单纯疱疹病毒性脑炎患者急性期癫痫发作和/或癫痫的影响因素——从脑脊液中单纯疱疹病毒序列数的角度进行分析  

Analysis on influencing factors of seizures and/or epilepsy in patients with acute herpes simplex virus encephalitis:from the perspective of the numbers of HsV sequences in the cerebrospinal fluid

作　　者：柴长凤 张秀天 王宝祥 CHAI Changfeng;ZHANG Xiutian;WANG Baoxiang(Department of Neurology,The First Afiliated Hospital of Naval Medical University,Shanghai 200433,China;Department of Neurology,Affiliated Hospital Of Jiaxing University,Jiaxing 314000,China)

机构地区：[1]海军军医大学第一附属医院神经内科,上海200433 [2]嘉兴大学附属医院神经内科,嘉兴314000

出　　处：《癫痫杂志》2024年第3期228-233,共6页Journal of Epilepsy

摘　　要：目的 探讨单纯疱疹病毒性脑炎(Herpes simplex virus encephalitis,HSE)包含急诊和病房住院患者急性期(≤21 d)癫痫发作的影响因素,主要从脑脊液中宏基因病原微生物组学(metagenomic Next-generation sequencing,mNGS)检出的单纯疱疹病毒(Herpes simplex virus,HSV)序列数的角度来分析其相关性。方法 选取海军军医大学第一附属医院2023年1月—2023年10月急诊和神经内科住院治疗的第一诊断为HSE患者28例,排除病史资料不详者,最终24例入组,收集其临床一般资料,包括年龄、性别、急性脑炎综合征、同时记录癫痫发作形式和发作次数、腰穿时间、脑脊液各项指标[压力、蛋白、细胞数(单核和多核细胞数)、mNGS、脑脊液自身免疫性脑炎相关的抗神经细胞抗体]、脑电图、头颅影像学检查报告、治疗方案等相关临床资料。结果 共24例患者入组,其中男18例、女6例,平均年龄为(53.17±17.19)岁,最大年龄73岁,最小年龄21岁,其中9例既往有高血压病史、4例既往有糖尿病病史。24例患者中,1例发病后先就诊于当地医院,后转入我院再行腰椎穿刺(入我院后腰穿时间距离发病时间30 d,另有1例患者家属初期拒绝完善腰椎穿刺术,故腰穿时间距离发病时间14 d),余22例均在起病7 d内完善腰椎穿刺术,其中急诊就诊患者均在入急诊24 h内完善腰椎穿刺术。mNGS:21例为HSV-1型脑炎,余1例HSV-2型脑炎。急性期(≤21 d)癫痫发作共6例,局灶性癫痫或全面性癫痫发作或癫痫持续状态为主要形式,另2例出现癫痫发作。8例患者中,5例头颅核磁共振(Magnetic resonance imaging,MRI)增强显示额颞叶有病灶,另3例头颅MRI无特异表现。同时mNGS提示,出现脑炎后癫痫的,HSV-1型序列数均>3 000。结论 HSE后急性期癫痫发作与颅内皮层受累密切相关,且mNGS结果显示病毒序列数的数目与急性期癫痫发作密切相关。Objective Exploring the influencing factors of acute phase(≤21 days)seizures and epilepsy in patients with Herpes simplex virus encephalitis(HSE)in our hospital,including emergency and inpatient wards,mainly from the perspective of the number of mNGS of Herpes simplex virus(HSV)in cerebrospinal fluid.Methods From January to Octomber 2023,28 emergency and inpatient patients in our hospital were collected,excepted clinical datas were not detailed.In the end,24 patients with HSE diagnosed were included in the study,and their clinical datas were collected,including age,gender,acute encephalitis syndrome,the form of the seizure and the number of seizures,time of lumbar puncture,and various indicators of cerebrospinal fluid[pressure,protein,cell count(mononuclear and multinucleated cells),metagenomic Next-generation sequencing(mNGS),neural autoantibodied associated with autoimmune encephalitis],electroencephalogram,cranial imaging examination reports,and treatment plans.Results A total of 24 patients were enrolled,including 9 patients with a history of hypertension and 4 patients with a history of diabetes.There were 18 males and 6 females,with an average age of(53.17±17.19)years.The maximum age was 73 years old,and the minimum age was 21 years old.Among the 24 patients,one patient first presented to the local hospital and then transferred to our hospital for lumbar puncture,so the time from the onset of the disease to lumbar puncture was 30 days,and the other patient's family members refused to complete lumbar puncture at first,so the time of lumbar puncture was 14 days from the onset of the disease.The remaining 22 patients were all completed lumbar puncture within 7 days of onset,and all emergency patients completed lumbar puncture within 24 hours of admission to the Emergency Department.mNGS results:23 cases were HSV-1,and the remaining 1 case was HSV-2.There were a total of 6 cases of seizures and epilepy in the acute phase(≤21 days),with focal or generalized seizures or epileptic status as the main form,and

关 键 词：脑炎 癫痫发作 癫痫 单纯疱疹病毒 

分 类 号：R742.1[医药卫生—神经病学与精神病学]