Herpes simplex encephalitis: treatment with adenine arabinoside and cytosine arabinoside

A series of three infants with herpes simplex encephalitis is reported, together with details of treatment with adenine arabinoside and cytosine arabinoside. The former appears to be the most effective treatment available. A more aggressive approach is urged in the diagnosis and treatment of this serious infantile disorder.     

阿糖胞苷减少白血病细胞亮氨酸氨基肽酶的表达

目的研究化疗药物阿糖胞苷对白血病细胞K562细胞亮氨酸氨基肽酶(leucine aminopeptidase,LAP)表达的影响,探讨其抗肿瘤机制。方法阿糖胞苷(终浓度442μmol/L)处理细胞48 h,倒置显微镜下观察细胞形态改变及细胞凋亡数目,RT-PCR方法检测LAP基因mRNA的表达。结果阿糖胞苷处理细胞48 h后,倒置显微镜下观察到细胞形态发生明显改变,凋亡细胞数显著增多;LAP基因mRNA的表达(0.429±0.061)明显低于对照组(0.789±0.059)(P<0.05)。结论减少白血病细胞株LAP的表达可能是阿糖胞苷致白血病细胞凋亡的机制之一。     

Surgery for the acute abdomen in adults with leukaemia

In a retrospective analysis five of 104 patients with acute leukaemia undergoing cytotoxic chemotherapy developed abdominal signs requiring emergency surgical exploration. Two common features in these patients were the inclusion of cytosine arabinoside in their treatment regimen and a necrotizing lesion involving the terminal ileum, appendix, and right colon. Appendicectomy was performed in two and hemicolectomy in three. Of the patients receiving high-dose cytosine arabinoside one died in the immediate post-operative period and two after recovery from surgery but before marrow regeneration; the remaining two patients received conventional dose cytosine arabinoside, and both recovered. The inclusion of this agent is standard in modern treatment programmes, resulting in significant improvement in long-term disease-free survival, so that a greater awareness of this complication is necessary. Early surgery, utilizing modern support techniques, is recommended as feasible and appears to offer the only realistic chance of survival.     

新生Balb/c鼠脑神经元和星形胶质细胞纯培养的实验研究

目的 探讨纯培养神经元和星形胶质细胞的合适方法.方法采用Balb/c鼠尾胶原、大鼠尾胶原、阿糖胞苷、贴壁处理及传代培养等方法纯培养Balb/c鼠神经元和星形胶质细胞.结果纯培养Balb/c鼠神经元的纯度为90%,纯培养星形胶质细胞的纯度为97%.结论纯培养神经元宜选择Balb/c尾胶原为生长基质并经3 mg·L-1阿糖胞苷处理.纯培养星形胶质细胞宜用大鼠尾胶原为生长基质和培养10天左右采用二次差速贴壁处理及传代培养.     

单纯疱疹病毒感染后自身免疫性脑炎的研究进展

单纯疱疹病毒脑炎所引发的自身免疫性脑炎日益受到关注,其发病机制可能与单纯疱疹病毒感染神经元后神经元裂解释放抗原引起免疫反应有关。这种继发性的自身免疫性脑炎临床表现多样,早期容易与复发性单纯疱疹病毒性脑炎相混淆,延误治疗导致严重的神经功能缺损及预后不良。脑脊液和血清中检出自身免疫性脑炎相关抗体则有助于诊断,免疫治疗有效。本文结合相关文献综述了单纯疱疹病毒感染后的自身免疫性脑炎的发展历史、发病机制、临床表现、辅助检查和诊疗流程,为临床医生提供借鉴。     

急性髓细胞白血病联合化疗药物敏感性及相互作用的研究

目的 :研究急性髓细胞白血病 (AML)联合化疗药物的体外敏感性及化疗药物间的相互作用。方法 :应用甲基噻唑基四唑法 (MTT法 )检测了柔红霉素、三尖杉酯碱、阿糖胞苷、长春新碱和氢化可的松单药与两种药物联合对 2 2例AML患者白血病细胞的细胞毒性 ,统计分析了药物的相互作用。结果 :三尖杉酯碱 (H)与氢化可的松(HC)的协同率最低 ( 4 5 %) ,阿糖胞苷 (Ara -C)与HC的相加作用发生率最低 ( 2 2 7%) ,H与Ara -C的相加作用发生率最高 ( 5 0 0 %) ,H与长春新碱 (VCR)、HC的拮抗作用发生率最高 ,分别为 5 0 0 %和 5 9 1%。结论 :联合化疗药敏试验更有助于指导临床用药。     

病毒性脑炎急性期治疗的进展

病毒性脑炎是指病毒感染引起的脑实质的炎症。发热、头痛、意识障碍、精神症状、抽搐、神经系统定位体征是其主要临床表现。许多病毒可引起该病,常见的有单纯疱疹病毒、水痘-带状疱疹病毒、巨细胞病毒、肠道病毒70及71、麻疹病毒、风疹病毒、流行性腮腺炎病毒及黄病毒属等,单纯疱疹病毒性脑炎是最常见的。目前临床大多采取综合性的治疗,抗病毒、脑细胞的保护、重要脏器功能的维持及并发症的预防。文章对该病急性期治疗的进展予以综述。     

神经细胞体外分离培养的比较研究

目的：对神经元分离、培养的不同实验方法进行比较研究。方法：取成年小鼠和新生小鼠的脑皮质或全脑组织，经胰蛋白酶消化分离后，分别在普通RPMI-1640培养基、含阿糖胞苷的培养基、含Neurol Medium和B27的培养基3种不同条件下进行培养，观察神经元的生长情况。结果：采用普通RPMI-1640培养基培养的神经元被胶质细胞掩盖，形态不典型，神经元比例小；用含阿糖胞苷的培养基培养的神经元所含比例较高，但形态不太典型；用含Neurol Medium和M27的培养基培养的神经元形态典型，生长良好。结论：采用含Neurol Medium和M27的培养基可以从的乳鼠的全脑组织中培养出形态典型，生长良好，较为纯净的神经元，方法简便，得率高，这为进一步深入探讨其功能奠定了良好基础。     

免疫组化法对单纯疱疹病毒脑炎早期诊断的意义

目的：探讨免疫组化法对单纯疱疹病毒脑炎（ＨＳＥ）早期诊断的意义。方法：用免疫组化法检测９例ＨＳＥ脑组织石蜡保存标本的单纯疱疹病毒抗原（ＨＳＶ－Ａｇ）。结果：４例存在ＨＳＶ－Ａｇ，ＨＳＶ－Ａｇ分布于大脑皮质的神经元、胶质细胞、单核细胞。结论：免疫组化法检测脑组织中ＨＳＶ－Ａｇ是ＨＳＥ早期诊断的敏感方法之一。     

Acyclovir treatment of herpes simplex encephalitis: experience in a district hospital

Herpes simplex encephalitis may be underdiagnosed in Britain. We report eight patients treated at one hospital over three years. Fever, impaired consciousness or focal neurological signs were seen in all patients at presentation but herpes simplex encephalitis was rarely considered as the initial diagnosis. The electroencephalogram was the only initial investigation that was abnormal in each case and was the most useful test in establishing a clinical diagnosis. The diagnosis was confirmed by laboratory methods in each case. Following acyclovir treatment five patients were able to resume normal activities, one patient has moderate disability and two patients died. Three patients showed clinical evidence of relapse but two improved after further treatment with acyclovir. Herpes simplex encephalitis is a treatable condition and should be considered in all patients presenting with fever and neurological signs. The electroencephalogram is usually abnormal and the changes may be characteristic of the condition.     

Diseases that mimic herpes simplex encephalitis. Diagnosis, presentation, and outcome. NIAD Collaborative Antiviral Study Group

A total of 432 patients underwent brain biopsy for presumptive herpes simplex encephalitis. Three patient groups were identified. The first group, 195 patients (45%), had herpes simplex encephalitis confirmed by the isolation of herpes simplex virus from brain tissue at biopsy (193 patients) or autopsy (2 patients). The second group, 95 patients (22%), had diseases that were identified but that were not caused by herpes simplex virus. Three subgroups were recognized: (1) 38 patients (9%) with treatable disease, (2) 40 patients (9%) with nontreatable but diagnosed viral infection, and (3) 17 patients (4%) with identified diseases neither of viral etiology nor treatable. The third group, 142 patients (33%), remained without a diagnosis. Clinical presentation of patients in the second group was similar to that of those with herpes simplex encephalitis and those without a diagnosis. Patients in the subgroup with nontreatable but diagnosed viral infections had the greatest likelihood of returning to normal.     

HSV-1感染后认知功能障碍小鼠海马组织细胞周期素依赖性蛋白激酶5 mRNA的表达

 目的 探讨CDK5在单纯疱疹病毒-1型（HSV-1）感染后认知功能障碍小鼠海马组织中的表达变化及其作用。方法 将雄性C57BL/6小鼠100只随机分为模型组、假手术组及正常组。采用颅内注射法建立单纯疱疹病毒性脑炎（HSE）动物模型,感染后20 d进行水迷宫实验评价认知功能,应用RT-qPCR方法检测小鼠海马组织CDK5 mRNA的相对表达。结果 与正常组及假手术组比较,模型组小鼠学习、记忆能力受损明显,模型组小鼠海马组织CDK5的表达水平明显升高(P<0.05)。结论 CDK5有可能参与了HSV-1感染后小鼠认知功能障碍的发生。     

HSE模型小鼠的水迷宫实验观察

目的对HSE模型小鼠进行经典的Morris水迷宫实验,以观察评估HSV-1感染后小鼠的学习记忆功能。方法雄性C57BL/6小鼠100只,随机法分为模型组、假手术组、正常组。采用颅内注射法建立HSE动物模型,接种后每日观察各组小鼠的一般状况,并于感染后20天进行经典的Morris水迷宫实验评价认知功能。水迷宫实验共训练5d,记录每天的潜伏期与游泳轨迹,第6天去除平台,记录小鼠在目标象限的停留时间。结果接种后3天开始,模型组小鼠出现进食减少、毛发蓬松、倦怠少动等症状;水迷宫实验中模型组小鼠逃避潜伏期明显延长,目标象限停留时间及经过平台次数较其它两组明显减少(P<0.05)。结论 HSV-1感染后小鼠认知功能明显减退。     

Relapse of herpes simplex encephalitis after conventional acyclovir therapy

Acyclovir sodium is the drug of choice for the treatment of herpes simplex encephalitis. We treated an immunocompetent patient with a ten-day course of intravenous acyclovir sodium at the recommended dosage of 10 mg/kg every eight hours for clinically apparent herpes simplex encephalitis. After marked improvement, his condition deteriorated four days after completing acyclovir therapy. A subsequent brain biopsy specimen disclosed acyclovir-sensitive herpes simplex virus type 1. A longer duration of acyclovir therapy (14 to 21 days) should be considered for treating herpes simplex encephalitis.     

精神障碍型与非精神障碍型散发性脑炎脑脊液和临床的对照研究

目的 :通过对照分析两组脑脊液的表现 ,探讨精神障碍型散发性脑炎和非精神障碍型散发性脑炎脑脊液改变的特点与治疗转归的关系。方法 :两组散发性脑炎都通过腰穿测定脑脊液压力并取适量脑脊液做常规和生化检查 ,结果用方差分析和 T检验比较两组脑脊液的差异 ,初步比较两组散发性脑炎抗病毒治疗的临床效果。结果 ,两组脑脊液都只表现部分常规内容的项目异常而无全部内容异常的病例 ,脑脊液异常也都以轻、中度为主。通过比较分析 ,精神障碍型散发性脑炎脑脊液改变不论是单项内容异常或多项内容异常 ,其发生率和异常程度都高于非精神障碍型散发性脑炎 ,尤其是潘迪氏和蛋白定量二项异常两组比较有极显著性差别 ;而且 ,精神障碍型发性脑炎用阿糖胞苷等抗病毒治疗效果表现出优于非精神障碍型散发性脑炎。结论 :精神障碍突出的散发性脑炎其脑脊液改变常较明显 ,认为这类散发性脑炎可能与病毒直接感染造成的、以脑表面灰质损害为主和脑膜反应相对明显的特点相关 ,是阿糖胞苷等抗病毒治疗的合理选择     

Radiculomyelopathy associated with herpes simplex genitalis treated with adenosine arabinoside.

A case of herpes simplex genitalis producing radiculomyelopathy with urinary retention is reported. The patient was treated with adenosine arabinoside intravenously and made a complete recovery over 4 weeks. Although herpes simplex genitalis is common, neurological sequelae, particularly cord involvement, are distinctly rare. It should, nevertheless, be considered in the differential diagnosis of urinary retention, with or without long-tract signs, in young patients.     

长沙地区疮疹病毒性脑炎的病原研究

目的：探讨长沙地区病毒性脑炎与疱疹病毒感染的关系。方法：应用间接免疫荧光技术（ＩＥＡ）检测病毒性脑炎患者脑脊液或血清中疱疹病毒特异性ＩｇＧ、ＩｇＭ。结果：９２１例病毒性脑炎患者中有１３３例（１４．４％）诊断为单纯疱疹病毒性脑炎,１０岁以下年龄为发病高峰,９例（０．９８％）诊断为巨细胞病毒性脑炎,１２例（１．３％）为水痘－带状疱疹毒性脑炎。结论：长沙地区疱疹病毒性脑炎病原以单纯疱疹病毒最常见;ＩＦＡ     

Is serodiagnosis of herpes simplex encephalitis safe?

We present a case of probable tuberculous meningitis in which serological changes 'diagnostic' of herpes simplex encephalitis were found. Evidence is provided that the serological changes in this case represent a true false positive, and that reliance on clinical plus serological criteria to diagnose herpes simplex encephalitis could result in failure to diagnose and treat tuberculous meningitis.     

长沙地区疱疹病毒性脑炎的病原研究

目的 :探讨长沙地区病毒性脑炎与疱疹病毒感染的关系。方法 :应用间接免疫荧光技术 (IFA)检测病毒性脑炎患者脑脊液或血清中疱疹病毒特异性IgG ,IgM。结果 :92 1例病毒性脑炎患者中有 1 33例 (1 4 4% )诊断为单纯疱疹病毒性脑炎 ,1 0岁以下年龄为发病高峰 ,9例 (0 98% )诊断为巨细胞病毒性脑炎 ,1 2例 (1 3 % )为水痘 带状疱疹病毒性脑炎。结论 :长沙地区疱疹病毒性脑炎病原以单纯疱疹病毒最常见 ;IFA法对疱疹病毒性脑炎具有诊断价值     

Herpes encephalitis. I. The clinical picture

The three forms of herpetic encephalitis have been outlined and particular stress has been laid on herpes simplex encephalitis, which accounts for a large percentage of cases showing necrotizing encephalitis.