255例病毒性脑炎预后分析

Prognosis in Patients with Acute Viral Encephalitis

【目的】探讨影响病毒性脑炎患者预后的因素。【方法】回顾性分析255例病毒性脑炎患者的临床资料。【结果】①治愈组患者和未愈组患者的性别和发病年龄差异无显著性(P>0.05)。②治愈组患者的治疗延误时间明显短于未愈组(P<0.01)。③治愈组患者中表现为精神行为异常、痫性发作、意识障碍和局灶神经功能缺损的比例明显少于未愈组(P<0.01)。④治愈组患者脑脊液压力、脑脊液细胞数与未愈组患者无显著性差异(P>0.05),但脑脊液红细胞数明显低于未愈组(P<0.01),且HSV1-IgM阳性率明显低于未愈组(P<0.01)。⑤治愈组患者脑电图的中、重度异常率和头部MRI阳性率明显低于未愈组(P<0.01),且未愈组患者病变多集中于颞叶、额叶或累及多脑叶。⑥治愈组患者的住院时间明显短于未愈组(P<0.01)。【结论】延误治疗,出现精神行为异常、痫性发作、意识障碍和局灶神经功能缺损,脑脊液红细胞增多,HSV1病毒感染,脑电图呈中重度异常及头部MRI发现颞叶病变或多发病灶均提示患者预后不良。

[Objective]To investigate the related factors influencing the prognosis of patients with acute viral encephalitis. [Methods]Clinical data of 255 cases of viral encephalitis were retrospectively analyzed. [Results]①There were no differences of age and gender between poor and good outcome. ② Delayed time of treatment of cured group was shorter than non-cured group （ P 〈0.01）.③The proportions of patients with mental and behavior disorder, seizures, impaired consciousness and focal dysfunction of nervous system in cured group were significantly lower than in non-cured group. ④ The differences of intracranial pressure of the first lumbar puncture and cell population of cerebrospinal fluid between the cured group and non-cured group were not signicantly（ P 〉0.05）. While the red blood corpuscle of cerebrospinal fluid and positive rate of HSVI-IgM in cerebrospinal fluid of cured group were lower than non-cured group （ P 〈0.01）. ⑤The moderately and severely abnormal rates of Electroencephalography and positive rate of MRI in cured group were significantly lower than non-cured group（ P 〈0.01）. ⑥ The length of stay in hospital of cured group were shorter than non-cured group（ P 〈0.01）. [Conclusion]Delayed treatment, mental and behavior disorder, seizures, impaired consciousness, focal dysfunction of nervous system, heighten red blood corpuscle of cerebrospinal fluid, HSV1 infection, moderately and severely abnormal Electroencephalography and temporal lesion or multipol focus of infection were meaning poor prognosis