36例成人流行性乙型脑炎临床分析和影像学特点  

Clinical and radiological features of 36 adult patients with epidemic encephalitis B

作　　者：苗萌[1] 贾国勇[2] 刘颖[2] 王翠兰[2] 

机构地区：[1]山东大学齐鲁医院神经内科(青岛),山东青岛266035 [2]山东大学齐鲁医院神经内科,山东济南250012

出　　处：《山东大学学报（医学版）》2018年第2期23-27,共5页Journal of Shandong University:Health Sciences

摘　　要：目的总结和分析成人乙脑的临床表现、脑脊液及颅脑影像学特点。方法对山东大学齐鲁医院神经内科2013年8月到2013年9月间收治的36例成人乙脑患者进行回顾性分析。结果乙脑患者主要表现为高热(100%)、意识及认知障碍、头痛、恶心、呕吐(86.1%)、脑膜刺激征(80.6%),帕金森样症状(30.6%)和癫痫(27.8%)也较常见。血清和脑脊液乙脑Ig M抗体阳性。颅压增高13例(54.2%),22例脑脊液细胞学检测出现异常细胞反应,16例(72.7%)混合细胞反应,6例(27.3%)淋巴细胞反应。17例(70.8%)蛋白升高,21例(87.5%)Ig G、19例(79.2%)Ig A、23例(95.8%)Ig M升高。22例(61.1%)行颅脑M RI,17例(47.2%)行颅脑CT。累及丘脑13例(59.1%),累及中脑4例(18.2%)、基底节3例(13.6%)、海马3例(13.6%)和其他脑叶5例(22.7%),4例(18.2%)未见异常。结论流行性乙型脑炎的临床表现为急性脑炎综合征,可合并锥体外系症状;脑脊液中性粒细胞比例明显增加,混合细胞反应持续时间长;丘脑损害是最常见的影像学改变。Objective To investigate clinical,cerebrospinal fluid（ CSF） and radiological features of adult patients with epidemic encephalitis B. Methods The data were collected from 36 adult patients with epidemic encephalitis B who were diagnosed and treated in Qilu Hospital of Shandong University,from August to September in 2013. Results The patients with epidemic encephalitis B presented with fever（ 100%）,consciousness and cognitive impairment,headache,nausea,vomiting（ 86.1%）,and meningeal irritation（ 80.6%）. Parkinson-like symptoms（ 30.6%） and seizure disorders（ 27.8%） were common. The Ig Mantibody against epidemic encephalitis B in serum and CSF was found. A total of 13 patients（ 54.2%） suffered intracranial hypertension,22 patients displayed abnormal CSF cytology reaction,16 patients（ 72.7%） displayed mixed-cell reaction,6 patients（ 27.3%） appeared lymphocyte reaction. Protein content of 17 patients（ 70.8%） increased,Ig G of 21 patients（ 87.5%） increased,Ig A of 19 patients（ 79.2%） increased,and Ig Mof 23 patients（ 95.8%） increased. A total of 22 patients（ 61.1%） underwent brain MRI,17 patients（ 47.2%） underwent brain CT. Neural damages displayed in thalamus（ 13 cases,59.1%）,midbrain（ 4 cases,18.2%）,basal ganglia（ 3 cases,13.6%）,hippocampus（ 3 cases,13.6%） and other brain lobes（ 5 cases,22.7%）. A total of 4 patients（ 18.2%） were normal. Conclusion The patients with epidemic encephalitis B present acute encephalitic syndrome,accompanied with extrapyramid symptoms. The important features of CSF present the significant increase of the proportion of neutrophils and the prolonged duration of mixed-cell reaction. Neural damages commonly appear in thalamus.

关 键 词：流行性乙型脑炎 临床特征 脑脊液 颅脑MRI 成人 

分 类 号：R512.32[医药卫生—内科学]