病毒性脑炎早期诊断及病原学探讨(附175例报道)

目的探讨病毒性脑炎的早期诊断方法及病原学诊断的临床价值。方法对我院2005年临床诊断病毒性脑炎的175份病例就其临床资料进行回顾性分析,并对部分患者的脑脊液标本应用ELISA方法检测脑脊液中单纯疱疹病毒,呼吸道合胞病毒,柯萨奇B组病毒的IgM。结果脑电图检查160例,异常136例(85.00%);头CT检查90例,异常15例(16.67%);头MRI检查65例,异常42例(64.62%);脑脊液细胞学检测175例,异常166例(94.86%);血清特异性病毒抗体IgM检测74例,阳性26例,其中单纯疱疹病毒IgM阳性的13例,柯萨奇B组病毒IgM阳性的6例,呼吸道合胞病毒IgM阳性4例,巨细胞病毒IgM阳性3例;脑脊液特异性病毒抗体IgM检测70例,结果均为阴性。结论脑脊液细胞学在病毒性脑炎早期诊断及鉴别诊断中具有重要的价值,病原学诊断是病毒性脑炎诊断研究的发展方向,但其方法学有待于进一步完善。

With early diagnosis way and pathogenic study of viral encephalitis (an analysis for 175 cases of viral encephalitis)

objective: To investigate the early diagnosis way and evaluate the clinical value of pathogenic detection of viral encephalitis(VE).Methods: Clinical data of 175 cases of VE were retrospectively analyzed. The specific IgM antibodies of herpes simplex virus(HSV),respirovirus(RSV), coxsackieviruses B(CoxBV) were determined by enzyme-kinked immunosorbent assay (ELISA) in the cerebrospinal fluid (CSF) in 70 cases. Results: Electroencephalogram(EEG) was performed in 160 cases, cranial computerized tomography(CT) in 90 cases, cranial magnetic resonance imaging(MRI) in 60cases, cerebrospinal fluid cytology(CSFC) in 175 cases. The abnormality rates of EEG, CT, MRI and CSFC were 85.00%, 16.67%,64.62%,94.86% respectively. It was found 26 serum specimens were IgM positive to virus detected among 74 samples. The specific IgM antibodies to HSV, CoxBV, RSV, cytomegalovirus(CMV) were positive in 13, 6, 4, 3 cases respectively. All CSF specimens were IgM negative to virus detected among 70 samples. Conclusions: CSFC has great potential value in the early diagnosis and differential diagnosis of VE .The detection of the pathogen is very important in the diagnosis of VE ,but the methods should be consummated and improved.