水痘-带状疱疹病毒脑炎/脑膜炎16例临床分析  

Clinical analysis of varicella-zoster virus encephalitis/meningitis in 16 cases

作　　者：薛红飞 王晓娟 秦灵芝 蒋玙姝 徐佳佳 张弥兰 代淑华 滕勇士 李玮 XUE Hong-fei;WANG Xiao-juan;QIN Ling-zhi;JIANG Yu-shu;XU Jia-jia;ZHANG Mi-lan;DAI Shu-hua;TENG Yong-shi;LI Wei(Department of Neurology,Zhengzhou University People's Hospital,Henan Provincial People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]郑州大学人民医院、河南省人民医院神经内科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2023年第3期300-303,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省科技攻关计划省部共建项目(SBGJ2018077)。

摘　　要：目的总结水痘-带状疱疹病毒(varicella-zoster virus,VZV)脑炎/脑膜炎患者临床特征,头颅MRI改变及脑脊液宏基因二代测序(metagenomic next-generation sequencing,mNGS)结果,探讨其疗效和预后。方法回顾性分析16例VZV脑炎/脑膜炎患者的临床资料,包括临床表现、头颅MRI影像特征、血清学、脑脊液常规及mNGS结果。16例明确诊断后均给予抗病毒治疗,10例联合应用小剂量甲泼尼龙,2例治疗期间合并肺部感染者同期给予抗菌药物治疗,治疗10~14 d行改良Rankin量表评分。随访6~24个月,记录患者生存及神经痛、血管病变、眼部病变等并发症发生情况。结果16例临床主要表现为发热、头痛、恶心呕吐、颈项强直,伴颅神经损害5例,精神行为异常1例,癫痫发作1例;发病前或发病时出现带状疱疹5例,其中播散性带状疱疹1例,合并中枢神经系统血管炎1例,合并脑出血1例;淋巴细胞计数升高4例[2.06(1.38,3.81)×10^(9)/L],单核细胞计数升高5例[0.50(0.26,0.64)×10^(9)/L],白细胞计数、中性粒细胞计数及肝功能、肾功能、电解质均未见明显异常。MRI表现为脑实质多发异常信号2例,软脑膜强化影增多6例。16例脑脊液均清亮透明,脑脊液压力升高11例[202.5(176.3,237.5)mm H2O],白细胞计数升高15例[151.0(63.3,296.8)×10^(6)/L](均以单核细胞升高为主),蛋白质水平升高14例[0.89(0.74,1.70)g/L],葡萄糖、氯化物水平无明显异常,细菌培养、革兰染色、抗酸染色、墨汁染色均阴性,细胞学检查均未见异性细胞;15例mNGS检出VZV阳性,核酸序列数≥3条。13例治疗后头痛、发热、恶心呕吐、颈项强直等症状消失,改良Rankin评分均≤2分,复查血液及脑脊液常规指标明显好转出院;3例改良Rankin评分均>2分者,1例合并脑出血者死亡,2例转入ICU治疗至症状好转出院。随访至2022年9月,15例中死亡2例,双眼视力丧失、双下肢无法站立1例,神经痛1例,余未发生相关并发�Objective To summarize the clinical manifestations,cranial MRI changes and the results of metagenomic next-generation sequencing(mNGS)of cerebrospinal fluid in varicella-zoster virus(VZV)encephalitis/meningitis,and to investigate the efficacy and prognosis.Methods The clinical data of 16 patients with VZV encephalitis/meningitis were retrospectively analyzed,including the clinical manifestations,cranial MRI changes,serologic test,cerebrospinal fluid routine examination result and mNGS result.All 16 patients were given antiviral treatment after diagnosis,besides which 10 patients were given low-dose methylprednisolone and 2 patients were given antibacterial drugs due to pulmonary infection.Modified Rankin scale scores were assessed after treatment for 10 to 14 days.All patients were followed up for 6 to 24 months,and the survival and the occurrence of complications such as neuralgia,vascular lesions and ocular lesions were recorded.Results The main clinical manifestations of 16 patients were fever,headache,nausea/vomiting,and cervial toncity.The complications included cranial nerve damage in 5 patients,abnormal mental behavior in 1 and seizure in 1.Herpes zoster appeared before or at the onset in 5 patients including 1 case of disseminated herpes zoste,1 patient was complicated with central nervous system vasculitis,and 1 patient was complicated with cerebral hemorrhage.Blood routine examination showed an elevated lymphocyte count in 4 patients[2.06(1.38,3.81)×10^(9)/L],elevated monocyte count in 5[0.50(0.26,0.64)×10^(9)/L],and normal white blood cell count,neutrophil count,liver function,renal function and electrolyte.MRI showed multiple abnormal signals in brain parenchyma in 2 patients and increased soft meningeal enhancement shadow in 6.The cerebrospinal fluid was clear and transparent in 16 patients.The cerebrospinal fluid pressure was elevated in 12 patients[202.5(176.3,237.5)mm H_2O].The cerebrospinal fluid examination showed an elevated white blood cell count in 15 patients[151.0(63.3,296.8)×10^(6)/L],a

关 键 词：脑炎/脑膜炎 水痘-带状疱疹病毒 宏基因二代测序 改良Rankin评分 

分 类 号：R511.5[医药卫生—内科学] R512.3[医药卫生—临床医学]