基于宏基因组高通量测序技术的水痘带状疱疹病毒脑炎/脑膜炎的临床特点分析  

Clinical characteristics of varicella-zoster virus encephalitis/meningitis based on metagenomic next-generation sequencing

作　　者：崇丽宁 韩翠芝 刘松 韩敬哲[1] Chong Lining;Han Cuizhi;Liu Song;Han Jingzhe(Ward III,Department of Neurology,Harison International Peace Hospital,Hengshui 053000,China;Ward I,Department of Neurology,Harison International Peace Hospital,Hengshui 053000,China;Department of Abdominal Surgery,Second People's Hospital of Hengshui,Hengshui 053000,China)

机构地区：[1]哈励逊国际和平医院神经内三科,衡水053000 [2]哈励逊国际和平医院神经内一科,衡水053000 [3]衡水市第二人民医院腹部外科,衡水053000

出　　处：《中华神经医学杂志》2024年第10期1006-1011,共6页Chinese Journal of Neuromedicine

基　　金：河北省医学科学研究课题(20240959)。

摘　　要：目的基于宏基因组高通量测序(mNGS)技术探讨水痘带状疱疹病毒(VZV)脑炎/脑膜炎患者脑脊液中检出序列数与临床特点的关系。方法选取哈励逊国际和平医院神经内科自2016年1月至2022年10月收治的54例VZV脑炎/脑膜炎患者为研究对象。采用mNGS检测患者脑脊液中VZV的序列数,根据检出序列数是否>1000将患者分为低检出序列数组(≤1000)和高检出序列数组(>1000)。比较2组患者临床特征、辅助检查结果、治疗和预后的差异。结果mNGS结果显示,低检出序列数组患者26例,高检出序列数组患者28例。与低检出序列数组比较,高检出序列数组患者的年龄较大[48.0(35.5,65.3)岁vs.63.0(54.0,71.8)岁],应用免疫抑制剂者占比较高(0.0%vs.14.3%),脑膜刺激征者占比较低(46.2%vs.17.9%),精神行为异常(15.4%vs.42.9%)、癫痫(3.8%vs.28.6%)、意识障碍者占比较高(11.5%vs.42.9%),脑脊液压力较大[150.0(127.5,177.5)mmH_(2)O vs.185.0(152.5,210.0)mmH_(2)O],脑电图结果阳性率较高(11.8%vs.47.7%),出院时预后不良率较高(26.9%vs.66.7%),差异均有统计学意义(P<0.05)。结论低检出序列数患者临床表型倾向于脑膜炎型,高检出序列数患者临床表型倾向于脑炎型。高检出序列数患者易脑脊液压力升高、脑电图结果异常、预后不良。ObjectiveTo investigate the relations of clinical manifestations with sequence numbers detected in the cerebrospinal fluid of varicella-zoster virus(VZV)encephalitis/meningitis patients based on metagenomic next-generation sequencing(mNGS).MethodsFifty-four VZV encephalitis/meningitis patients admitted to Department of Neurology,Harrison International Peace Hospital from January 2016 to October 2022 were selected.Sequence numbers of VZV in the cerebrospinal fluid of these patients were detected by mNGS;these patients were divided into low-detected sequence number group(≤1000)and high-detected sequence number group(>1000)accordingly.Differences in clinical manifestations,auxiliary examination results,treatments and prognoses were compared between the two groups.ResultsTwenty-six patients were into low-detected sequence number group and 28 patients were into high-detected sequence number group.Compared with the low-detected sequence number group,the high-detected sequence number group had significantly older age(48.0[35.5,65.3]years vs.63.0[54.0,71.8]years),higher proportion of patients using immunosuppressants(0.0%vs.14.3%),lower proportion of those with meningeal irritation signs(46.2%vs.17.9%),higher proportions of those with abnormal mental behaviors(15.4%vs.42.9%),epilepsy(3.8%vs.28.6%),and consciousness disorders(11.5%vs.42.9%),greater cerebrospinal fluid pressure(150.0[127.5,177.5]mm H_(2)O vs.185.0[152.5,210.0]mm H_(2)O),higher electroencephalogram positive rate(11.8%vs.47.7%),and higher poor prognosis rate at discharge(26.9%vs.66.7%,P<0.05).ConclusionsThe clinical phenotype of the low-detected sequence number group tends to meningitis,while that of the high-detected sequence number group tends to encephalitis.Patients with high-detected sequence numbers have high cerebrospinal fluid pressure and abnormal electroencephalogram,enjoying poor prognosis.

关 键 词：水痘带状疱疹病毒 脑炎/脑膜炎 宏基因组高通量测序 临床特点 

分 类 号：R752.12[医药卫生—皮肤病学与性病学] R512.3[医药卫生—临床医学]