人类疱疹病毒感染后继发自身免疫性胶质纤维酸性蛋白星形胶质细胞病20例临床分析  

Autoimmune glial fibrillary acidic protein astrocytopathy secondary to human herpesvirus infection in 20 patients

作　　者：张思雨 王晓娟 蒋玙姝 张弥兰 薛红飞 杨玉洁 李玮 秦灵芝 ZHANG Siyu;WANG Xiaojuan;JIANG Yushu;ZHANG Milan;XUE Hongfei;YANG Yujie;LI Wei;QIN Lingzhi(Department of Neurology,Zhengzhou University People's Hospital,Henan Provincial People'sHospital,Zhengzhou,Henan 450003,China;Department of Neurology,Zhengzhou Central Hospital,Zhengzhou,Henan 450007,China)

机构地区：[1]郑州大学人民医院河南省人民医院神经内科,河南郑州450003 [2]郑州市中心医院神经内科,河南郑州450007

出　　处：《中华实用诊断与治疗杂志》2025年第2期117-122,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省科技攻关计划项目(232102310187)。

摘　　要：目的 分析人类疱疹病毒(HHV)感染后继发自身免疫性胶质纤维酸性蛋白(GFAP)星形胶质细胞病(GFAP-A)患者的临床资料,探讨其临床特征及预后。方法 2021年4月—2024年4月河南省人民医院诊治HHV感染后继发GFAP-A患者20例,分析其临床特征、实验室和影像学检查结果及治疗转归。结果 20例患者中HHV感染后7 d内出现症状8例,感染后2周内出现症状12例;有HHV 4型感染史14例,单纯疱疹病毒感染史3例,水痘-带状疱疹病毒感染史3例;临床表现主要为发热12例,头痛10例,肢体无力或麻木8例,恶心呕吐6例;脑脊髓炎9例,脑膜脑炎3例,软脊膜炎2例,未见明显异常6例。13例行头颅MRI平扫,脑白质T_(2)高信号9例,合并老年性脑萎缩10例;10例行头颅MRI增强扫描,软脑膜强化4例,双侧大脑半球多发线样强化5例,未见明显异常1例;12例行全脊髓MRI平扫,颈胸髓内及脊膜多发异常强化5例,颈胸腰脊膜多发异常强化4例,颈胸髓内散在异常强化灶4例;10例行全脊髓MRI增强扫描,软脊膜受累4例,未见明显异常6例。20例脑脊液GFAP抗体均为阳性,脑脊液压力升高10例,部分患者脑脊液白细胞计数及蛋白、乳酸、白细胞介素-6、免疫球蛋白水平升高,氯化物、葡萄糖水平降低;部分患者血钾、血钠、血尿酸水平降低,血清降钙素原、C反应蛋白、白细胞介素-6、白细胞介素-8、白细胞介素-10、干扰素-α水平升高;10例行风湿免疫相关抗体检测,抗核抗体阳性3例,抗SSA抗体阳性2例。20例患者经糖皮质激素治疗后,10例临床症状较前明显减轻,1例有视力障碍,2例有单侧肢体运动障碍;6例无明显症状,1例失访。结论 HHV感染后继发GFAP-A的发病时间和临床表现有个体差异,临床症状以发热、头痛和肢体麻木无力为主;MRI和脑脊液GFAP抗体检测有助于早期诊断,糖皮质激素治疗效果较好,患者预后良好。Objective To analyze the clinical data of patients with autoimmune glial fibrillary acidic protein(GFAP)astrocytopathy(GFAP-A)secondary to human herpesvirus(HHV)infection,and to explore their clinical characteristics and prognosis.Methods Twenty patients with GFAP-A secondary to HHV infection were diagnosed and treated in Henan Provincial People's Hospital from April 2021 to April 2024.Their clinical characteristics,laboratory and imaging examination results,and treatment outcomes were analyzed.Results Among these 20 patients,the symptoms developed within 7 d after HHV infection in 8 patients and within 2 weeks in 12 patients;14 patients had a history of HHV-4 infection,3 had herpes simplex virus infection,and 3 had varicella-zoster virus infection.The main clinical manifestations included fever in 12 patients,headache in 10,limb weakness or numbness in 8,and nausea and vomiting in 6.There were 9 cases of meningoencephalomyelitis,3 of meningoencephalitis,2 of leptomeningitis,and 6 of no significant abnormalities.Brain MRI plain scan was done in 13 patients,showing T_(2) hyperintensities in white matter in 9 patients and age-related brain atrophy in 10 patients.Enhanced brain MRI was done in 10 patients,showing leptomeningeal enhancement in 4 patients,multiple linear enhancements in the bilateral cerebral hemispheres in 5 patients,and no significant abnormalities in 1 patient.Whole spine MRI plain scan was done in 12 patients,showing multiple abnormal enhancements in the cervical and thoracic cord and meninges in 5 patients,multiple abnormal enhancements in the cervical,thoracic and lumbar meninges in 4 patients,and scattered abnormal enhancement lesions in the cervical and thoracic cord in 4 patients.Enhanced whole spine MRI was done in 10 patients,showing leptomeningeal involvement in 4 patients and no significant abnormalities in 6 patients.GFAP antibodies were positive in cerebrospinal fluid(CSF)in all patients and elevated CSF pressure was observed in 10 patients.In some patients,the CSF test showed elevated

关 键 词：自身免疫性胶质纤维酸性蛋白星形胶质细胞病 人类疱疹病毒 胶质纤维酸性蛋白 

分 类 号：R511[医药卫生—内科学] R741[医药卫生—临床医学]