癫痫手术标本中HSV的检测意义

Significance of HSV detection in epileptic tissues

目的 了解某些原发性或难治性癫痫的单纯疱疹病毒 (herpessimplevirus,HSV)感染情况和感染的皮层定位及神经细胞类别。方法 利用PCR和免疫组化法检测了 30例癫痫手术标本中HSV的感染情况 ,并选用 2 0例无脑病病史的尸体解剖正常脑组织颞叶作为对照组。结果 在PCR检测的 30例癫痫标本中有 8例 (2 6 % )显示HSV阳性 ,其中免疫组化检测呈阳性 6例 ,阳性细胞主要为分布于外颗粒层及椎体细胞层的神经元细胞和胶质细胞。在 2 0例对照组中PCR和免疫组化检测无1例HSV阳性 (P <0 0 5 )。结论 在临床诊断为原发性癫痫或用大量抗癫痫药物治疗无效的难治性癫痫患者中有相当部分存在嗜神经病毒感染 ,可能因感染症状为一过性或处于亚临床状态或以癫痫为首要表现 ,而常被临床医生忽视。对“原发性”或“难治性”癫痫病人进行详细的病史询问和病毒血清学、脑脊液检查有利于正确诊断和治疗 ,有时可以考虑使用实验性抗病毒治疗。

Purpose To observe herpes simplex virus(HSV) infection in some human idiopathic or refractory epilepsy diagnosed clinically, and HSV infection layers in brain and cellular localization. Methods HSV was detected using polymerase chain reaction (PCR) and immunohistochemistry in 30 surgical specimens of epilepsy and 20 normal corresponding temporal lobe tissues of postmortem cases without neurological disease. Results Eight (26%) of the 30 epilepsy cases were tested positive for HSV with PCR, and there were 6 cases positive with immunohistochemistry among those positive cases. The positive cells mainly spread in neuronal and glial cells of external granular layer and layer of pyramidal cells. With those two detecting methods, 20 postmortem cases were all HSV negative (P=0.015). Conclusions Many patients diagnosed clinically as idiopathic or intractable epilepsy, are possibly infected by some viruses, such as HSV. This fact, however, is often ignored by clinicians, for infection symptoms are transient or subclinical, or the first symptom is epilepsy. Therefore, it is useful for epilepsy diagnosis and treatment, asking exhaustively case history, virus serological examination, and cerebrospinal fluid detection, especially when all kinds of antiepileptic treatments including drugs and surgical operation are not effective.