水痘-带状疱疹病毒性脊髓神经根炎的临床特征分析  

Clinical features analysis of varicella zoster virus myeloradiculitis

作　　者：马玉宝 向凤 张芳芳 张旭 苏敏 张家堂 于生元 MA Yubao;XIANG Feng;ZHANG Fangfang;ZHANG Xu;SU Min;ZHANG Jiatang;YU Shengyuan(Department of Neurology,The First Medical Center of Chinese People s Liberation Army General Hospital,Beijing 100853,China;不详)

机构地区：[1]中国人民解放军总医院第一医学中心神经内科医学部,100853

出　　处：《中国神经免疫学和神经病学杂志》2024年第2期102-107,共6页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探讨水痘-带状疱疹病毒性脊髓神经根炎(varicella-zoster virus myeloradiculitis,VZVM)的临床特征。方法选择2016年6月—2021年6月作者医院收治确诊的8例VZVM,分析其临床表现、影像学、肌电图、脑脊液病原学基因检测、治疗及预后等。结果8例中男5例、女3例,发病年龄56~80岁,中位数(四分位数)59.5(57.0,60.0)岁。患者均急性起病,病程5~90 d,病程中位数(四分位数)15.5(14.0,17.0)d。8例患者发病前均有皮肤疱疹病史,出现皮肤疱疹至发生脊髓病变潜伏期1~36 d,中位数(四分位数)11.5(10.0,13.0)d。7例患者以疼痛起病,肢体无力8例,肢体麻木6例,尿便失禁6例;表现为脊髓横贯性损害6例,脊髓局灶性损害2例。7例患者行肌电图检查,其中4例可见脊髓病变相应神经支配区肌电图自发电位。5例患者行脑脊液和(或)血液病毒基因检测,其中3例均行血和脑脊液PCR疱疹病毒基因检测,2例均阳性,1例均阴性;2例行脑脊液微生物二代测序(mNGS),1例检测到VZV基因。8例脊椎MRI均表现为脊髓、神经根、神经节异常强化,病变仅累及颈段3例、胸段2例,同时累及颈、胸段2例,同时累及胸、腰段1例;8例均有髓内强化,4例呈髓内环形强化,2例髓内呈片状强化、2例髓内呈结节状强化;髓内长节段病变4例,其中累及颈、胸段各1例,累及颈-胸段,胸-腰段各1例。8例均应用阿昔洛韦和糖皮质激素治疗,5例症状基本恢复正常,2例遗留截瘫,1例病灶发展至延髓后死亡。结论VZVM常以疼痛起病,增强MRI可见神经根及脊髓异常强化,肌电图可检测到脊髓神经根病变支配区肌肉自发电位,脑脊液病毒基因测序可检测到VZV病毒可明确诊断。通过多种诊断方法,尽早明确诊断、早期抗病毒和适量激素治疗对改善预后十分重要。Objective To investigate the clinical features of varicella-zoster virus myeloradiculitis(VZVM).Methods Eight cases of VZVM diagnosed in our hospital from June 2016 to June 2021 were selected,and their clinical manifestations,imaging,electromyography,etiological gene detection of cerebrospinal fluid,treatment and prognosis were analyzed.Results Among the 8 cases,5 were males and 3 were females.The age of onset was 56-80 years old,with a median(quartile)of 59.5(57.0,60.0)years.All patients had acute onset and duration of disease ranging from 5 to 90 days,with a median(quartile)duration of 15.5(14.0,17.0)days.All the 8 patients had a history of skin herpes before onset,and the incubation period from skin herpes to myelopathy was 1-36 days,with a median(quartile)of 11.5(10.0,13.0)days.The onset symptom of the disease was pain in 7 patients,limb weakness in 8 cases,limb numbness in 6 cases,urinary and fecal incontinence in 6 cases;There were 6 cases of transverse spinal cord injury and 2 cases of focal spinal cord injury.Electromyography was performed in 7 patients,and electromyography spontaneous potential was found in the corresponding innervation area of myelopathy in 4 of them.Cerebrospinal fluid(CSF)and/or blood virus gene detection was performed in 5 patients,of which 3 patients underwent PCR herpesvirus gene detection in CSF and blood,2 cases were positive and 1 case was negative.Cerebrospinal fluid microorganism next-generation sequencing(mNGS)was performed in 2 cases,and VZV gene was detected in 1 case.All patients showed abnormal enhancement of spinal cord,nerve root and ganglion in spinal MRI.The lesions involved only the neck segment in 3 cases and the chest segment in 2 cases,and the neck and chest segment in 2 cases,and the chest and waist segment in 1 case.All 8 cases had intramedullary enhancement,4 cases had intramedullary ring enhancement,2 cases had intramedullary lamellar enhancement,and 2 cases had intramedullary nodular enhancement.There were 4 cases of intramedullary long segment lesions,includ

关 键 词：水痘-带状疱疹病毒性脊髓神经根炎 增强MRI 肌电图 病毒学 

分 类 号：R511.5[医药卫生—内科学] R744.9[医药卫生—临床医学]