单纯疱疹病毒性脑炎的脑电图特点研究

发布时间：2018-03-14 00:08

本文选题：单纯疱疹病毒性脑炎　切入点：脑电图　出处：《山东大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的单纯疱疹病毒性脑炎为单纯疱疹病毒感染所致。疱疹病毒在成人为I型(非生殖器型),而新生儿则是II型(生殖器型)。HSE(单纯疱疹病毒性脑炎)虽可有原发性感染引起,但大多数是潜伏病毒(潜伏于三叉神经节或星形细胞内)的再活化或由新的病毒珠在感染所致。病毒进入脑组织的途径：II型多经血行传播,I型主要通过三叉神经及嗅神经。病变广泛分布于脑部,主要侵犯颞叶中部、额叶眶面和脑边缘系统(包括海马、杏仁核、嗅皮质、脑岛和扣带回),有时枕叶、下丘脑、延髓和脑桥亦可累及,受损程度两侧常呈不对称性。病理改变的主要特点是脑组织出血性坏死,神经元和胶质细胞核内有Cowdry A型包涵体,内含疱疹病毒颗粒及抗原；此外还可见神经元变形、胶质细胞增生、血管周围淋巴细胞及浆细胞浸润和脑病灶周围的水肿等改变。目前主要通过脑电图、脑脊液、影像学等检查诊断该疾病,我们希望通过本文章进一步研究HSE的早期诊断方法。脑电图(electroencephalogram, EEG)是从颅外头皮或颅内记录到的局部神经元电活动的总和。脑电活动的产生主要来自突触后电位。此外,某些神经元的内源性爆发电位和神经元之间的缝隙链接(电突触)也构成脑电活动中的某些成分。从40年代起,EEG开始进入临床应用。发展到现在,脑电图已经被广泛应用到癫痫、中枢神经系统感染性疾病、脑血管疾病、颅内肿瘤、神经遗传代谢病和变性病等疾病的相关诊断中,对疾病的早期诊断、治疗及预后监测过程中起到重要作用。我们希望通过本文章进一步探讨单纯疱疹病毒性脑炎早期脑电图诊断的临床意义。方法 1.收集2013.01-2014.06期间神经内科150名脑炎患者。根据病例纳入标准,分别将该150名脑炎患者分为81名非HSE患者,69名HSE患者。 2.按脑电图异常度诊断标准,分别将HSE患者、非HSE患者脑电图分为：轻度异常、中度异常、重度异常、正常四类。利用软件SPSS21.0对表1数据进行Ridit分析,观察HSE患者与非HSE患者脑电图异常度有无差别。 3.按150患者脑电图检查结果中出现的主要波形分别将HSE患者及非HSE患者分为：e波为主型(单、双侧)、δ波为主型(单、双侧)、PLEDs(单、双侧)、正常波形。分别对两组数据进行X2检验,通过统计学分析HSE组与非HSE组患者脑电图波形有无差异。 4.按病程中出现θ波为主型(单、双侧)、δ波为主型(单、双侧)、PLEDS(单、双侧)为主型的脑电图对两类患者进行分类,对两组患者早期(≤3天)、急性期(4-14天)各类波形脑电图(单、双侧)出现的次数进行X2检验,分析早期、急性期两组脑电图波形有无统计学差异。结果 1.HSE组的R1=0.2625,非HSE组R2=0.3436,u=0.207(P0.05),差别没有统计学意义,即尚不能认为HSE组与非HSE组脑电图异常度有差异。 2.HSE组与非HSE组两组脑电图行X2检验,得出两组单侧的θ波为主型、δ波为主型、PLEDs波为主型形有统计学差异,双侧θ波为主型、δ波为主型、PLEDs波为主型形无明显统计学差异。 3.病程≤3天HSE组与非HSE组单侧的e波为主型、δ波为主型有统计学差异,双侧θ波为主型、δ波为主型、PLEDs波为主型无明显统计学差异。病程4-14天HSE组与非HSE组脑电图比较无明显统计学差异。结论 1.病毒性脑炎脑电图检查异常率达88%,单纯疱疹病毒性脑炎早期脑电图异常率高达90%。 2.HSE患者单侧的θ波为主型、δ波为主型、PLEDs波为主型脑电图区别于非HSE患者。 3.病程早期(≤3天)：HSE患者单侧θ波为主型、δ波为主型脑电图区别于非HSE患者。病程急性期(4-14天)：HSE组与非HSE组脑电图比较无明显统计学差异。
[Abstract]:objective
Herpes simplex virus encephalitis caused by herpes simplex virus infection. The herpes virus in adult type I (non genital type), but the infant is II type (genital type).HSE (herpes simplex encephalitis) can have primary infection, but most of them are latent virus lurking in the trigeminal ganglion (or star intracellular) reactivation or by a new virus. The virus infection caused by beads in way into the brain tissue: II type hematogenous spread, I mainly through the trigeminal nerve and olfactory nerve. The lesions are widely distributed in the brain, mainly involving middle temporal, frontal orbital surface and limbic system (including hippocampus the entorhinal cortex, amygdala, insula and cingulate), sometimes occipital lobe, hypothalamus, medulla oblongata and pons were involved, the extent of the damage on both sides are asymmetric. The main feature is the pathological changes of cerebral hemorrhage and necrosis of neurons and glial cells with Cowdry A Type inclusion bodies, including herpes virus particles and antigens; in addition, the neurons deformation, the proliferation of glial cells, surrounding perivascular infiltration of lymphocytes and plasma cells and edema. The cerebral lesions mainly through CSF, EEG, imaging examination and diagnosis of the disease, we hope that through the method of early diagnosis of the further study of HSE..
Electroencephalogram (electroencephalogram, EEG) is the sum of the extracranial scalp or intracranial recording to local neuronal activity. EEG activity is derived from the postsynaptic potential. In addition, some endogenous neurons burst gap link between potential and neurons (electrical synapses) also constitute some components of brain electrical activity in the. In 40s, EEG began to enter the clinical application. Until now, the EEG has been widely applied to epilepsy, central nervous system infectious disease, cerebrovascular disease, intracranial tumor, diagnosis of inherited metabolic diseases and neural degeneration diseases, early diagnosis of the disease, which plays an important role in the process of treatment and prognosis.
We hope to further explore the clinical significance of early EEG diagnosis of herpes simplex encephalitis.
Method
1. during the period of 2013.01-2014.06, 150 encephalitis patients in neurology department were divided into 81 non HSE patients and 69 HSE patients according to the inclusion criteria.
2. according to the diagnostic criteria of EEG abnormality, EEG of HSE patients and non HSE patients were divided into four categories: mild, moderate, severe, and normal. The software SPSS21.0 was used for Ridit analysis of Table 1 data to observe the difference of EEG abnormalities between HSE patients and non HSE patients.
There are 3. main waveforms according to 150 patients with EEG findings respectively in HSE patients and non HSE patients were divided into e wave type (single, double), delta wave type (single, double), PLEDs (single, double), normal waveform. X2 test was used for the two groups of data, through the statistics analysis of HSE group had no difference with the non HSE group with EEG waveform.
4. according to the course in theta type (single, double), delta wave type (single, double), PLEDS (single, double) type EEG classification of two patients, two groups of early (less than 3 days), acute period (4-14 days) of EEG waveform (single the number of occurrences of bilateral), X2 test, analysis of early acute stage, two groups have no significant difference in EEG waveforms.
Result
The R1=0.2625 of group 1.HSE, non HSE group R2=0.3436, u=0.207 (P0.05), the difference was not statistically significant, that is, there is no difference between the HSE group and the non HSE group.
2.HSE group and non HSE group two groups of EEG X2 test, we found that the two groups of unilateral theta wave dominated, delta wave dominated, PLEDs wave dominated, there was statistically significant difference, bilateral theta wave dominated, delta wave dominated, PLEDs wave dominated form had no significant difference.
E wave is the main type of unilateral 3. course less than 3 days HSE group and non HSE group, there were significant differences in delta wave type, bilateral theta type, delta wave type, PLEDs wave type has no significant difference in duration of 4-14 days. The EEG HSE group and non HSE group had no significant difference.
conclusion
The abnormal rate of electroencephalogram of 1. viral encephalitis was 88%, and the abnormal rate of early EEG of herpes simplex encephalitis was up to 90%.
The unilateral theta wave of 2.HSE patients was the main type, the delta wave was the main type, and the PLEDs wave based electroencephalogram was different from the non HSE patients.
3. early stage (less than 3 days) in the patients with type:HSE theta, delta wave type EEG differ from non HSE patients. The duration of acute period (4-14 days) of EEG in:HSE group and non HSE group is no significant difference.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.3

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