成人中枢神经系统水痘-带状疱疹病毒感染七例并文献复习  

Varicella-zoster virus infection in adult central nervous system:seven cases reports and literature review

作　　者：陈瑞玲 韩春玉[1] 李金鑫 杨柳[1] 刘贝贝[1] 王淑辉[1] 田瑛[2] 李在村 脱厚珍[1] Chen Ruiling;Han Chunyu;Li Jinxin;Yang Liu;Liu Beibei;Wang Shuhui;Tian Ying;Li Zaicun;Tuo Houzhen(Department of Neurology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院神经内科,100050 [2]首都医科大学附属北京友谊医院干部病房,100050 [3]首都医科大学附属北京佑安医院感染中心门诊

出　　处：《北京医学》2024年第5期355-362,共8页Beijing Medical Journal

摘　　要：目的探讨成人中枢神经系统水痘-带状疱疹病毒(varicella-zoster virus,VZV)感染的临床特点及预后。方法选取2013年7月至2024年4月首都医科大学附属北京友谊医院的中枢神经系统VZV患者,收集患者的一般资料和临床资料,分析患者的临床特点及预后,并复习既往文献。结果共纳入7例患者,其中男6例、女1例;发病年龄35~94岁,平均65.1岁。7例均为急性或亚急性起病、伴发热,4例伴意识障碍,5例脑膜刺激征(+),4例伴肢体瘫痪、头痛、头晕,3例伴周围性面瘫,5例伴皮肤疱疹。脑脊液压力80~190 mmH2O(1 mmH2O=0.0098 kPa)、WBC 14~1039×106/L、蛋白40.38~444.43 mg/dl、葡萄糖2.34~6.01 mmol/L、氯化物108.90~125.00 mmol/L。脑脊液宏基因二代测序(metage⁃nomic next-generation sequencing,mNGS)检测的VZV病毒DNA序列数7~8869。影像学结果示脑干及小脑受累3例,颈髓受累1例,硬脑膜或脊膜强化3例,伴硬膜下积液或出血1例、伴急性脑梗死2例。治疗后,住院期间死亡1例(发病后4个月),好转出院6例;死亡2例(发病后1.5~10个月),好转4例(发病后6~63个月)。既往文献报道,成人中枢神经系统VZV感染患者有病情重、预后差,脑脊液葡萄糖降低、合并颅神经或周围神经或脑血管受累等表现,但未见合并硬脑膜强化的病例报道。结论成人中枢神经系统VZV感染患者年龄分布较广、青年至高龄老年均可见,脑脊液蛋白和WBC可明显升高,部分患者葡萄糖和氯化物降低,类似结核杆菌感染。脑膜脑实质多同时受累时病情危重,高龄者预后差。怀疑中枢神经系统VZV感染者应尽早完善腰穿、脑脊液mNGS等辅助检查,在早期诊断和治疗后规范应用抗病毒感染药物,以改善预后。Objective To explore the clinical features and prognosis of varicella-zoster virus(VZV)infection in adult central nervous system.Methods Patients with VZV infection in central nervous system admitted to Beijing Friendship Hospital,Capital Medical University from July 2013 to April 2024 were selected,the general and clinical data of the patients were collected,the clinical features and prognosis were analyzed,and previous literatures were reviewed.Results A total of seven patients were selected,among which six were males and one was female.The onset age ranged from 35 to 94 years old,with an average age of 65.1 years.All the seven cases had acute or subacute onset with fever,four cases with consciousness disorders,five with positive meningeal irritation sign,four accoumpanied by limb paralysis,headache,dizziness,three accoumpanied by peripheral facial paralysis,and five accompanied by skin herpes.Cerebrospinal fluid pressure was 80~190 mmH2O(1 mmH2O=0.0098 kPa),WBC 14~1039×106/L,protein 40.38~444.43 mg/dl,glucose 2.34~6.01 mmol/L,and chloride 108.90~125.00 mmol/L.The number of VZV virus DNA sequences detected by cerebrospinal fluid metagenomic next-generation sequencing(mNGS)was 7~8869.Imaging findings showed that brainstem and cerebellum were involved in three cases,cervical spinal cord in one case,dura mater or spinal cord strengthened in three cases,accompanied by subdural effusion or hemorrhage in one case,and acute cerebral infarction in two cases.After treatment,one case died during hospitalization(four months after onset),and six cases got better and were discharged.A total of two cases died(1.5~10 months after onset),and four cases got better(six to sixty-three months after onset).Previous literatures reported that adult patients with VZV infection in the central nervous system had severe illness,poor prognosis,decreased glucose levels in cerebrospinal fluid,and involvement of cranial or peripheral nerves or cerebrovascular vessels,but no case was reported of concurrent dural enhancement.Conclusions The a

关 键 词：水痘-带状疱疹病毒 中枢神经系统感染 宏基因二代测序 脑膜 

分 类 号：R741[医药卫生—神经病学与精神病学]