水痘-带状疱疹病毒合并神经系统感染13例临床分析并文献复习

Clinical analysis of 13 cases of varicella-zoster virus with nervous system infection and literature review

目的总结水痘-带状疱疹病毒(varicella-zoster virus,VZV)合并神经系统感染患者的临床表现、治疗及预后。方法回顾性分析2000-2019年在首都医科大学附属北京同仁医院神经内科住院的13例神经系统VZV感染患者的临床资料,总结其实验室检查和影像学特征。结果13例患者中,男7例,女6例;年龄30~73岁;9例分别合并糖尿病、高血压、淋巴瘤、皮肌炎及系统性红斑狼疮等基础疾病;第Ⅱ对脑神经受累4例(30.8%),第Ⅲ对受累6例(46.2%),第Ⅳ对受累1例(7.7%),第Ⅴ对受累4例(30.8%),第Ⅵ对受累2例(15.4%),第Ⅶ对受累3例(23.1%),第Ⅷ对受累2例(15.4%),脊神经受累3例(23.1%),表现为拉姆齐-亨特综合征(Ramsay-Hunt syndrome)2例(15.4%)。ESR增高11例(84.6%);6例(46.2%)行腰椎穿刺,颅压均正常,脑脊液白细胞均增高,以单核细胞为主,总蛋白均升高;5例脑脊液IgG合成率升高;8例(61.5%)眼眶或头颅MRI异常;2例(15.4%)行脑脊液二代测序检出VZV。所有患者均予以阿昔洛韦和甲泼尼龙治疗,神经痛略好转,但其他神经系统损害如眼球运动、视功能、面瘫及肢体无力等症状恢复不理想。结论VZV具有嗜神经性,感染后可潜伏于脑神经及脊神经后根神经节内,随着年龄增长或抵抗力下降,病毒可再次激活并导致神经系统损害,虽经积极抗病毒及糖皮质激素治疗,预后多不佳。

Objective To summarize the clinical manifestations,treatment and prognosis of varicella-zoster virus(VZV)with nervous system infection.Methods Clinical data of patients with VZV infection who were hospitalized in the department of neurology,Beijing Tongren Hospital,Capital Medical University,from 2002 to 2019 were retrospectively analyzed,and the laboratory examination and imaging characteristics were summarized.Results A total of 13 patients were enrolled,including seven males and six females,aged 30 to 73 years old.Nine cases had basic diseases such as diabetes,hypertension,lymphoma dermatomyositis and systemic lupus erythematosus.There were four patients(30.8%)involved in theⅦcranial nerve,six patients(46.2%)involved in theⅦcranial nerve,one patient(7.7%)involved in theⅦcranial nerve,four patients(30.8%)involved in theⅦcranial nerve,two patients(15.4%)involved in theⅦcranial nerve,three patients(23.1%)involved in theⅦcranial nerve,two patients(15.4%)involved in theⅦcranial nerve,three patients(23.1%)involved in spinal nerve,and Ramsay-hunt syndrome was found in two patients(15.4%).ESR increased in 11 cases(84.6%).Lumbar puncture was performed in six patients(46.2%)with normal intracranial pressure,increased WBC in cerebrospinal fluid(CSF),mainly monocytes,and increased total protein in CSF.The synthesis rate of IgG in CSF was increased in five cases.Eight cases(61.5%)had orbital or cranial MRI abnormalities.The second-generation sequencing detection of VZV in CSF was performed in two cases.All patients were treated with acyclovir and methylprednisolone,neuralgia improved slightly,but other neurological damage such as eye movement,visual function,facial paralysis and limb weakness and other symptoms did not recover well.Conclusions VZV is neurotropic,after infection can be latent in the cerebral nerve and spinal nerve root ganglion.As age increasing or resistance decline,the virus can be reactivated and lead to nervous system damage.Although active antiviral and glucocorticoid therapy,the prognosis is not good.