小儿心肌疾病抗肌球蛋白抗体和粒细胞-巨噬细胞集落刺激因子的研究

为探讨病毒性心肌炎（VMC）和扩张型心肌病（DCM）发病的自身免疫机制，采用酶联免疫吸附和放射免疫技术检测30例VMC、14例DCM患儿血浆中抗肌球蛋白抗体和粒细胞-巨噬细胞集落刺激因子（GM－CSF）。结果：VMC和DCM患儿抗肌球蛋白抗体和GM－CSF的阳性率均为54．5％（24／44），而正常对照组分别为4．0％（1／25）和8．0％（2／25）（均P＜0．01），且抗肌球蛋白抗体与GM－CSF的血浆水平有正相关性（r＝0．3583，P＜0．05）。提示：抗肌球蛋白抗体和GM－CSF均参与了VMC和DCM的发病，与心肌的自身免疫损伤过程有关。     

Granulomatous amoebic encephalitis caused byAcanthamoeba in a patient with systemic lupus erythematosus

A 25-year-old chronically immunosuppressed woman with systemic lupus erythematosus (SLE) died after developing subacute granulomatous encephalitis caused byAcanthamoeba. Amoebic trophozoites were also found in the lung, suggesting a primary pulmonary focus of infection. The infectious encephalitis was difficult to differentiate from a flare-up of central nervous system lupus. This case illustrates thatAcanthamoeba can cause fatal encephalitis in lupus patients, as well as in patients with acquired immunodeficiency syndrome as previously reported. To our knowledge, this is the first reported case of granulomatous amoebic encephalitis due toAcanthamoeba in a patient with SLE.     

用通用引物建立的RT-PCR诊断肠道病毒性脑炎及脑膜炎

目的　用通用引物建立逆转录聚合酶链反应（ＲＴ－ＰＣＲ），达到广谱、特异及快速诊断肠道病毒（ＥＶ）性脑炎及脑膜炎。方法　用针对ＥＶ基因组５’端非编码区保守区的１对通用引物建立的ＲＴ－ＰＣＲ检测多种ＥＶ标准血清型，同时检测病毒性脑膜炎和脑炎患儿的脑脊液。结果　此种ＲＴ－ＰＣＲ可检测４２种ＥＶ的标准血清型，所用毒株在１０－１ＴＣＩＤ５０时仍可见到１９４ｂｐ的阳性条带。检测了３２例病毒性脑膜炎和脑炎患儿的脑脊液中ＥＶ－ＲＮＡ，１８例为阳性（５６．３％）。ＥＶ－ＲＮＡ阳性患儿的昏迷、瘫痪、抽搐、ＣＳＦ－蛋白质及低密度灶数（ＣＴ）分别为４（２２．２％）、８（４４．４％）、１２（６６．７％）、４６２ｍｇ／Ｌ（ｘ）及４（２２．２％）；ＥＶ－ＲＮＡ阴性患儿的昏迷、瘫痪、抽搐、ＣＳＦ－蛋白质、及低密度灶数（ＣＴ）分别为１０（７１．４％）、６（４２．９％）、１２（８５．７％）、３８６ｍｇ／Ｌ（ｘ）及４（２８．８％），仅昏迷发生率有极显著差异（Ｐ＜０．０１）。结论　用通用引物建立的ＲＴ－ＰＣＲ诊断ＥＶ性脑膜炎和脑炎，具有广谱性、特异性、敏感性及简洁、快速的特点，诊断ＥＶ性脑膜炎和脑炎主要依靠病原学检查。     

Miller-Fisher综合征和Bickerstaff脑干脑炎的临床特点及鉴别诊断

目的 探讨Miller-Fisher综合征(MFS)和Bickerstaff脑干脑炎(BBE)的临床特点及鉴别诊断.方法 回顾性分析12例MFS和15例BBE患者的临床资料.结果 MFS组表现为视物成双12例,瞳孔对光反射消失3例,周围性面瘫7例,饮水呛咳1例,四肢无力6例,感觉障碍4例,共济失调10例;BBE组表现为视物成双11例,中枢性面瘫4例,耳鸣4例,饮水呛咳6例,四肢无力10例,感觉障碍2例,共济失调10例,嗜睡或昏迷5例,病理征9例.脑脊液检查MFS组和BBE组各有10例表现为蛋白升高;MFS组脑脊液白细胞升高2例,BBE组6例.MFS组3例、BBE组1例肌电图出现神经源性损害.BBE组有6例CT或MRI检查异常,主要部位为脑干、丘脑等.两组患者治疗后预后良好.结论 MFS和BBE有相似特点,临床表现可以相互重叠,提示这两种疾病密切相关并形成一个连续的疾病谱;主要鉴别点是BBE患者可以有意识障碍、病理征和影像学异常.     

Proton magnetic resonance spectroscopy in childhood brainstem lesions

Background Diagnosis of brainstem lesions in children based on magnetic resonance imaging alone is a challenging problem. Magnetic resonance spectroscopy (MRS) is a noninvasive technique for spatial characterization of biochemical markers in tissues and gives information regarding cell membrane proliferation, neuronal damage, and energy metabolism. Methods We measured the concentrations of biochemical markers in five children with brainstem lesions and evaluated their potential diagnostic significance. Images and spectra were acquired on a 1.5-T imager. The concentrations of N-acetylaspartate, tetramethylamines (e.g., choline), creatine, phosphocreatine, lactate, and lipids were measured within lesions located at the brainstem using Point-resolved spectroscopy sequences. Results Diagnosis based on localized proton spectroscopy included brainstem glioma, brainstem encephalitis, demyelination, dysmyelination secondary to neurofibromatosis type 1 (NF 1), and possible infection or radiation necrosis. In all but one patient, diagnosis was confirmed by biopsy or by clinical follow-up. Conclusions This small sample of patients suggests that MRS is important in the differential diagnosis between proliferative and nonproliferative lesions in patients without neurofibromatosis. Unfortunately, in cases of NF 1, MRS can have a rather misdiagnosis role.     

芪芍五味子复方制剂抗CVB3病毒抑制心肌细胞凋亡机制的研究

目的 研究中药芪芍五味子复方制剂抗柯萨奇B3病毒(CVB3)效果及抑制病毒性心肌炎小鼠心肌细胞凋亡的机制.方法 采用细胞培养法观察细胞病变效应(CPE)与广谱抗病毒药物病毒唑对照,进行复方制剂体外抗病毒实验;BALB/c小鼠接种CVB3建立病毒性心肌炎动物模型,随机分为正常对照组、病毒对照组、复方制剂治疗组和维生素C与病毒唑联用组,观察各组心肌病理变化,Real-time定量PCR检测小鼠心肌CVB3RNA水平,流式细胞仪检测心肌细胞凋亡和坏死率.结果 复方制剂体外最大无毒浓度为19.53g/L,预防给药、同时给药和治疗给药3种方式细胞培养所需有效药物浓度均低于病毒唑;与同期病毒对照组小鼠比较,复方制剂治疗组小鼠心肌炎症性病理变化明显减轻,CVB3RNA拷贝数降低(P<0.05),心肌细胞凋亡和坏死率显著降低(P<0.05).结论 芪芍五味子复方制剂可有效抗病毒,抑制病毒诱导心肌细胞凋亡,对CVB3感染小鼠心肌有良好的保护作用.     

森林脑炎疫苗效果的评价研究

本文采用组织培养中和试验及间接免疫荧光中和法检测森林脑炎组织培养灭活疫苗的使用效果。人群抗体在二次接种后约1/3人检出阳性,三次接种后约1/2人检出阳性,流行病学调查发现疫苗的质量差,需要改进。     

小儿病毒性脑炎86例临床分析

目的 探讨小儿病毒性脑炎的诊断及治疗方法.方法 对86例小儿病毒性脑炎的临床表现、辅助检查及治疗方法和治疗效果做回顾性分析.结果 小儿病毒性脑炎大多于2～3周完全恢复.脑脊液检查、头颅MRI、脑电图（EEG）有助于病毒性脑炎的诊断.综合治疗基础上分别合用激素、干扰素、静脉注射用丙种球蛋白（IVIG）疗效好.结论 小儿病毒性脑炎病程呈自限性.确诊主要靠脑脊液检查.激素、干扰素、IVIG值得临床推广应用.     

Slowly progressive hemiparesis in childhood as a consequence of Rasmussen encephalitis without or with delayed-onset seizures

Five young children developed slowly progressive hemiparesis as the initial manifestation of Rasmussen encephalitis (RE). Three have remained seizure free over an observational period of 1.3–1.9 years. In the remaining two patients, seizures occurred after 0.5 and 0.6 years respectively. We suggest that RE might be presently underdiagnosed and should be suspected in cases of new onset hemiparesis. In this series, three out of five patients showed oligoclonal bands on examination of cerebrospinal fluid (CSF) which represented additional diagnostic hints towards an immune-mediated condition. According to recently published formal diagnostic criteria, evidence of progressive cerebral hemiatrophy or bioptic identification of RE-typical inflammation confirms the diagnosis in such cases. Long-term immunotherapy is recommended in order to prevent further tissue loss and functional decline.     

林培政教授从“暑湿”论治成人风疹病毒性脑炎验案

成人风疹病毒性脑炎是风疹病毒感染的少见并发症,是一种累及神经系统的罕见病,目前发病机制尚未明确,尚无特异治疗,西医以抗病毒、抗炎、增强免疫力等治疗为主。林培政教授以温病理论为指导,结合患者发病特点,辨病为暑湿病,辨证先后属暑湿弥漫三焦、困阻中下焦、暑湿伤气,分别以清暑化湿、宣通三焦,清暑化湿、健脾化湿消积,清暑化湿、培元和中为法,完全治愈1例成人风疹病毒性脑炎患者,无任何后遗症,疗效确切。