小儿病毒性脑炎100例临床分析

本文对１００例小儿病毒性脑炎临床症状及脑脊液病毒学，脑电图改变做初步探讨，发现：（１）在单纯疱疹病毒脑炎（ＨＳＥ）的临床表现中，意识障碍的发生率显著高于非单纯疱疹病毒脑炎（ＮＨＳＳＥ），提示的病原学诊断对于早期诊断及指导临床治疗具有重要意义。（２）病毒性脑炎脑电图异常率为８４．３％（７０／８３），说明病毒性脑炎患者大多数有脑电图改变，但脑电图的改变与疾病的轻重并不呈完全正相关。     

更昔洛韦联合丙种球蛋白治疗病毒性脑炎的疗效观察

目的：观察更昔洛韦联合丙种球蛋白治疗病毒性脑炎的临床疗效。方法：将120例病毒性脑炎患者随机分为治疗组和对照组各60例,治疗组在降颅内压、降温、止痉、补液、补充电解质、保护胃黏膜及支持治疗基础上,应用更昔洛韦及大剂量静注丙种球蛋白治疗;对照组在降颅内压、降温、止痉、补液、补充电解质、保护胃黏膜及支持治疗基础上,应用更昔洛韦治疗。结果：治疗组发热、头痛、呕吐、精神行为异常等临床症状缓解时间与对照组比较,差异有统计学意义（P〈0.05）。结论：更昔洛韦联合丙种球蛋白治疗病毒性脑炎的临床疗效优于单用更昔洛韦。     

更昔洛韦眼用凝胶联合干扰素治疗单纯疱疹病毒性角膜炎80例临床疗效分析

目的分析更昔洛韦眼用凝胶联合干扰素治疗单纯疱疹病毒性角膜炎的临床疗效。方法选取80例单纯疱疹病毒性角膜炎患者并分为观察组和对照组,给予观察组更昔洛韦眼用凝胶联合干扰素治疗,对照组单纯使用更昔洛韦眼用凝胶治疗,对比两组临床治疗效果。结果观察组的总有效率明显优于对照组,且复发率明显低于对照组;两组患者在视力方面治疗前后差异均较大,且治疗后观察组的视力平均值明显高于对照组,P0.05。结论更昔洛韦眼用凝胶联合干扰素治疗单纯疱疹病毒性角膜炎临床疗效显著。     

更昔洛韦治疗小儿病毒性脑炎的临床研究

目的：观察更昔洛韦治疗小儿病毒性脑炎的临床疗效。方法：将病毒性脑炎患儿随机分成病毒唑治疗组（52例）及更昔洛韦治疗组（46例）,对两组患儿的临床表现及治疗效果进行观察。结果：结果显示,更昔洛韦组头痛、呕吐及抽搐症状和恢复神志的时间明显较病毒唑治疗组缩短,发热症状消退的时间虽有所缩短,但两者比较无显著性差异。结论：更昔洛韦对小儿病毒性脑炎有明显疗效。     

更昔洛韦治疗成人病毒性脑炎的临床研究

目的比较更昔洛韦与阿昔洛韦治疗成人病毒性脑炎的l临床疗效。方法66例患者随机分为两组,分别给予更昔洛韦和阿昔洛韦,比较其主要临床症状及体征恢复的时间。结果更昔洛韦组取得显著临床疗效的时间比阿昔洛韦组缩短（P〈0．05）。结论更昔洛韦治疗病毒性脑炎的疗效优于阿昔洛韦。     

更昔洛韦眼用凝胶治疗单疱病毒性角膜炎疗效观察

目的观察局部使用0.15%更昔洛韦眼用凝胶治疗单纯疱疹病毒性角膜炎的临床疗效。方法选取单纯疱疹病毒性角膜炎患者46例,随机分为治疗组24例（24只眼）,局部点用0.15%更昔洛韦眼用凝胶,4次/d,疗程7d;对照组22例（22只眼）,局部点用0.1%阿昔洛韦滴眼液,1次/2h,疗程7d。结果治疗组与对照组有效率分别为91.67%和63.64%,两组比较差异有显著性（P〈0.05）。结论0.15%更昔洛韦眼用凝胶比0.1%阿昔洛韦滴眼液具有更好的治疗效果。     

秦皮汤加味治疗单纯疱疹病毒性角膜炎的效果及对炎性因子的影响研究

目的 探讨秦皮汤加味治疗单纯疱疹病毒性角膜炎（HSK）的临床效果。方法 40例HSK患者随机分为两组,对照组采用更昔洛韦治疗,观察组采用更昔洛韦联合秦皮汤加味治疗,比较两组的干预效果。结果 观察组的总有效率高于对照组,复发率低于对照组（P <0.05）。治疗后,观察组的TNF-α、 IL-6水平均低于对照组,IFN-γ水平高于对照组（P <0.05）。结论 秦皮汤加味治疗单纯疱疹病毒性角膜炎可有效改善患者的炎性因子水平,提高治疗效果,降低复发率。     

56例病毒性脑炎临床特征及预后

目的探讨病毒性脑炎的临床特征,为其临床诊断和治疗提供帮助。方法对56例病毒性脑炎患者的临床资料进行回顾性分析。结果本组患者主要表现为头痛45例（80.4%）、发热48例（85.7%）、精神异常29例（51.8%）、意识障碍11例（19.6%）及癫痫发作12例（21.4%）。本组患者腰穿检查颅内压增高者36例（64.3%）,细胞数增多者31例（55.4%）,蛋白轻度增高者9例（16.1%）,糖和氯化物均无明显异常。49例行脑电图检查,其中40例（81.6%）可见异常脑电波。32例行头部CT检查,8例（25%）可见异常低密度灶。25例行头部MRI检查,14例（56%）可见异常信号灶。予以抗病毒及对症治疗后出院时24例（42.9%）患者临床症状基本消失,30例（53.6%）遗留有轻度精神异常、智力障碍、癫痫发作等后遗症,2例（3.6%）死亡。结论头痛、发热、精神异常、意识障碍及癫痫发作为病毒性脑炎常见临床表现;病毒性脑炎诊断主要依靠临床表现、脑脊液检查、脑电图及头部影像学,多种手段结合更加可靠;疗效较好,对临床上高度疑诊病例应及早予以抗病毒治疗及正规治疗以改善预后。     

单纯疱疹病毒性脑炎预后的影响因素分析

目的探讨单纯疱疹病毒性脑炎预后的影响因素。方法35例诊断为单纯疱疹病毒性脑炎的患者，依其应用阿昔洛韦治疗两月后的转归分为预后好和顸后差2组。记录患者的9个参数：性别、年龄、起病到应用阿昔洛韦时的天数、GCS（Glasgow Coma Scale）评分、第一次脑脊液的白细胞计数、第一次脑脊液的蛋白含量、急性期是否应用激素、头部MRI是否发现局限性病灶，以及脑电图是否发现周期性单侧癫痫样放电（PLEDs）。用单变量logistic回归分析得出与单纯疱疹病毒性脑炎预后显著相关的变量，后用多变量stepwise logistic回归分析得出预后的最佳回归方程。结果logistic回归分析表明与预后显著相关的独立变量包括：年龄，GCS评分，急性期是否应用激素和头部MRI是否发现局限性病灶。结论急性期用阿昔洛韦联合激素治疗可改善单纯疱疹病毒性脑炎患者的预后。     

更昔洛韦联合干扰素治疗小儿病毒性脑炎的临床观察

目的 观察更昔洛韦联合干扰素治疗小儿病毒性脑炎的临床疗效.方法 将64例病毒性脑炎患儿随机分为观察组32例和对照组32例,对照组静脉滴注更昔洛韦,观察组在对照组基础上加用重组人干扰素α-2b肌肉注射.结果 观察组总有效率为90.63%,明显优于对照组的68.75%,两组比较差异有统计学意义（P〈0.05）.结论 干扰素联合更昔洛韦治疗小儿病毒性脑炎疗效显著,值得临床推广.     

Another case of West Nile fever in the Netherlands: a man with encephalitis following a trip to Canada

Shortly after his return to the Netherlands from a trip to Ontario, a part of Canada where infection with West-Nile virus has been reported, a 69-year-old man became increasingly confused and generally unwell, accompanied by fever. The clinical picture was compatible with viral encephalitis and this was supported by EEG findings and the results of the cerebrospinal-fluid examination. MRI of the brain did not contribute to the diagnosis. The patient was treated with aciclovir because herpes simplex encephalitis was suspected, and he recovered from his illness within a few days. The EEG normalised as well. The most important remaining symptom was diminished short-term memory function. After the patient was discharged, rising antibody titres against West-Nile virus were found in two consecutive sera; there were no antibodies to other encephalitis-causing viruses (such as Q fever virus and St. Louis encephalitis virus). This case report concerns the second imported case of West-Nile fever in the Netherlands and the first one with encephalitis.     

探讨儿童脑电图儿童病毒性脑炎的早期诊断和预后评估方面临床研究

目的探讨脑电图在儿童病毒性脑炎的早期诊断和预后评估方面临床研究价值。方法对115例儿童病毒性脑炎患者的脑电图和临床资料进行全面分析研究：97例为脑电图异常,异常率为84.34%。轻度异常51例（44.34%）,中、重度异常46例（40%）。结果治疗2-4周后,脑电图恢复正常81例,未恢复正常11例：轻度异常1例,中度异常6例,4例有明显的意识障碍,1例有经常发作性脑电图异常改变。脑电图异常改变表现为弥漫性慢波,α波节律减弱,或以θ波为主,其中一部分患儿有局限性异常脑电图表现。结论脑电图作为一种检查手段,脑电图异常改变与临床症状、大脑脑实质损伤的严重程度成正向关系,因此脑电图对儿童病毒性脑炎的早期诊断和临床预后评估有着非常重要的正相关性。     

The use of acyclovir in suspected encephalitis.

The early use of intravenous acyclovir in herpes simplex encephalitis (HSE) is essential. However, rapid diagnostic tests are not freely available. Hence, all patients with suspected encephalitis may need to be commenced on acyclovir. In our study, of 34 patients with suspected encephalitis, only two eventually had HSE confirmed, 19 had encephalitis not due to herpes simplex and in 13 a non-encephalitis illness was finally diagnosed. Guidelines for the use of acyclovir in suspected encephalitis are given aimed at minimizing the drug cost whilst still protecting all cases of presumed HSE.     

The immune response to herpes simplex virus encephalitis in mice is modulated by dietary vitamin E

Herpes simplex virus encephalitis (HSE) is the most common fatal sporadic encephalitis in humans. HSE is primarily caused by herpes simplex virus (HSV)-1 infection of the brain. HSE results in increased levels of oxidative stress, including the production of reactive oxygen species, free radicals, and neuroinflammation. The most biologically active form of vitamin E (VE) is alpha-tocopherol (alpha-TOC). In cellular membranes, alpha-TOC prevents lipid peroxidation by scavenging free radicals and functioning as an antioxidant. Supplementation with VE has been shown to decrease immunosenescence, improve immune function, and may be neuroprotective. To determine how VE deficiency and VE supplementation would alter the pathogenesis of HSE, we placed weanling male BALB/cByJ mice on VE-deficient (VE-D), VE-adequate (VE-A), or 10x VE-supplemented diets for 4 wk, and then infected the mice intranasally with HSV-1. VE-D mice had more severe symptoms of encephalitis than VE-A mice, including weight loss, keratitis, hunched posture, and morbidity. VE-D mice had increased cytokine and chemokine expression in the brain and increased viral titers. In contrast, VE supplementation failed to decrease cytokine production and had no effect on viral titer. We demonstrated that adequate levels of VE are important in limiting HSE pathology and that 10x supplementation does not enhance protection.     

55例病毒性脑炎脑电图诊断分析

目的探讨脑电图（EEG）对病毒性脑炎的诊断价值。方法回顾分析55例病毒性脑炎患者的I临床资料和检查结果。结果所有病例均在入院当天内做了脑电图检查,异常53例（96．36％）,其中轻度异常33例,中度异常15例,重度异常5例。经过治疗后复查脑电图．脑电图好转情况和临床好转情况相吻合。结论病毒性脑炎患者脑电图异常率高,脑电图检查对儿童病毒性脑炎的诊断具有重要的价值。     

病毒性脑炎患儿脑脊液病毒核酸检测及临床分析

目的了解合肥地区儿童病毒性脑炎的病原构成及不同年龄组患儿临床表现差异。方法将53例病毒性脑炎患儿根据年龄分为A组（〈3岁）、B组（3岁～6岁）及C组（〉6岁）3组。（1）采用PCR法检测脑脊液常见病毒核酸,包括肠道病毒（EV）、单纯疱疹病毒（HSV）、水痘-带状疱疹病毒（VZV）和人巨细胞病毒（HCMV）。（2）分析不同年龄组临床表现特点。结果（1）32例核酸检测阳性（60.38%）,其中EV 23例（43.40%）,HSV 8例（15.09%）,HCMV 1例（1.89%）,未检出VZV。（2）A、B两组中有惊厥者明显多于C组（P〈0.01）,C组以头痛为早期症状者23例（85.19%）,而A、B两组分别只有1例和4例（P〈0.01）。HSV脑炎惊厥发生明显多于其他病毒性脑炎。结论证实合肥地区儿童病毒性脑炎病原以EV和HSV为主,HSV脑炎临床症状较严重,提示临床应加强病毒性脑炎病原检测工作,而PCFR检测患儿脑脊液中特异性病毒核酸片段符合临床快速、特异诊断要求。     

高压氧治疗急性一氧化碳中毒性肺水肿72例分析

目的探讨高压氧对一氧化碳中毒性肺水肿的治疗作用。方法采用高压氧配合临床用药治疗一氧化碳中毒性肺水肿72例,并和单纯临床用药治疗一氧化碳中毒性肺水肿进行疗效对比。结果高压氧综合治疗组对一氧化碳中毒性肺水肿的临床治愈率（84.7%）明显高于对照组（55.9%）,差异有统计学意义（P〈0.01）;高压氧综合治疗组病程为（42.2±5.6）d,对照组为（58.4±7.2）d,高压氧综合治疗组病程明显缩短（P〈0.01）。结论高压氧对一氧化碳中毒性肺水肿患者有着确切的疗效,能有效提高临床治疗效果和缩短病程。     

Atypical computed tomographic appearance of herpes simplex encephalitis

In cases of herpes simplex encephalitis, a low density lesion in the temporal lobe is a common CT finding, whereas hemorrhagic lesion is rarely observed on CT in this disorder despite the frequent occurrence on pathologic studies. Two cases of hemorrhagic lesion observed on CT in herpes simplex encephalitis are reported, and atypical CT findings of herpes simplex encephalitis is discussed.     

To biopsy or not to biopsy in suspected herpes simplex encephalitis: a quantitative analysis

The authors performed a decision analysis to determine whether a patient suspected to have herpes simplex encephalitis (HSE) should undergo a brain biopsy or be treated empirically with medical therapy. In most cases, empiric treatment with acyclovir would be slightly favored; brain biopsy was not essential in management. However, brain biopsy was found useful for patients who had low CSF glucose at the time of initial lumbar puncture; such patients may have a very high risk to have other treatable conditions such as tuberculosis, brain abscess, toxoplasmosis, or cryptococcosis. The results of the analysis suggest that even with the advent of safe antiviral drug therapy such as acyclovir, brain biopsy is useful in a well-defined subset of patients with possible HSE. The rationale, however, is not to confirm HSE but rather to detect other treatable conditions.     

35例路易体痴呆临床特点分析

目的了解中国路易体痴呆（DLB）的临床特点,提高临床诊治水平。方法电子检索中国生物医学文献数据库和中国知识仓库医学专题全文数据库1980～2012年收录的DLB病例报告,并分析其临床特点。结果共纳入18个研究35例患者,其中男26例,女9例。平均起病年龄（67.2±9.8）岁。以记忆力减退起病者占58.8%,以帕金森综合征起病者占11.8%,以视幻觉起病者占8.8%,以强迫症为首发症状占2.9%,以3种核心症状中的两种同时起病者占17.6%。随着病程的进展,68.6%的患者有波动性认知功能障碍,97.1%的患者有视幻觉,100%的患者有帕金森综合征,81.8%的患者对神经镇静药高度敏感,22.9%的患者有睡眠行为障碍,40.0%的患者有反复跌倒,17.1%的患者有短暂意识丧失,85.7%的患者有精神症状。26例患者行简易精神状态量表（MMSE）检查,评分均≤24分。影像学检查中,29.4%行头颅CT或MRI检查的患者显示海马和颞叶中部结构相对保留。3例患者行SPECT/PET检查,1例提示枕叶葡萄糖代谢减低。脑电图检查患者中63.2%表现为基本节律慢化,波率调节差,额、颞叶区明显。结论 DLB患者多在老年期发病,波动性认知功能障碍、视幻觉和帕金森综合征为3大核心症状,可合并存在。神经心理学、影像学及脑电图检查有一定诊断及鉴别诊断的价值。