSV),占脑炎住院死亡患者的21.8%[2]。HSV感染CNS可有多种表现,包括自限性

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