中国全科医学2017，Vol.20Issue(8)：992-996,5.DOI:10.3969/j.issn.1007-9572.2017.08.021
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
Clinical Features and Prognosis of Acute Herpes Simplex Viral Encephalitis and Meningitis Patients
摘要
Abstract
Objective To present the clinical manifestations,cerebrospinal fluid (CSF) characteristics,imaging studies and to investigate the risk factors for adverse clinical outcomes among adults with herpes simplex virus (HSV) encephalitis or meningitis.Methods The subjects enrolled in this study were 80 patients with HSV encephalitis (n =20) or meningitis (n =60) treated in Department of Emergency,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from 2009 to 2015.We recorded the data of the patients,such as gender,age,clinical manifestations,neural imaging and EEG examination results.The measurement of white blood cell count,lymphocyte percentage,granulocyte percentage,red blood cell count,protein and glucose levels in CSF collected through lumbar puncture was performed in the patients.Glasgow Outcome Scale was used to evaluate the clinical prognosis at discharge.Results Seven patients had abnormal change of cranial CT,among them,2 had abnormal density shadow in the unilateral temporal lobe or temporal frontal area,1 had subacute infarction on the left insular cortex,1 had high-density shadow on the inside of left temporal bone,and 3 had nonspecific changes.Fourteen cases of cranial MRI had abnormal changes,including 5 cases in unilateral temporal lobe or temporal frontal zone,1 case in bilateral temporal frontal zones,1 case with dotted hemorrhage and subacute infarction in the left insular cortex,1 case with diffuse high-density shadows on bilateral frontal cortexes,6 cases with nonspecific changes.Nine patients had abnormal EEG changes,of whom,3 had unusual waveforms in frontal or temporal lobe areas,and 6 had nonspecific changes.Ten cases had adverse clinical outcomes,including 2 of vegetative state,7 of severe impairments and 1 of moderate function defect.Significant differences were observed between HSV encephalitis and meningitis patients in terms of age,proportions of patients with headache,changes in state of consciousness,seizures and focal neurologic deficits,neck stiffness,abnormal CT,MRI,and EEG,as well as the length of stay,and the incidence of adverse clinical outcome (P ＜ 0.05).Multivariate Logistic regression revealed that the risk factors for adverse clinical outcomes were comorbidity [β =2.701,SE =0.804,OR=14.895,95％CI (3.081,72.013)] and HSV encephalitis [β=3.766,SE=0.750,OR =43.207,95％CI (9.934,187.917)] (P ＜ 0.05).Conclusion HSV encephalitis and meningitis have differences in clinical presentations,imaging and EEG manifestations and clinical outcomes.Adverse clinical outcome are observed more frequently in those patients with comorbidities and an HSV encephalitis presentation.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Key words
Encephalitis/herpes simplex/Meningitis/viral/Signs and symptoms/Prognosis/Risk factors分类
医药卫生引用本文复制引用
李瑾,董利昭,陈一冰,范国峰,钱健,徐鹏,沙杜鹃,王军,张均..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[J].中国全科医学,2017,20(8):992-996,5.基金项目
江苏省医学会急性感染性疾病研究项目(2015JZKY01) （2015JZKY01）
