单纯疱疹病毒性脑炎治疗措施的临床证据评价

目的评价不同治疗方案对单纯疱疹病毒性脑炎的作用及不良反应,以为循证制定最佳治疗方案。方法以脑炎、病毒性脑炎、单纯疱疹病毒、抗病毒治疗、肾上腺皮质激素、治疗等词组作为检索词,分别检索MEDLINE、Cochrane图书馆、万方数据知识服务平台学术期刊库和中国知网中国期刊全文数据库,并辅以手工检索,获取临床指南、系统评价、随机对照试验、临床对照试验及病例观察研究的相关文献,采用Jadad量表对文献质量进行评价。结果经筛选共纳入与单纯疱疹病毒性脑炎治疗有关的临床指南2篇、系统评价2篇、随机对照试验2篇、临床对照试验2篇、病例观察研究3篇;其中9篇被评为高质量文献(3篇Jadad量表评分为4分、5篇评分为5分、1篇评分为7分),2篇为低质量文献(评分为3分)。对各种治疗方法的疗效及安全性评价显示:(1)抗病毒药物为单纯疱疹病毒性脑炎的首选治疗方法。(2)若病情不能缓解,应在充分评价肾上腺皮质激素利弊后考虑激素类药物治疗。(3)肾上腺皮质激素疗效欠佳者可考虑加用免疫治疗药物以缓解症状。(4)外科手术治疗不作为推荐治疗方法,唯有在颅内压过高的情况下方考虑施行手术减压。结论借助循证医学评价方法可为单纯疱疹病毒性脑炎患者的治疗提供最佳临床证据。

Evidence-based evaluation of therapeutic measures for herpes simplex virus encephalitis

Objective To evaluate the therapeutic efficacy and side effects of various treatment for herpes simplex virus encephalitis(HSE) in order to formulate the best therapeutic regimen.Methods Encephalitis,viral encephalitis,herpes simplex virus or HSV,antivirus,adreno-cortical hormone or ACH, treatment were appointed as retrieval words.MEDLINE,Cochrane Library,Wanfang Database for Scientific Journals in China and Chinese National Knowledge Infrastructure(CNKI) for Scientific Journals Database were used for retrieval.Manual searching was also used.Related clinical guidelines,systematic reviews, randomised controlled trials,controlled clinical trials and case-observation studies were collected and evaluated by Jadad Scale.Results After screening,11 related articals were selected as follow:2 clinical guidelines,2 systematic reviews,2 randomised controlled trials,2 controlled clinical trials,and 3 caseobservation studies.Nine articals were of high quality(according to Jadad Scale,3 with score 4,5 with score 5,and one with score 7),while 2 were of low quality with score 3.According to the evaluation of therapeutic efficacy and side effects of various therapies,it is suggested that 1) antiviral therapy is the first choice for HSE treatment;2) when the patients’ condition is not relieved,the pros and cons should be considered before the application of ACH therapy;3) if the condition is still not improved,immune therapy can be considered to alleviate symptoms;4) surgical treatment is not usually recommended,with the exception of high intracranial pressure.Conclusion Evidence-based medicine can provide best clinical evidence on HSE treatment.