水痘-带状疱疹病毒脑炎/脑膜炎患者预后因素分析  

作　　者：张艳[1] 王俊 严永兴[1] 顾婧 沈咏慧[1] 

机构地区：[1]杭州市第三人民医院,310009

出　　处：《浙江临床医学》2023年第7期1035-1037,共3页Zhejiang Clinical Medical Journal

基　　金：杭州市卫生科技重点项目(ZD20210010);杭州市科技局自主引导项目(20211231Y034)。

摘　　要：目的分析水痘-带状疱疹病毒再激活导致的脑炎/脑膜炎患者预后因素。方法收集2019年1月至2021年12月39例经脑脊液水痘-带状疱疹病毒(VZV)DNA确诊的VZV脑炎/脑膜炎患者临床资料及出院3个月随访资料,根据是否影响患者的生活质量原则将患者分为预后良好组18例与预后不良组21例,全面分析两组患者一般情况、临床特点以及实验室检查,探讨影响VZV脑炎/脑膜炎预后的因素。结果与预后良好组比较,预后不良组VZV脑炎/脑膜炎患者发热(体温>38℃)比例更高,从出现神经系统症状到开始抗病毒治疗间隔时间明显延长,脑脊液白细胞计数、ADA含量、CRP明显增高,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,脑脊液腺苷脱氨酶(ADA)含量(OR=1.279,95%CI=0.996~1.642),从出现神经系统症状到开始抗病毒治疗间隔时间(OR=1.299,95%CI=1.011~1.669)均是患者预后不良的独立危险因素(P<0.05)。结论VZV脑炎/脑膜炎患者出院3个月后出现影响患者生活质量并发症发生率较高。脑脊液ADA含量越高,从出现神经系统症状到开始抗病毒治疗间隔时间越长,患者预后越差。Objective To investigate the predictive factors of encephalitis and meningitis caused by varicella-zoster virus(VZV)reactivation.Methods The VZV encephalitis/meningitis patients(n=39)who were treated from January 2019 to December 2021 in neurology department of Hangzhou Third People's Hospital were included.Patients were followed up for 3 months after discharge and divided into the favorable outcome group(n=18)and the unfavorable outcome group(n=21)according to whether it affects the patient's quality of life.The clinical data were retrospectively analyzed and compared between groups.Results As compared to favorable outcome group,patients in the unfavorable outcome group were more likely to have higher body temperature(>38℃)at admission,longer interval from onset of CNS symptoms to initial of anti-viral therapy,higher white blood cells(WBC)and Adenosine deaminase(ADA)in the cerebrospinal fluid(CSF)and higher CRP in the blood,with statistical significance(P<0.05).Univariate logistic regression analysis showed CSF ADA(OR=1.279,95%CI=0.996~1.642)and interval from onset of CNS symptoms to initial of anti-viral therapy(OR=1.299,95%CI=1.011~1.669)were independent risk factors of unfavorable outcomes(P<0.05).Conclusion VZV encephalitis/meningitis patients have a high incidence of complications affecting their quality of life at 3 months after discharge.Higher CSF ADA and longer interval from onset of CNS symptoms to initial of anti-viral therapy predict the unfavorable outcome.

关 键 词：水痘-带状疱疹病毒 脑炎 脑膜炎 预后 

分 类 号：R512.3[医药卫生—内科学]