复发性病毒性脑炎的临床特点和发病机制探讨

目的 探讨复发性病毒性脑炎的诊断和复发机制.方法 回顾分析150例病毒性脑炎患者,其中5例为复发性病毒性脑炎,还有1例来自尸检病例.其中5例临床高度怀疑为单纯疱疹性脑炎,并且其中2例得到病理结果的证实.结果 6例患者在症状缓解后1个月至2年2个月,再次出现神经系统损害的表现,症状加重.并且6例患者中5例复发时,MRI或CT出现以额、颞灰质损害为主的新病灶;除1例患者死亡,其余5例患者承新给予阿昔洛韦抗病毒治疗后,病情均明显好转;例3脑组织HSV免疫组化染色阳性,例6尸检脑组织内可见细胞内包涵体,HSV免疫组化阳性,提供了病毒感染的直接病理依据.结论 这6例复发性病毒性脑炎复发的机制与病毒活化直接侵犯中枢神经系统有关.复发的原因仍不是十分清楚,可能与阿昔洛韦剂量不足或治疗不够充分有关.阿昔洛韦抗病毒治疗应遵循早期、足最、个体化的治疗原则,将有助于改善预后.

Clinical characteristics of relapsing virus encephalitis and mechanisms of relapse

Objective To investigate the clinical characteristics of herpes simplex encephalitis (HSE) and to discuss the mechanism of its relapse. Method The clinical data of 6 patients with relapsing encephalitis, 4 male and 1 female, aged 14 -49, out of 150 encephalitis cases were analyzed: 5 of them were suspected as with HSE clinically, and HSE was confirmed by pathology via biopsy in 2 of the 6 patients. The 5 patients were followed up for 2 -6 years. Result The duration between the onset and relapse was 1 -26 months. Brain MRI or CT showed new lesions in the temporal lobe in 5 patients. Necropsy revealed intracellular inclusions,positive in HSV-1 antigen, in the neurons and glial cells of temporal lobe in one case. Second course of acyclovir therapy was effective in 5 of these 6 patients. One patient died 10 months later. Conclusion Direct invasion of activated virus into the central nervous system and insufficiency of acyclovir treatment are the causes of relapse of HSE. Acyclovir treatment should be early, with sufficient amount, and individualized.