25例成人流行性乙型脑炎的临床特点分析

Analysis on the clinical characteristics of 25 cases of epidemic encephalitis B in adults

目的分析25例成人流行性乙型脑炎的临床特点,提高临床对该病的认识及诊断水平。方法回顾性分析2017年7~9月甘肃省人民医院收治的25例确诊的流行性乙型脑炎患者的临床特点、血及脑脊液实验室检查及临床治疗情况和最终结局。结果25例确诊的流行性乙型脑炎患者,其中男15例,女10例,发病年龄19~83岁,平均(45.8±19.6)岁,主要临床表现为发热25例(100%),平均体温(39.1±1.2)℃,头痛21例(84%),意识障碍16例(64%),抽搐15例(60%),呼吸困难19例(76%);GCS评分介于5~15分,APACHEⅡ评分介于5~29分。实验室检查血液白细胞升高23例(92%),中性粒细胞升高18例(72%),淋巴细胞下降18例(72%),脑脊液压力升高6例(24%),脑脊液白细胞升高22例(88%),脑脊液蛋白升高20例(80%),发病3个月随访病死4例(16%),13例患者遗留认知功能障碍和运动功能障碍。结论成人流行性乙型脑炎患者病情重,主要临床表现为发热、头痛、意识障碍、抽搐及呼吸困难,血常规多表现为白细胞升高,中性粒细胞升高,淋巴细胞下降,脑脊液表现白细胞、蛋白升高常见,病死率高,部分病例可留有严重后遗症。

Objective To analyze the clinical characteristics of 25 cases of epidemic encephalitis B in adults to improve the clinical understanding and diagnosis of the disease.Methods Retrospective analysis was performed on the clinical characteristics,blood and cerebrospinal fluid(CSF)laboratory tests,as well as clinical treatment and final outcome of 25 patients diagnosed with epidemic encephalitis B admitted and treated in our hospital from July to September 2017.Results There were 25 patients diagnosed with epidemic encephalitis B,including 15 males and 10 females,with an onset age of 19 to 83 years old and an average age of(45.8±19.6)years old;the main clinical manifestations were fever in 25 cases(100%),average body temperature of(39.1±1.2)℃and headache in 21 cases(84%),disturbance in consciousness in 16 cases(64%),convulsion in 15 cases(60%),and dyspnea in 19 cases(76%);the GCS score ranged from 5 to 15 points,and the APACHEⅡscore ranged from 5 to 29 points.After laboratory examination,there were 23 cases(92%)of elevated white blood cells in blood,18 cases(72%)of elevated neutrophils,18 cases(72%)of decreased lymphocytes,6 cases(24%)of elevated CSF pressure,22 cases(88%)of elevated CSF white blood cells,20 cases(80%)of elevated CSF protein,and 4 cases(16%)of death during follow-up after 3 months of onset;13 patients had residual cognitive dysfunction and motor dysfunction.Conclusion The condition of adult patients with epidemic encephalitis B is serious.The main clinical manifestations are fever,headache,disturbance of consciousness,convulsion,and dyspnea;the blood routine manifestations are mostly elevated white blood cells,elevated neutrophils,and decreased lymphocytes;the common CSF manifestations are elevated white blood cells and proteins;the fatality rate is high;and some cases may leave serious sequelae.