阿片多肽参与流行性乙型脑炎发病机制的临床研究

目的研究内源性阿片多肽参与流行性乙型脑炎的发病机制与病理意义.方法采用改良放射免疫法分别测定乙脑患者极期及恢复期血及脑脊液中亮氨酸-脑啡肽、β-内啡肽、强啡肽值进行统计学分析.并分别设立阿片多肽特异对抗剂一纳络酮治疗组与对照组,进行疗效比较.结果乙脑患者极期时血及脑脊液中阿片多肽显著升高,进入恢复期下降至正常水平.纳络酮治疗组优于对照组,各症状疗效统计学分析有显著差异.结论乙脑患者极期时血及脑脊液中显著升高的阿片多肽与乙脑发病有关,并证实纳络酮治疗有效,值得推广.     

强力宁与病毒唑联合治疗流行性乙型脑炎45例

我们在综合治疗的基础上,对早期流行性乙型脑炎(乙脑)患者应用国产强力宁和病毒唑联合治疗并与地塞米松作对照进行疗效比较,获得了较为满意的效果.现报道如下.     

21例儿童流行性乙型脑炎临床分析

目的 掌握儿童流行性乙型脑炎（简称乙脑）的临床特征,为诊治乙脑提供参考。方法 收集我院儿科确诊的21例乙脑患儿资料,对他们的预防接种史、临床表现、辅助检查及诊疗过程进行分析。结果 本组患儿均来自农村,发病月份为7-9月,大多患儿未接种乙脑疫苗或接种史不详,临床表现为高热、颅高压症状、频繁抽搐、意识障碍、呼吸衰竭;病初外周血白细胞计数及中性粒细胞均增高,病后3-7天血清或脑脊液乙脑IgM阳性;大多患儿出院时有各种不同程度神经系统损害。结论 儿童乙脑病情危重,早诊断、积极治疗可降低病死率和致残率。     

乙型脑炎研究进展

流行性乙型脑炎,简称乙脑。由日本乙型脑炎病毒（JEV）引起的常见的病毒性脑炎,全球每年病死人数超过1万人^[1]。主要在东亚、东南亚地区流行。目前临床上尚无特效的治疗药物。CDC报告的病死率约为25%,存活者约半数留下永久性的神经系统后遗症。目前对乙脑的研究取得了一定的发展,现综述如下。     

纳洛酮治疗流行性乙型脑炎27例疗效初步观察

纳洛酮治疗流行性乙型脑炎２７例疗效初步观察胡家庭，濮艳姑目前，流行性乙型脑炎（乙脑）尚缺乏特异性治疗方法，１９９１年７月至１９９３年９月，我们采用纳洛酮治疗乙脑２７例，现将结果报告如下。临床资料一、病例选择选择住院乙脑患儿５２例随机分为两组，治疗组２...     

重型乙型脑炎102例急救与护理体会

流行性乙型脑炎简称乙脑。一旦发病,病情急,变化快,如治疗及抢救护理不及时患者易死亡。1993～1998年,我院共收治102例重型乙脑。现将抢救与护理体会总结如下。     

循证护理在流行性乙型脑炎患者护理中的应用

自流行性乙型脑炎(简称乙脑)疫苗的接种普及后,乙脑的收治明显下降,据报导2011年至今乙脑的发病率有所下降,今年我科收治13例乙脑重症患者,本文通过循证护理的方法对我科2013年收治的13例乙脑患者的护理展开研究。结果通过循证护理在乙脑护理中的应用,分析总结乙脑患者的护理特点。     

降低流行性乙型脑炎病死率的治疗体会

降低流行性乙型脑炎病死率的治疗体会王福臣我院自１９９０～１９９４年共治疗流行性乙型脑炎（乙脑）４５０例，现将降低乙脑病死率的治疗总结如下。临床资料按《实用内科学》分型标准。除结合发病季节、症状体征脑脊液常规和白细胞总数及分类外，脑脊液ＩｇＭ抗体阳性做...     

流行性乙型脑炎迟发型脑病临床分析

目的 总结流行性乙型脑炎(乙脑)迟发型脑病的临床特点.方法　回顾性调查2009年7-9月我院收治的18例发生迟发型脑病的乙脑患者(迟发脑病组)的流行病学及临床资料,与同期收治的34例未发生迟发型脑病的乙脑患者(非迟发脑病组)资料进行对比,探讨迟发型脑病的特点.结果　52例乙脑患者中18例(34%)发生迟发型脑病.2组的...     

重症流行性乙型脑炎的抢救

流行性乙型脑炎(以下简称乙脑)是由虫媒病毒引起的,以中枢神经系统病变为主的全身性传染病。起病急、来势猛、进展快,如不及时抢救,病死率很高。目前乙脑尚无特异治疗方法,多采用综合性治疗,包括针对病理生理各环节发生的变化,进行对症处理。维护各脏器的生理功能,防止心、肺、肾功能衰竭,注意水、电解质平衡及热卡、营养等支持疗法。防止继发感染,治疗合并症。     

Neurological Sequelae of Hospitalized Japanese Encephalitis Cases in Gansu Province,China

We conducted a follow-up survey for 55 Japanese encephalitis (JE) cases 1–2 years after hospital discharge in Gansu province, China. Community-, education-, and gender-matched healthy individuals without history of neurologic disease were selected as the comparison group. All subjects received neurological examination, intelligence quotient (IQ) measurement, adaptive behavior measurement, and Wechsler memory scale (WMS) assessment. We found 43.6% JE cases had at least one nervous system sequelae compared with 3.6% healthy individuals. Among JE cases, 22.4% had subnormal IQ, 18.4% subnormal verbal IQ (VIQ), 20.4% subnormal performance IQ (PIQ), and 78.4% had subnormal memory quotient (MQ). Among healthy individuals, 2.0% had subnormal IQ, VIQ, or PIQ and 8.1% had subnormal MQ. Among adult JE cases, 47.8% and 39.1% had adaptive behavior impairments and intellectual disability, respectively, compared with 18.8% and 9.7% among young cases, respectively. The results showed both adult and young surviving JE cases had significant neurological sequelae and mental disability 1–2 years after discharged.     

The clinical features about 5 cases of Japanese encephalitis reported in Japan, 2002

We discussed the clinical features of 5 Japanese encephalitis (JE) cases which we experienced in 2002. Today there are few opportunities for a clinician to see JE patients. Until the 1950s, the number of JE patients was more than 2000 in Japan, but the annual cases of JE are decreasing remarkably due to the extermination of mosquitoes, thorough vaccination and improvement of environmental sanitation. However, even today the disease still has a high fatality rate. In fact 4 in 5 cases we experienced had poor prognosis and one of them resulted in death despite the relatively early diagnosis. It shows the difficulty of diagnosis and treatment. When we see elderly patients with high fever, headache, and impaired consciousness in late summer and autumn, the important thing is to recognize the possibility of JE. Moreover it turned out that brain MRI and detecting serologic JE virus antibodies was very helpful for diagnosis and treatment. Nowadays we clinicians tend to consider JE as a disease of the past in Japan, however, this experience taught us that it is necessary for us to study JE again and to continue educating the public about it.     

An unexpected outbreak of Japanese encephalitis in the Chugoku district of Japan, 2002

Six patients unexpectedly presented with Japanese encephalitis (JE) from early August to mid-September 2002 in the Chugoku district of Japan. The mean age was 67.5 years (range 42 - 89 years); the onset period in two patients shifted to the middle of September. The JE virus was isolated from the cerebrospinal fluid samples from two patients, and the strain isolated in the one was identified as genotype III. Neurologically, consciousness impairment, meningeal signs, rigidity, hemiparesis, tetraparesis, and convulsive seizures were commonly observed. Magnetic resonance imaging uniformly revealed high signal intensities in the bilateral thalami, brainstem (substantia nigra), hippocampi, and brain cortices. In all patients, acyclovir was used, due to the unexpected outbreak of JE. Five patients, except for one without sequelae, had a severe outcome, including one death. This report indicates that JE in Japan is still a threat to adults and the elderly with decreased or absent immunity to the JE virus.     

The effect of dengue virus infection on the clinical sequelae of Japanese encephalitis: a one year follow-up study in Thailand.

In order to determine if prior dengue virus infection reduces the severity of Japanese encephalitis (JE), we examined 127 patients hospitalized during the 1970 JE epidemic in the Chiangmai and Lampang Valleys of northern Thailand. Patients were studied during the first 30 days after onset of JE; 120 of these patients were examined one year later for residual neurologic sequelae. About 21% of patients had serological evidence of a prior dengue virus infection. Morbidity and mortality in patients with and without prior dengue virus experience were compared. These comparisons were made within two age groups to exclude differences due to age alone;     

Japanese encephalitis: surveillance and elimination effort in Japan from 1982 to 2004

Japanese encephalitis (JE) surveillance has been conducted since 1965 as a part of the National Epidemiological Surveillance of Vaccine Preventable Diseases in Japan. Over 1,000 JE cases were reported annually in the late 1960s. The number of JE cases has since markedly decreased, with less than 10 cases reported annually from 1992 to 2004. A total of 361 JE cases were reported between 1982 and 2004. Prognosis was available for 320 cases; 58 (18%) died, 160 (50%) recovered with neuropsychiatric sequelae, and 102 (32%) completely recovered. Seventy-eight percent of these cases were 40 years old or over with a peak age group of 60-69 years old. JE predominantly occurred in unvaccinated populations. A high seroconversion rate among sentinel pigs was recorded every year. This suggests the presence of JE virus-infected mosquitoes during the summer in most areas of Japan, including the northern districts where no JE cases were reported from 1982 to 2004. Although JE cases have been reported in single figures since 1992, the risk of JE virus infection is still present. Thus, high immunization rates of JE vaccine should be maintained in Japan.     

中国大陆地区流行性乙型脑炎后遗症的系统评价

目的 评价中国大陆地区流行性乙型脑炎(JE)的后遗症发生率.方法 系统检索CNKI、CQVIP、WanFang、CBM、PubMed、EMbase和Web of science数据库,收集有关中国大陆地区JE后遗症发生率的观察性研究.按照纳入与排除标准选择文献、提取数据,应用AHRQ推荐的横断面研究评价标准对纳入的研究...     

Central nervous system lesions due to juvenile myelomonocytic leukemia progressed in a boy undergoing first line chemotherapy

Juvenile myelomonocytic leukemia is a rare malignancy that occurs in pediatric patients. Previous reports, have described leukemic cells may infiltrate many organs, such as the lungs, skin, liver, spleen, and intestines, but not the central nervous system, although central nervous system infiltration remains a point of concern in every patient with acute leukemia. Here, we present one case of a boy with juvenile myelomonocytic leukemia who developed multiple lesions in the brain while undergoing chemotherapy with 6-mercaptopurine and cytarabine. We diagnosed the central nervous system involvement by magnetic resonance imaging, cerebrospinal fluid cytology, and the patient's clinical course. He was treated with a high dose of cytarabine and intrathecal chemotherapy, then with unrelated cord blood stem cell transplantation. He has been in a first complete remission for more than 18 months after cord blood stem cell transplantation without any neurological sequelae. In conclusion, we encountered a boy with juvenile myelomonocytic leukemia who developed central nervous system lesions under standard chemotherapy. We subsequently switched treatment to central nervous system-oriented chemotherapy, which resulted in a good clinical condition and successful cord blood stem cell transplantation.     

The effect of interferon-alpha A on two cases of Japanese encephalitis in Thailand

Two Japanese encephalitis cases with serious comatous symptoms were treated with the Human Recombinant Interferon-alpha A. The clinical responses to IFN were found to be satisfactory. The first case showed improvement on the 5th day of IFN treatment and the general condition slowly improved. The second case recovered from the comatous stage on the 6th day of IFN, followed by quick improvement of general symptoms in the 2nd week and complete recovery without any mental sequelae. Leukopenia and neutropenia occurred during the first week of administration of IFN, but were only temporary. Slight elevation of SGOT and SGPT was observed in the first case. No other side effects including general toxicity, neurotoxicity or allergy, or any abnormal hematological and blood chemistry changes were observed in these 2 cases. Two other JE cases (the 3rd and 4th consecutive JE cases) were not treated with IFN, but received the usual regimens of symptomatic and supportive drugs. Both patients died on the 7th-9th day of illness. This study suggests that the Human Recombinant Leukocyte A Interferon possibly is an effective and promising agent in the treatment of Japanese encephalitis in Thailand. More studies to treat JE cases with this IFN are being performed in order to assess the efficacy, tolerance and safety of rIFN-alpha A on Japanese encephalitis in Thailand.     

Acute viral encephalitis: the recent progress

In the new Japanese control law for infectious diseases, most varieties of acute viral encephalitis belong to Category IV requiring report of all cases at sentinel hospitals. Herpes simplex virus type 1 (HSV-1) encephalitis comprises the majority of cases. With the increased prevalence of diagnostic procedures such as polymerase chain reaction (PCR), several forms of HSV-1, and -2 central nervous system (CNS) infections, including acute disseminated encephalomyelitis, brainstem encephalitis, and myelitis, have been clarified. Since 1990 we have conducted a survey of HSV CNS infections in the Kyushu and Okinawa regions, and the data are reviewed here. Trends include an increase in a new subtype of non-herpetic acute limbic encephalitis. In contrast, the incidence of Japanese encephalitis (JE) in Japan has dramatically decreased to a few patients per year; however, JE remains a threat for those with decreased or absent immunity to the JE virus. Imported emerging and reemerging CNS infections such as Murray Valley and West Nile encephalitis can occur in Japan. Influenza-associated encephalitis/encephalopathy is also described as a threat for adults as well as young children.     

酶标SPA用于检测人和某些哺乳动物流行性乙型脑炎抗体的研究

以SPA-HRP作第二抗体进行ELISA,用于乙脑病人及猪等哺乳动物乙脑血清流行病学的检测。本法重复性好,特异性强,敏感性高。用该法对68份乙脑病人血清、80份猪血清及兔、豚鼠等哺乳动物血清进行检测,同时用HI进行对比测定,结果表明:乙脑病人或猪等血清的SPA-ELISA乙脑抗体阳性率都较HI高。发现SPA-ELISA与HI之间有良好的正相关;而与常规ELISA的敏感性、特异性相似。利用SPA-HRP作第二抗体的ELISA技术,对乙脑病人的诊断和疫区猪等哺乳动物乙脑血清流行病学检查都是适用的。