自身免疫性脑炎临床鉴别诊断及治疗研究

目的探讨自身免疫性脑炎(AE)临床鉴别诊断及治疗,以期提高该病的临床诊治水平。方法回顾性分析2011年3月-2013年1月90例老年自身免疫性脑炎患者临床资料,将其分成3组,分别为抗VGKC脑炎、抗NMDA脑炎和边缘叶脑炎,比较3组年龄、性别、临床特点、脑脊液、辅助检查等的差异性,采用SPSS13.0软件进行统计分析。结果抗VGKC脑炎和抗NMDA脑炎好发性别、肿瘤的相关性、临床特点、辅助检查、脑脊液、MRI和免疫肿瘤效果等差异明显;边缘叶脑炎相关疾病中代谢性脑炎、桥本脑病、非血管炎自身免疫性脑膜脑炎均表现为困倦和意识障碍;代谢性脑炎、精神病、桥本脑病、非血管炎自身免疫性脑膜脑炎MRI检查正常;代谢性脑炎、阿尔茨海默病、精神病、非血管炎自身免疫性脑膜脑炎、Wernicke-Korsakoff脑病、进行性多灶性白质脑病脑脊液检查正常;诊断性检查可明确的有单疱脑炎、代谢性脑炎、克罗伊茨费尔特-雅各布病、桥本脑病、进行性多灶性白质脑病等。结论自身免疫性脑炎病种较多,在临床上鉴别时要依据患者的临床特点结合相关的检查等予以诊治。     

肺炎支原脑炎21例临床分析

目的探讨肺炎支原体感染性脑炎(MP)的特点、诊断方法、治疗措施。方法回顾性分析我院2012年1月至2012年8月收治MP感染性脑炎患儿的临床表现、辅助检查、治疗措施及转归。结果 21例患儿中5例出现抽搐、昏迷、尿储留,其中1例死亡,2例病程较长,经治疗后出院,14例病情较轻,治愈出院。结论小儿MP脑炎多发于学龄儿童,如果临床上用病毒或细菌感染不能解释一些症状、体征,并合并多系统改变时,应想到支原体脑炎的可能性,及时做血清MP-IgM及脑脊液中MP-IgM检查。同时早期诊断、及时治疗可提高治愈率。     

边缘系统胶质瘤患者预后因素分析

的　探讨边缘系统胶质瘤患者的预后因素。方法　分析经手术治疗边缘系统胶质瘤 6 0例 ,分析其临床、影像学表现 ,,并予以随访 ,对所得的各项指标进行单因素及多因素分析。结果　用Kaplan -Meier法单因素分析显示年龄、术前KPS、病理级别、瘤 -脑组织界面、肿瘤内钙化、手术方式、术后放疗、肿瘤家族史等 8个因素是影响边缘系统胶质瘤患者生存期的危险因素 ;Cox回归多因素分析显示病理级别、手术方式、术后放疗三个因素对边缘系统胶质瘤患者生存期的影响具有统计学意义。结论　运用新的诊疗手段 ,结合预后影响因素、注意治疗中的各环节 ,合理安排治疗模式 ,将有助于不断改善边缘系统胶质瘤患者的预后。     

颞叶性癫痫的治疗体会和家庭护理

颞叶性癫痫属局灶性癫痫的主要类型之一，主要表现为精神症状、意识障碍、醉梦样表现和嗅觉异常等。病因很多包括：脑炎、肿瘤、外伤、动静脉畸形、灰质或白质异位症等。有的也查不出原因，中枢定位是在颞叶或边缘系统。是颞叶或边缘系统中癫痫病灶异常放电所致，多次发作后影响智力和性格。近5年来，笔者采用卡马西平与硝基安定治疗颢叶性癫痫40例，现报告如下。     

儿童病毒性脑炎应用脑电图检查的早期诊断价值分析

目的：探析儿童病毒性脑炎运用脑电图检查的早期诊断价值.方法：将我院2011年3月-2013年10月期间收治的300例病毒性脑炎患儿作为主要研究对象,对其临床治疗资料进行回顾性分析.结果：经脑电图检查,260例轻度异常,15例中度异常,1例重度异常,异常率为92%,发病后1d,呈阳性改变,发病后3-5d,呈典型EEG 改变,具有较高阳性率.结论：临床上运用脑电图对病毒性脑炎患儿进行检查,有助于早发现、早治疗,在一定程度上可以提高治疗效果,改善患儿预后生活质量.     

皮质激素治疗慢性活动性肝炎十年随访

在日本,应用皮质激素或免疫抑制剂治疗慢性活动性肝炎甚为普遍。近年来对乙型肝炎病毒的认识不断深入,对上述药物的应用也应重新加以估价。本文系对10年前用皮质激素或免疫抑制剂治疗的慢性活动性肝炎进行随访并对10年前收集的肝组织切片作了HBsAg检查,藉以判断其治疗效果。     

病毒性脑炎患儿微量元素及免疫功能观察

病毒性脑炎有不同程度的免疫功能紊乱 ,为观察病毒性脑炎微量元素及免疫功能改变的相关关系 ,本文对 30例病毒性脑炎患儿微量元素锌、铜、铁、T细胞亚群、IL - 2R、NK细胞、及体液免疫作了检测 ,以了解其变化及相互关系。1　资料和方法病毒性脑炎患儿 30例 ,诊断标准 :起病急 ,有脑实质受损及颅内压增高的症状体征 ,有发热等感染的全身症状 ,脑脊液(CSF)正常或轻中度异常 ,除外中枢神经系统其他疾病 ,并经病毒学及血清学检测确诊。男 2 0例 ,女 10例 ,年龄 3个月 -13岁 ,平均住院天数 17.94d ,抗感染对症支持处理 ,未用免疫抑制剂 ,正常…     

1例海绵状血管瘤患者并发病毒性脑炎的护理

目的探讨海绵状血管瘤患者并发病毒性脑炎的护理措施。方法在熟悉患者病情、检查化验情况及治疗用药的基础上,找出护理问题,采取相应护理措施。结果经治疗和护理11d后,患者病情好转出院。结论虽然海绵状血管瘤患者并发病毒性脑炎,病情急骤危重,但只要治疗、护理得当,可控制病情并达到治愈。     

副肿瘤综合征23例临床分析

目的 分析副肿瘤综合征患者的临床特点.方法 回顾性分析23例副肿瘤综合征患者的临床资料.结果 副肿瘤综合征患者的临床表现形式多种多样,23例患者中包括周围神经病11例,Lamber-Eaton综合征7例,运动神经元病2例,进行性多灶性白质脑病1例,进行性小脑变性1例,边缘系统脑炎1例.多为慢性或亚急性起病,18例先出现神经系统症状后进一步检查发现肿瘤,5例为发现肿瘤后出现神经系统症状.结论 早期识别副肿瘤综合征对隐匿性肿瘤的发现和治疗非常重要.     

江苏省2008年乙型脑炎经济负担调查及免疫规划成本效益分析

目的了解2008年江苏省乙型脑炎的疾病经济负担及开展乙型脑炎疫苗接种在防控乙脑工作中产生的社会效益和经济效益,为制定免疫规划决策提供重要依据。方法通过问卷调查了解乙型脑炎病例的治疗总费用,运用成本-效益分析模型,对江苏省乙型脑炎疫苗免疫规划项目进行成本-效益分析。结果 83例乙型脑炎病例平均每例治疗总费用为12 920.3元。江苏省自1978年起将乙型脑炎疫苗纳入儿童免疫规划后,江苏省乙型脑炎发病率逐年下降,由1965-1977年的平均发病率20.88/10万降至2008年的0.06/10万。2008年人群避免发病所产生的直接效益为19 359.96万元,当年乙型脑炎疫苗免疫总成本为2 476.548万元,效益-成本比值为7.8:1,效益远大于成本。结论乙型脑炎给患者家庭带来沉重的精神负担和经济压力,使用乙型脑炎疫苗预防乙脑可产生较好的社会效益和经济效益。     

儿童患者超剂量应用抗生素致抗生素脑病误诊为病毒性脑炎临床分析

目的 探讨儿童患者超剂量应用抗生素致抗生素脑病的临床特点及病毒性脑炎临床鉴别。 方法 用HIS系统检索和查阅病历资料,回顾2009年1月20日-2011年6月20日某医院临床诊断为病毒性脑炎患儿504例,记录患儿临床用药史,疾病发生与演变过程,临床治疗与检查结果,分析儿童抗生素脑病临床特点及儿童病毒性脑炎的鉴别。结果 儿童抗生素脑病与超剂量应用抗生素直接相关,临床表现为呕吐、意识障碍、抽搐、腹泻、脑膜刺激征,实验室检查、病原学检查和脑影像学检查阴性,脑脊液压力、白细胞数(>200)、降钙素原(procalcitonin,PCT)较病毒性脑炎低,两组患儿统计数据差异有统计学意义(P＜0.05)。 结论儿童超剂量应用抗生素是抗生素脑病的直接因素,严格掌握抗生素的使用指征、种类、用法用量是预防的关键;充分了解患儿抗生素应用情况结合实验室检查、病原学检查和脑组织影像学检查是鉴别病毒性脑炎的可靠依据。     

流行性乙型脑炎的临床及影像学特征分析

目的 探讨山东省济宁市流行性乙型脑炎(乙脑)的临床及影像学特征。方法 收集2013年1月至2016年12月山东省济宁市第二人民医院收治的的18例乙脑临床资料,回顾性分析其临床与影像学特征。对病例资料采用描述性分析的统计学方法。结果 18例乙脑患者除均表现出高热、意识障碍、惊厥、肢体瘫痪外,其中1例还表现出帕金森综合征的症状及体征。影像学方面,流行性乙型脑炎主要累及双侧基底节区、丘脑,DWI弥散受限呈高信号,相应部位ADC图未见明显信号减低,强化后病灶未见明显强化。结论 乙脑除病毒性脑炎常见临床表现外,部分病例表现出双侧基底节、丘脑对称性受累,并且弥散受限是乙脑的特征性影像学改变。     

Toxoplasma meningoencephalitis in HIV-seronegative patients: clinical patterns, imaging features and treatment outcome

We evaluated the clinical and imaging features of cranial toxoplasmosis in patients without HIV infection. Between 1995 and 2005, 15 patients with serologically proven cranial toxoplasmosis were selected for clinical and imaging study from 233 patients with chronic meningitis and 364 patients with seizures/psychosis. All patients had poor immune status due to nutritional and metabolic causes. Neurological presentations included focal encephalitis, multifocal encephalitis and diffuse meningoencephalitis. The three groups had distinct symptoms and imaging features, with some overlap. Magnetic resonance imaging showed single or multiple nodular or ring-enhancing lesions often at the grey-white junction with subcortical white matter perifocal oedema. Within the large diffuse lesions there were discrete small haemorrhagic lesions and contrast medium administration showed fine-beaded parallel lines or small discrete nodules traversing the white matter suggesting perivenous spread. Complete clinical recovery was noted in 12 patients after several 6-week courses of pyrimethamine and sulfonamide/clindamycin. Five patients required two such courses, three patients required three courses, three patients required five courses and two patients required six courses for the final radiological healing, which was complete in nine patients. One patient was lost to follow-up and one patient died of cardiomyopathy. Knowledge of these three distinct initial presentations may help in the early diagnosis of cranial toxoplasmosis in HIV-seronegative patients. Prognosis in early cases is generally good but complete recovery may need several courses of treatment.     

乙型肝炎疫苗与婴儿期常用疫苗同时接种的免疫应答与反应观察:Ⅱ.乙型肝炎疫苗与乙型脑炎、麻疹疫苗同时接种的免疫应答与反应观察

本文对HBV与JEV、MV同时接种的免疫应答性和反应作了研究。对0~9月龄215名婴儿随机分为Ⅰ组单独接种HBV,Ⅱ组分别接种JEV、MV,Ⅲ组HBV分别与MV、JEV同时接种,三针间隔为0、1、5个月。均作免前和免后的血清抗体测定,同时接种组的抗-HBs,JEV抗体的阳转率,GMT与单独接种无显著性差异,JEV抗体低于常规接种,MV的免疫应答性Ⅲ组低于Ⅱ组,有显著性差异。未见异常反应,一般反应均很轻微,二组间无差别,说明MV不宜与HBV同时接种,JEV不能用HBV免疫程序同时接种。     

2011年卢氏县麻疹、乙型脑炎抗体检测分析

目的通过开展适龄儿童的麻疹、乙脑疫苗免疫效果检测,了解适龄儿童接种疫苗后的免疫状况,评价免疫预防接种服务质量和水平,为全县制定免疫预防策略和工作方案提供科学的依据。方法按照有关传染病诊断国家标准和其他参考资料进行检验和判定,采用Excel 2003及SPSS13.0软件对汇总数据分别进行统计图的制作及分析。结果卢氏县分别共检测麻疹、乙脑血清标本5 657例、4 737例,阳性率分别为98.29%、97.51%;经x2检验,各地区的麻疹、乙脑抗体分布不同。各个年龄段中麻疹、乙脑抗体阳性率均为>2剂次的最高,分别为99.45%、99.00%。结论卢氏县适龄儿童的麻疹、乙脑疫苗免疫效果较好,接种全剂次麻疹、乙脑疫苗可有效提高抗体阳性率。     

Three patients with a paraneoplastic neurological syndrome: the significance of paraneoplastic antibodies

Establishing the presence of paraneoplastic antibodies is important in identifying an often severe neurological syndrome as paraneoplastic and hence directing the search for an underlying neoplasm. A paraneoplastic neurological syndrome was diagnosed in 3 patients. The first was a 64-year-old woman in whom paraneoplastic encephalomyelitis was diagnosed. The diagnosis was strongly supported by a high titre of serum anti-Hu antibodies, despite three negative biopsies from a mediastinal mass. The patient died of a non-convulsive status epilepticus; autopsy revealed not only paraneoplastic encephalomyelitis but also small-cell lung cancer. The second patient was a 55-year-old woman with metastatic breast cancer. After a three-year period of progressive neurological deterioration, a high titre of anti-CV2/CRMP5 antibodies was detected, on the basis of which the clinical syndrome was diagnosed as paraneoplastic. She received immunotherapy and her condition stabilised. The third patient, a 41-year-old man, presented with severe limbic encephalitis. Biopsy from a paraaortic mass was positive for undifferentiated carcinoma. The patient had a high titre ofanti-Ma2 antibodies and was subsequently tested positive for serum alpha-foetoprotein (AFP) and beta-human-chorionic gonadotrophin (bta-HCG). During chemotherapy for a non seminoma testicular cancer, the limbic encephalitis improved both clinically and radiologically, but the patient died as a result of the toxicity of the treatment.     

Encéphalites avec anticorps anti-récepteur NMDA

Anti-NMDA-receptor encephalitis has been described only recently among other causes of paraneoplastic and auto-immune limbic encephalitis. Its frequency is probably underestimated. The very characteristic clinical presentation, the severity of symptoms frequently leading to the intensive care unit, the therapeutic implications of the diagnosis whatever the cause, paraneoplastic or not and, once treated, the possibility of a full recovery or mild sequels in the majority of cases justify a surveillance either in neurology wards or in infectious, psychiatric, intensive care, or pediatric units. The authors review the history of this disease, the available epidemiological data, the characteristic clinical presentation of patients, the differential diagnosis, and the suggested treatment according to an up-to-date literature review.     

Arboviruses as aetiological agents of encephalitis in the People's Republic of China.

A serological study was undertaken to determine the role of arboviruses as etiological agents of encephalitis in the People's Republic of China (PRC). Paired sera were collected during mosquito seasons in 1988-1990 from 614 patients with possible viral encephalitis in 15 regions of PRC and tested for haemagglutination inhibiting antibodies to selected arboviruses. Seroconversions were documented to alphavirus and flavivirus antigens in 13.0 and 18.7% of patients respectively in most of the study areas. No California group seroconversion was detected. The age of alphavirus seroconvertors ranged from 2 months to 32 years and of flavivirus seroconvertors from 6 months to 50 years, with higher numbers in males. Serious central nervous system manifestations were seen more commonly in flavivirus seroconvertors. This study affirms the importance of flavivirus as causative agents of encephalitis in PRC and provides evidence that one or more alphaviruses are causing symptomatic infections with neurological involvement in PRC.     

Bacterially expressed recombinant envelope protein domain III of Japanese encephalitis virus (rJEV-DIII) elicits Th1 type of immune response in BALB/c mice

Japanese encephalitis is a major cause of encephalitis in Asia. Cases occur largely in rural areas of the South and East Asian region resulting in significant morbidity and mortality. Multiple vaccines exist to control Japanese encephalitis, but all suffer from problems. Envelope protein domain III of Japanese encephalitis virus is involved in binding to host receptors and it contains specific epitopes that elicit virus-neutralizing antibodies. Earlier, the protective efficacy of domain III has been evaluated in mice by some researchers, but these studies are lacking in explanation of humoral and cellular immune responses. We have earlier reported cloning, expression, purification and in vitro refolding of Japanese encephalitis virus envelope protein domain III (rJEV-DIII). Ninety percent JEV is neutralized when the serum against refolded rJEV-DIII is used at a dilution of 1:80. In the present study, we have evaluated the immunomodulatory potential of refolded rJEV-DIII protein in BALB/c mice with Freunds complete/incomplete adjuvants. Mice were tested for humoral immune response by ELISA. Cell-mediated immune response was tested by lymphocyte proliferation assay and cytokine profiling. The rJEV-DIII generated high IgG antibody and its isotypes (IgG2a and IgG3) and induced significant expression of INF-γ and IL-2 cytokines. The rJEV-DIII induced significant lymphoproliferation of splenocytes. In conclusion rJEV-DIII induced Th1 type of immune response which plays an important role in protection for intracellular pathogens.     

显微镜下多血管炎肺部受累的CT表现与临床分析

目的 研究显微镜下多血管炎(MPA)肺部受累的病理基础与影像学、临床表现特点.方法 对2003-2006年收治的6例MPA患者的临床资料进行回顾性分析.结果 肺部受累影像学表现:(1)两肺多发斑片状影3例.(2)两肺磨玻璃样密度影1例.(3)弥漫性肺间质改变2例.临床表现:肺部症状除咳嗽、咯痰外,多以咯血为主,肺外受累以肾功能损害为主.实验室检测6例患者抗中性粒细胞胞质抗体(ANCA)均阳性,5例为P-ANCA/MPO-ANCA阳性.结论 MPA肺部受累CT影像学表现无明显特异性,结合临床及实验室检查,可以提高认识,早期诊治.