流行性乙型脑炎的临床特点与S100B的相关研究

发布时间：2018-04-30 09:19

本文选题：流行性乙型脑炎 + 脑脊液　；参考：《河北医科大学》2014年硕士论文

【摘要】：目的：流行性乙型脑炎（Japanese encephalitis，JE）简称乙脑，是由乙脑病毒感染，流行在亚洲和太平洋地区重要的病毒脑炎。大多数乙脑感染是无症状的，但有症状的乙脑可从非特异性的发热到严重脑炎不同。临床上以高热、意识障碍、抽搐、局灶神经功能障碍、脑膜刺激征等为特征，病死率高、后遗症严重，并且在流行区主要侵犯儿童。随着乙脑疫苗的应用，乙脑的发病率明显减少，但部分地区仍有暴发，且成人感染乙脑的病例数增多。因此，尽早确诊，尽早评估乙脑病情轻重，对于临床具有重要的意义。S100B作为中枢神经系统(CNS)损伤时体现星形胶质细胞增生的敏感标志蛋白，目前在临床被很多学者重视。本研究旨在了解乙脑患者的临床特点，并测定乙脑患者脑脊液中S100B蛋白的含量，探究S100B在乙脑发病过程中的重要意义。方法：2013年8月～2013年10月河北医科大学第二医院神经内科收治的诊断为流行性乙型脑炎的患者92例，依据石家庄市防疫站检测的乙脑病毒IgM抗体阳性和临床特征确诊，并收集脑脊液共107份。通过脑脊液常规、生化、细胞学，影像学和脑电图等辅助检查，了解乙脑患者的临床特点。其中将资料完整的45名乙脑患者，共57份脑脊液，依据病程、病情轻重和影像学表现，分成若干亚组进行相关比较。对照组：共12例，其中周围神经病变2例，良性颅内压增高症1例，陈旧腔隙性脑梗死1例，静脉窦血栓1例，，面神经麻痹1例，血管性头疼1例，门诊腰椎穿刺术排除中枢神经系统感染患者5例。对所有入选患者进行腰椎穿刺术，并行脑脊液常规、生化、细胞学系列检查，包括MGG染色及阿利新兰染色，并且资料完整的45名乙脑患者的脑脊液应用ELISA法测定S100B蛋白的含量。结果:1流行病学：所有患者男：女=55%：45%，发病数八月升高，九月达到高峰，患者年龄小于15岁的只有4人，15-45岁占50%，45-65岁占43.48%，所有患者中农民占79%。 2脑脊液常规、生化：经过统计本实验所有乙脑患者相关资料，脑脊液白细胞数多轻度升高，葡萄糖和氯化物含量多正常，蛋白质含量多升高。将资料完整的45名乙脑患者按各种分类方法分成各亚组（轻型组、中型组、重型组、极期组、恢复期组），经比较各亚组的乙脑患者脑脊液白细胞数及蛋白含量明显高于对照组，且差异有统计学意义（P＜0.05）。但比较乙脑各亚组和对照组的葡萄糖、氯化物含量，差异无统计学意义（P0.05）。 3乙脑患者脑脊液细胞学早期呈混杂细胞学反应，随着病程嗜中性粒细胞逐渐减少，淋巴细胞逐渐增多，病程中可见到激活性单核细胞和浆细胞，恢复期多以淋巴细胞反应为主或呈典型淋巴细胞反应。影像学上以双侧丘脑受累为主，并且基底节区和海马区也是常见受累部位为特征。脑电图多为广泛中度至重度异常，治疗后可恢复。 4脑脊液S100B蛋白含量测定：乙脑组轻型531.94±166.95pg/m（l极期组627.77±155.93pg/ml，恢复期组412.15±83.14pg/ml），中型组852.25±309.75pg/ml （极期组822.76±275.99pg/ml，恢复期组907.03±382.24pg/ml），重型组1045.60±468.93pg/ml （极期组1155.5±559.22pg/ml，恢复期组923.40±333.21pg/ml）。总极期组864.53±409.94pg/ml，总恢复期组748.22±371.22pg/ml。MRI未显示病灶组629.38±215.49pg/ml，MRI显示病灶组950.93±364.52pg/ml。对照组295.29±97.20pg/ml。经比较S100B水平在乙脑轻型组、中型组、重型组、总极期组、总恢复期组、MRI未显示病灶组及MRI显示病灶组都高于对照组，并且差异都有统计学意义（P＜0.05）。轻型组S100B浓度低于中、重型组，差异都有统计学意义（P＜0.05），重型组S100B浓度比中型组高，但差异无统计学意义（P0.05）。MRI未显示病灶组S100B水平比MRI显示病灶组低，并且之间差异有统计学意义（P＜0.05）。轻型极期S100B浓度高于轻型恢复期，并且差异有统计学意义（P＜0.05），但中型极期与中型恢复期、重型极期与重型恢复期之间差异无统计学意义（P0.05）。 5比较其中12例乙脑患者在病程的不同时期多次测量的脑脊液中S100B蛋白水平。分别在第6~9天及第12~18天测量的9名乙脑患者，在第6~9天S100B平均含量为1126.0±555.78pg/ml，而在第12~18天S100B平均含量为1007.4±366.24pg/ml，经比较第12~18天的S100B含量有所降低，但差异无统计学意义（P0.05）。分别在第6~9天及超过20天测量的8名患者，在第6~9天S100B平均为869.83±413.40pg/ml，在超过20天S100B平均为823.87±218.11pg/ml。病程超过20天的乙脑患者S100B水平比第6~9天的水平低，但比较差异没有统计学意义（P0.05）。结论：1、乙脑的患者主要是小于15岁的儿童，但成人感染乙脑在局部地区有暴发趋势。 2、乙脑患者脑脊液细胞学混杂细胞学反应持续时间较一般病毒脑炎长。 3、乙脑患者影像上以丘脑，特别是双侧丘脑受累为特征，基底节及海马也是常见受累部位。在流行地区、流行季节，影像学上双侧丘脑受累应高度怀疑乙脑。 4、乙脑患者脑脊液中的S100B含量升高。 S100B蛋白含量与乙脑病情轻重、病程及影像学表现有一定相关，动态观察其含量变化，对乙脑患者的病情监测及判断疗效均具有重要意义。
[Abstract]:Objective: Japanese encephalitis (JE), abbreviated to the encephalitis B, is an important viral encephalitis epidemic in Asia and the Pacific region. Most of the infection is asymptomatic, but symptomatic encephalitis is different from non specific fever to severe encephalitis. The symptoms of focal nerve dysfunction, meningeal irritation are characterized by high mortality, severe sequelae, and major invasion of children in epidemic areas. With the application of the vaccine, the incidence of the encephalitis is obviously reduced, but there are still outbreaks in some areas, and the number of cases of adult infected with the brain is increasing. Therefore, the early diagnosis and assessment of the seriousness of the state of the encephalitis B as soon as possible, .S100B is a sensitive marker of astrocyte proliferation when it is damaged in the central nervous system (CNS). At present, many scholars pay more attention to the clinical characteristics of the patients in the brain, and determine the content of S100B protein in cerebrospinal fluid of the patients with encephalitis, and explore the process of S100B in the pathogenesis of the brain. The importance of it.
Methods: from August 2013 to October 2013, 92 cases of epidemic encephalitis B were diagnosed in the neurology department of the second hospital of Hebei Medical University. According to the positive and clinical characteristics of IgM antibody and clinical characteristics of the encephalitis B virus detected in Shijiazhuang epidemic prevention station, 107 cerebrospinal fluid were collected. The routine, biochemical, cytology, imaging and brain of the cerebrospinal fluid were used. The clinical characteristics of the patients with encephalitis B were examined by electrogram. Of the 45 patients with complete data, 57 cerebrospinal fluid were divided into several subgroups according to the course of disease, the severity of the disease and the imaging findings. The control group was 12 cases, including 2 cases of peripheral neuropathy, 1 cases of benign intracranial hypertension, and old lacunar infarction. There were 1 cases of death, 1 cases of venous sinus thrombosis, 1 cases of facial nerve paralysis, 1 cases of vascular headache, and 5 cases of central nervous system infection excluded from outpatient lumbar puncture.
All selected patients were treated with lumbar puncture, routine, biochemical, and cytological examination of cerebrospinal fluid, including MGG staining and aliran blue staining. The cerebrospinal fluid of 45 patients with complete data was determined by ELISA method for the determination of S100B protein.
Results: 1 epidemiology: all the patients were male: female =55%:45%, the incidence of the disease increased in August, reached the peak in September, the patient was less than 15 years old only 4, 15-45 year old 50%, 45-65 years old 43.48%, all the patients accounted for 79%..
2 cerebrospinal fluid routine, biochemistry: after statistics, all the data of the patients with encephalitis were collected, the white blood cells in cerebrospinal fluid increased slightly, the content of glucose and chloride was more normal, and the content of protein was increased. The 45 patients with complete data were divided into subgroups according to various classification methods (light group, medium group, heavy group, polar group, stage of recovery, and recovery period. The number of white blood cells and protein content in cerebrospinal fluid of the patients in the comparison group were significantly higher than those in the control group, and the difference was statistically significant (P < 0.05), but there was no significant difference in the content of glucose and chloride in the subgroups of the group B and the control group (P0.05).
In the early stage of the cerebrospinal fluid cytology of 3 patients with encephalitis, there was a mixed cytological reaction. With the gradual decrease in the neutrophil and the increase of the lymphocyte, the activation monocytes and plasma cells were seen in the course of the disease. The recovery period was mainly by lymphocyte reaction or typical lymphocyte reaction. The basal ganglia and hippocampus are also common locations. EEG is mostly generalized to moderate to severe abnormalities, and can be recovered after treatment.
4 S100B protein content in cerebrospinal fluid: light 531.94 + 166.95pg/m in group B group (627.77 + 155.93pg/ml in L polar group, 412.15 + 83.14pg/ml in recovery period), 852.25 + 309.75pg/ml in medium group (822.76 + 275.99pg/ml in polar group, 907.03 + 382.24pg/ml in recovery period) and 1045.60 + 468.93pg/ml in severe group (1155.5 + 559.22pg/ml in polar group), 923 in recovery period. .40 + 333.21pg/ml). The total polar phase group was 864.53 + 409.94pg/ml, the total recovery group was 748.22 + 371.22pg/ml.MRI without 629.38 + 215.49pg/ml, MRI showed that the focus group was 950.93 + 364.52pg/ml. control group 295.29 + 97.20pg/ml. after comparison S100B level in the light group of encephalitis, middle group, heavy type, total polar group, total recovery period, MRI did not show the focus The group and MRI showed that the lesion group was all higher than the control group (P < 0.05). The S100B concentration in the light group was lower than that in the heavy group (P < 0.05), and the concentration of S100B in the heavy group was higher than that in the medium group, but the difference was not statistically significant (P0.05).MRI did not show that the level of S100B in the focus group was lower than that in the MRI group. The difference was statistically significant (P < 0.05). The concentration of S100B in light polar period was higher than that in light recovery period, and the difference was statistically significant (P < 0.05), but there was no significant difference between the medium and medium recovery period, the heavy and heavy recovery period (P0.05).
5 compared the level of S100B protein in the cerebrospinal fluid which was measured repeatedly in 12 patients at different stages of the course of the disease. The average content of S100B was 1126 + 555.78pg/ml on day 6~9 and day 12~18, respectively, on day 6~9 and 12~18. The average content of S100B was 1007.4 + 366.24pg/ml on day 12~18, and the S100B content of day 12~18 days was compared. The amount was reduced, but the difference was not statistically significant (P0.05). 8 patients were measured at day 6~9 and over 20 days respectively, on day 6~9, the average S100B was 869.83 + 413.40pg/ml, and the S100B level of the patients with 823.87 + 218.11pg/ml. in more than 20 days more than 20 days was lower than the level of day 6~9, but the difference was not statistically significant. Meaning (P0.05).
Conclusion: 1, the children of JE are mainly younger than 15 years old, but there is an outbreak trend in adults.
2, the cytological response of cerebrospinal fluid in patients with encephalitis B was longer than that of common viral encephalitis.
3, the brain is characterized by thalamus, especially the involvement of the bilateral thalamus. The basal ganglia and hippocampus are also the common sites of involvement. In epidemic areas, the epidemic season, imaging of bilateral thalamus should be highly suspected of encephalitis.
4, the content of S100B in cerebrospinal fluid of patients with encephalitis is increased. The content of S100B protein is related to the seriousness of the disease, the course of disease and the manifestation of imaging. It is of great significance to observe the changes of the content of the cerebrospinal fluid, and to monitor the patient's condition and judge the curative effect.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.32

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