Development of a High-throughput Sequencing Platform for Detection of Viral Encephalitis Pathogens Based on Amplicon Sequencing

Objective Viral encephalitis is an infectious disease severely affecting human health.It is caused by a wide variety of viral pathogens,including herpes viruses,flaviviruses,enteroviruses,and other viruses.The laboratory diagnosis of viral encephalitis is a worldwide challenge.Recently,high-throughput sequencing technology has provided new tools for diagnosing central nervous system infections.Thus,In this study,we established a multipathogen detection platform for viral encephalitis based on amplicon sequencing.Methods We designed nine pairs of specific polymerase chain reaction(PCR)primers for the 12 viruses by reviewing the relevant literature.The detection ability of the primers was verified by software simulation and the detection of known positive samples.Amplicon sequencing was used to validate the samples,and consistency was compared with Sanger sequencing.Results The results showed that the target sequences of various pathogens were obtained at a coverage depth level greater than 20×,and the sequence lengths were consistent with the sizes of the predicted amplicons.The sequences were verified using the National Center for Biotechnology Information BLAST,and all results were consistent with the results of Sanger sequencing.Conclusion Amplicon-based high-throughput sequencing technology is feasible as a supplementary method for the pathogenic detection of viral encephalitis.It is also a useful tool for the high-volume screening of clinical samples.

Analysis of the Effectiveness of Targeted Nursing in Children with Severe Viral Encephalitis Complicated with Respiratory Failure

Objective:To explore and analyze the effectiveness of targeted nursing in children with severe viral encephalitis complicated with respiratory failure.Methods:From April 2021 to April 2023,74 children with severe viral encephalitis complicated with respiratory failure admitted to the Department of Pediatrics of our hospital were selected as the research objects and divided into the target group(n=37)and the reference group(n=37).Targeted nursing was given to the target group,while general nursing was given to the reference group.Physical rehabilitation,motor scores,and lung function were compared between the groups.Results:The recovery time of limb abnormalities,convulsions,abnormal consciousness,and cranial nerve disorders in the target group was significantly better than that in the reference group(P<0.05).The motor function,joint activity and pain,sensory function,and total score of the target group were significantly lower than those of the reference group(P<0.05).After the intervention,lung function indicators including VC(vital capacity),FVC(forced vital capacity),and MVV(maximum voluntary ventilation)of the target group were better than those of the reference group(P<0.05).Conclusion:Targeted nursing can shorten the recovery period of severe viral encephalitis complicated with respiratory failure in children,speed up the recovery of motor function,and improve lung function.This nursing model has a significant application effect in children with severe viral encephalitis complicated with respiratory failure.

The Diagnostic Value of Oligoclonal Band Detection in Viral Encephalitis

Objective: This study aims to explore the differences in cerebrospinal fluid oligoclonal band (CSF-OCB) expression among different age groups in viral encephalitis and its reference value for diagnosis. Methods: Forty-two patients with viral encephalitis were divided into two groups: 25 adults and 17 children. The presence of oligoclonal bands in the cerebrospinal fluid (CSF) was detected using polyacrylamide gel electrophoresis, and CSF routine analysis was conducted for comparative analysis. Results: The CSF-OCB positivity rate was higher in the adult group (48%) compared with the pediatric group (11.76%), with a statistically significant difference (P Conclusion: 1) The expression of CSF-OCB positivity in patients with viral encephalitis is age-related, with higher positivity rates observed in adults compared to children. 2) Although CSF oligoclonal band detection is not a specific diagnostic marker for viral encephalitis in adults, it still holds certain reference value.

Advances in viral encephalitis:Viral transmission,host immunity,and experimental animal models

Viral infections have led to many public health crises and pandemics in the last few centuries.Neurotropic virus infection-induced viral encephalitis(VE),especially the symptomatic inflammation of the meninges and brain parenchyma,has attracted growing attention due to its high mortality and disability rates.Understanding the infectious routes of neurotropic viruses and the mechanism underlying the host immune response is critical to reduce viral spread and improve antiviral therapy outcomes.In this review,we summarize the common categories of neurotropic viruses,viral transmission routes in the body,host immune responses,and experimental animal models used for VE study to gain a deeper understanding of recent progress in the pathogenic and immunological mechanisms under neurotropic viral infection.This review should provide valuable resources and perspectives on how to cope with pandemic infections.

Alterative application of five anticonvulsants according to the half life for the treatment of status epilepticus in children with severe viral encephalitis

BACKGROUND： Traditional subhibernation therapy may easily cause complications, such as respiratory depression and hyportension because of application of chlorpromazine hydrochloride and promethazine in a large dosage. OBJECTIVE： To observe therapeutic effect of modified subhibernation therapy （alterative application of five anticonvulsants according to the half life） on status epilepticus in children with severe viral encephalitis （VE）. DESIGN： Contrast observation. SETTING： Department of Pediatrics, the First Hospital of Jilin University. PARTICIPANTS： The participants in present study were 96 patients with severe viral encephalitis including 52 boys and 44 girls who received treatment in the Department of Pediatrics, the First Hospital of Jilin University from February 2000 to March 2006. All children met the diagnostic criteria of Zhufutong Practice Pediatrics （the seventh edition）. Two weeks ago, they ever got upper respiratory infection or enteronitis and so on before the onset, spirit abnormal, behavior disorder, limbs act disorder, vomit, headache, convulsion, nervous system masculine signs such as limbs act disord, autonomic nerve damage manifestation, brain nerve palsy, dysreflexia, meningeal irritation sign, cerebrospinal fluid and electroencephalography （EEG） abnormity. All parents provided the confirmed consent. The patients were randomly divided into control group （n =40） and experimental group （n =56）. METHODS： Patients in the control group received anticonvulsion, ice compress and routine treatment. The convulsion was treated with five drugs： 0.5 mg/kg wintermin and phenergan, respectively, 100 g/L chlorpromazine hydrochloride （0.5 mL/kg）, 5 mg/kg luminal, 0.3 mg/kg ansiolin. When convulsion attacked, those five drugs were given alternatively; however, those were not given if the convulsion did not attack. Children in the experimental group were treated with improved subhibernation therapy based on routine treatment. The dosages of anticonvulsants were as the same as those in the control group. Based on the half life, every drug was alternated every 4-6 hours. In addition, anticonvulsants administrated for 2 successive days whether tic attacked or not. Then the hypnotic was removed gradually. MAIN OUTCOME MEASURES： Therapeutic efficacy, time of disappeared clinical symptoms and physical sign, and security of administration. RESULTS： All the 96 patients were involved in the final analysis. ① Total effective rate and reliability： Total effective rate was higher in the treatment groups than the control group （χ2=5.871 7, P 〈 0.05）. All patients did not have respiratory depression and side effects. ② Time of disappeared clinical symptoms and physical sign： Recovery time of convulsion, fever, headache and vomit was shorter in the treatment group than that in the control group, and there was significant difference （t =17.612 1-34.330 7, P 〈 0.05）; in addition, symptoms of status epilepticus were relieved obviously. Meanwhile, recovery time of paralysis, coma and anepia was shorter in the treatment group than that in the control group, and there was significant difference （t =10.660 8-24.700 8, P 〈 0.05）. CONCLUSION： Therapeutic effect of improved subhibernation therapy on status epilepticus induced by severe viral encephalitis is positively and safer.

Serum VCAM-1 content in children with viral encephalitis and its correlation with nerve injury and inflammatory response

Objective: To investigate the serum VCAM-1 content in children with viral encephalitis and its correlation with nerve injury and inflammatory response. Methods: A total of 60 children with viral encephalitis who were treated in Xianyang First People's Hospital between December 2015 and January 2017 were selected as viral encephalitis group, and 50 healthy children who accepted vaccination in the hospital during the same period were selected as normal control group. The differences in serum levels of VCAM-1, nerve injury-related indexes and inflammatory factors were compared between two groups of children, and Pearson test was used to further evaluate the correlation of serum VCAM-1 content with nerve injury and inflammatory response in children with viral encephalitis. Results: Immediately after admission, serum VCAM-1 content of children with viral encephalitis was significantly higher than that of normal control group;serum nerve injury-related indexes CK-BB, MBP, β-EP and NSE contents were higher than those of normal control group;serum inflammatory factors IL-6, IL-18 and γ-IFN contents were higher than those of control group. Pearson test showed that serum VCAM-1 content in children with viral encephalitis was positively correlated with nerve injury and inflammatory response. Conclusion: Serum VCAM-1 content is high in children with viral encephalitis, and the specific content is directly correlated with the severity of nerve injury and inflammatory response.

Correlation between SP-D content in cerebrospinal fluid and severity of viral encephalitis

Objective:To detect the content of SP-D in cerebrospinal fluid(CSF) of children with viral encephalitis, evaluate the correlation between SP-D and indexes of brain injury, inflammatory reaction and cellular immune disorder.Methods: 78 cases of viral encephalitis children diagnosed in our hospital during December 2016 to May 2018 were selected as Viral encephalitis group, 51 cases of fever without intracranial infection children were selected as Control group. The cerebrospinal fluid samples of two groups were taken and SP-D, brain injury-related indicators, inflammatory indicators and T lymphocyte subsets were detected. Pearson test was used to analyze the relationship between SP-D content in CSF and above indicators.Results: Content of SP-D in CSF of Viral encephalitis group was lower than that of control group (P<0.05). Contents of MBP, CK-BB, NSE and S100B in CSF of Viral encephalitis group were higher than those of Control group;contents of IL-1β, TNF-αand ICAM-1 in CSF of Viral encephalitis group were higher than those of Control group;distribution proportion of CD3+, CD4+ T lymphocytes and CD4+/CD8+ ratio in CSF were lower than those of Control group, and levels of CD8+ were higher than that of Control group (P<0.05). Correlation analysis showed that, SP-D content in CSF of viral encephalitis children was directly related to brain injury indexes, inflammatory indexes and T lymphocyte subsets distribution levels(P<0.05).Conclusion: Content of SP-D in CSF of viral encephalitis children decreases abnormally, the specific content is directly related to the degree of brain injury, intracranial inflammation and cellular immune dysfunction. It is important to evaluate the severity of the disease.

Detection and significance of EEG, neurological function, immune function and related factor levels in children with viral encephalitis

Objective:To analyze the changes of EEG,neurological function,immune function and inflammatory factors in children with viral encephalitis and their clinical significance.Methods:60 children with viral encephalitis in our hospital were collected as observation group and 60 healthy children were collected as control group during the same period.The electroencephalogram(EEG)of the children in the observation group was observed,and the serum levels of S100B protein(S100B),neuron specific enolase(NSE),myelin basic protein(MBP),immunoglobulin G(IgG),immunoglobulin M(IgM),hypersensitive C-reactive protein(hs-CRP)and cystatin C(Cyst C)were detected and compared between the two groups.Results:The electroencephalogram results of the observation group showed that 55 cases were abnormal,the positive rate was 91.67%.Among them,30 cases were mild abnormal,19 cases were moderate abnormal and 6 cases were severe abnormal.The serum levels of S100B,NSE and MBP of patients in the observation group were(231.26±25.74)ng/L,(18.92±2.03)ug/L,(1.44±16.23)ug/L,which were significantly higher than the control group(P<0.05);The serum levels of IgG and IgM were(7.45±0.76)g/L,(0.83±0.09)g/L respectively,which were significantly lower than those in the control group(P<0.05).The serum levels of hs-CRP and Cyst C of patients in the observation group were(4.59±0.51)mg/L,(14.38±0.09)mg/L,respectively,which were higher than those of the control group(P<0.05).Conclusion:The positive rate of EEG diagnosis was high.The changes of neurological function,immune function factors,hs-CRP and Cyst C levels may become important reference indicators for auxiliary diagnosis and early treatment of children with viral encephalitis.Neurological function,immune function factors,hs-CRP and Cyst C are all related to the progression of viral encephalitis.The above indicators can be used as important indicators for assistant diagnosis and early treatment of viral encephalitis in children.

Inhibitory effects of Shuanghuanglian injection on nuclear factor-kappa B expression in mice with viral encephalitis in a time-and dose-dependent manner

Previous studies have confirmed that the anti-virus effects of Shuanghuanglian injection may be associated with nuclear factor-kappa B activity. This study observed nuclear factor-kappa B expression in mice with viral encephalitis, and showed significant decreases in nuclear factor-kappa B protein and mRNA levels following Shuanghuanglian injection. The inhibitory effect was more significant with prolonged intervention duration and increased treatment dose. These findings verify that Shuanghuanglian injection plays a therapeutic role in viral encephalitis by reducing expression of nuclear factor-kappa B in a time- and dose-dependent manner.

Shuanghuanglian injection downregulates nuclear factor-kappa B expression in mice with viral encephalitis

A mouse model of viral encephalitis was induced by intracranial injection of a Coxsackie virus B3 suspension. Quantitative real-time reverse transcription-PCR and western blot assay were applied to detect mRNA and protein expression of intelectin-2 and nuclear factor-kappa B in the viral encephalitis and control groups. Nuclear factor-kappa B and intelectin-2 mRNA and protein expression were significantly increased in mice with viral encephalitis. After intraperitoneal injection of Shuanghuanglian at a dose of 1.5 mg/kg for 5 successive days, intelectin-2 and nuclear factor-kappa B protein and mRNA expression were significantly decreased. To elucidate the relationship between intelectin-2 and nuclear factor-kappa B, mice with viral encephalitis were administered an intracerebral injection of 107 pfu recombinant lentivirus expressing intelectin shRNA. Both protein and mRNA levels of intelectin and nuclear factor-kappa B in brain tissue of mice were significantly decreased. Experimental findings suggest that Shuanghuanglian injection may downregulate nuclear factor-kappa B production via suppression of intelectin production, thus inhibiting inflammation associated with viral encephalitis.

Human Herpesvirus 6 Infection Complicated by Viral Encephalitis Following Liver Transplantation:A Case Report

Human herpesvirus 6(HHV-6)is a significant pathogen following solid organ transplantation.Here,we report a 64-year-old female with cirrhosis related to nonalcoholic fatty liver disease who underwent orthotopic allogeneic liver transplantation and was ultimately diagnosed with HHV-6 encephalitis through cerebrospinal fluid analysis and MRI.Empirical treatment with daily ganciclovir was initiated according to characteristics indicative of viral encephalitis 3 days before confirmed diagnosis.Subsequent improvement in symptoms was observed,with clearance of HHV-6 from the blood.The complex diagnosis and management of this case accentuate the possibility of serious consequences of HHV-6 infection in postoperative liver transplant patients.Clinicians must maintain a high index of suspicion for HHV-6 reactivation,especially given its association with immunosuppressive drug regimens.Prompt recognition and initiation of antiviral therapy are paramount,particularly when patients present with fever or psychiatric symptoms,as these may indicate HHV-6 encephalitis.

Clinical Efficacy and Application Progress of Reduning Injection in Children with Viral Encephalitis

Viral encephalitis in children caused by multiple viral infections,as a common central nervous system disease in pediatrics,has a high incidence in China.Its clinical symptoms usually include infection,poisoning,intracranial hypertension,and disturbance of consciousness.In severe cases,it can even endanger the lives of patient children.At present,the clinical treatment of the viral encephalitis mainly uses traditional Chinese medicine preparations such as Reduning Injection.The efficacy is significant.It can not only relieve the uncomfortable symptoms in a short time,but also has low incidence of adverse reactions.In this study,the factors that cause viral encephalitis in children were analyzed,and the efficacy,pharmacological action and clinical application of Reduning Injection were comprehensively elaborated,to provide a reference for clinical doctors to rationally treat viral encephalitis in children.

APPLIED STUDY ON BA IN SPORADIC VIRAL ENCEPHALITIS

目的:探讨脑电地形图在散发性病毒性脑炎中的应用价值。方法:40例散发性病毒性脑炎患者的脑电地形图被检查了。结果:这40例病人的脑电地形图的改变是明显的。结论:脑电地形图在散发性病毒性脑炎的诊断、治疗和预后中有重要应用价值。

THE STUDY APPLIED ON BA IN PATIENTS WITH SPORADIC VIRAL ENCEPHALITIS

目的:探讨脑电地形图在散发性病毒性脑炎患者中的应用价值。方法:94例散发性病毒性脑炎患者的脑电地形图被检查。结果:94例散发性病毒性脑炎患者的脑电地形图改变是明显的。结论:脑电地形图在散发性病毒性脑炎患者的诊断、治疗和预后中有重要应用价值。

神经肌肉电刺激联合口腔感觉训练对重症病毒性脑炎合并吞咽障碍患儿的康复效果

目的探讨神经肌肉电刺激(NMES)联合口腔感觉训练对重症病毒性脑炎(SVE)合并吞咽障碍患儿的康复效果、吞咽功能、神经功能、营养状况的影响。方法选择河北省儿童医院2021-01—2023-03收治的SVE合并吞咽障碍患儿108例。随机数字表法分为口腔感觉训练组和NMES联合组各54例。2组患者均进行抗病毒、降颅内压、去高热、控制惊厥、保护脑神经等对症支持治疗。口腔感觉训练组给予口腔感觉运动训练,NMES联合组在口腔感觉训练基础上进行NMES康复治疗。比较2组患者康复效果、吞咽功能[吞咽障碍调查量表(DDS)]、神经功能指标[血清脑源性的神经营养因子(BDNF)、神经元特异性的烯醇化酶(NSE)水平]、营养状况[主观的综合性营养评分量表(SGA)]、生活质量[吞咽障碍特异性生存质量量表(SWAL-QOL)]。结果康复治疗4周后,NMES联合组康复总有效率为92.59%,高于口腔感觉训练组的72.22%(P<0.05);NMES联合组口腔期、咽期、食管期DDS评分、SGA评分、SWAL-QOL评分、血清BDNF水平明显高于口腔感觉训练组,血清NSE水平低于口腔感觉训练组(P<0.05)。结论NMES联合口腔感觉训练用于SVE合并吞咽障碍患儿的康复治疗,可有效提升康复效果,进一步改善吞咽功能和神经功能,改善患儿的营养不良状况,提升患儿生活质量。

病毒性脑炎患者预后不良的危险因素分析

目的探讨病毒性脑炎患者预后不良危险因素。方法以医院2019年6月至2022年5月收治的259例病毒性脑炎患者为研究对象,根据预后情况将患者分为预后不良组(79例)和预后良好组(180例)。比较两组一般临床资料[性别、年龄、偏瘫、发热、低钠血症、低钾血症、住院时间、发病至住院时间、脑电图情况、脑膜刺激征、血肌酐(Scr)、血尿素氮(BUN)、谷丙转氨酶(GPT)、谷草转氨酶(GOT)、血清增殖诱导配体(APRIL)、血清B淋巴细胞刺激因子(BlyS)、血清T细胞正常表达和分泌刺激因子(RANTES)、血清纤维胶凝蛋白3(FCN3)、血清陷窝蛋白1(Caveolin-1)、血清基质金属蛋白酶-2(MMP-2)],logistic多因素回归分析病毒性脑炎患者预后不良的危险因素,采用受试者工作特征(ROC)曲线分析血清APRIL、BlyS、RANTES、FCN3、Caveolin-1、MMP-2水平联合检测对病毒性脑炎患者预后不良的预测价值。结果预后不良组血清APRIL、BlyS、RANTES、FCN3、Caveolin-1、MMP-2水平高于预后良好组(P<0.05);logistic回归分析显示,血清APRIL(>7.48μg·L^(-1))、BlyS(>7.14μg·L^(-1))、RANTES(>273.64 ng·L^(-1))、FCN3(>17.02 mg·L^(-1))、Caveolin-1(>15.62μg·L^(-1))、MMP-2(>496.13 ng·L^(-1))水平是病毒性脑炎患者预后不良的危险因素(P<0.05);ROC曲线结果显示,血清APRIL、BlyS、RANTES、FCN3、Caveolin-1、MMP-2水平联合预测病毒性脑炎患者预后不良的曲线下面积为0.804,最佳预测敏感度为92.41%,特异度为68.33%。结论病毒性脑炎患者预后与血清APRIL、BlyS、RANTES、FCN3、Caveolin-1、MMP-2水平存在关联性,上述血清联合应用时可有效预测预后不良发生风险,便于临床早期制定防治措施。

新型冠状病毒相关副感染性脑病三例

研究背景副感染性脑病是一种继发于系统性感染性疾病的急性炎症性脑病,包括急性坏死性脑病和伴胼胝体压部可逆性病变的轻度脑炎/脑病(MERS)等亚型。本文报告内蒙古自治区鄂尔多斯市中心医院2022年12月至2023年2月诊断与治疗的3例新型冠状病毒相关副感染性脑病患者,并复习相关文献,总结疾病临床特征。方法与结果共3例新型冠状病毒相关副感染性脑病患者包括新型冠状病毒相关急性坏死性脑病2例和新型冠状病毒相关MERS 1例,均于发热后2~4 d出现意识障碍,以及失语、精神异常、抽搐发作等;新型冠状病毒咽拭子检测均呈阳性;头部MRI显示1例脑干和双侧丘脑对称性异常信号,1例双侧丘脑对称性异常信号,1例胼胝体压部异常信号;均予以激素冲击治疗和(或)静脉注射免疫球蛋白;1例死亡,2例痊愈。结论新型冠状病毒相关副感染性脑病包括新型冠状病毒相关急性坏死性脑病和MERS等临床亚型,前者进展迅速,病情较严重,病残率和病死率较高,预后较差;后者症状相对较轻微,预后较好。

拉考沙胺联合高压氧治疗病毒性脑炎合并癫痫患者的效果

目的研究拉考沙胺联合高压氧对病毒性脑炎(VE)合并癫痫患者的疗效及对神经功能、免疫功能的影响。方法选取2021年1月至2023年1月郑州大学第一附属医院收治的92例VE合并癫痫患者为研究对象,根据治疗方案将患者分为参照组和试验组,每组46例。参照组接受高压氧治疗,试验组接受拉考沙胺联合高压氧治疗。比较两组临床疗效、临床症状改善时间、治疗前后免疫功能指标(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、血清神经功能指标[神经元特异性烯醇化酶(NSE)、中枢神经特异性蛋白S100β、髓鞘碱性蛋白(MBP)、脑源性神经营养因子(BDNF)]水平、血清白细胞介素(IL-6、IL-1β)、T细胞正常表达和分泌刺激因子(RANTES)、嗜酸性粒细胞趋化因子(Eotaxin)水平。结果试验组临床总有效率(97.83%)高于参照组(82.61%),差异有统计学意义(P<0.05);试验组体温恢复、惊厥消失、脑膜刺激征消失、意识恢复时间均短于参照组,差异有统计学意义(P<0.05);与参照组相比,治疗后试验组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平较高,CD8^(+)水平较低,差异有统计学意义(P<0.05);与参照组相比,治疗后试验组血清NSE、S100β、MBP水平降低,BDNF水平升高,差异有统计学意义(P<0.05);与治疗前相比,两组治疗后血清IL-6、IL-1β、RANTES、Eotaxin水平降低,其中试验组更低,差异有统计学意义(P<0.05)。结论拉考沙胺联合高压氧对VE合并癫痫患者疗效确切,可改善临床症状,减轻炎症反应及神经损伤,提高免疫功能,促进患者病情恢复。

功能磁共振对于病毒性脑炎及颅内结核的诊断价值研究

目的探讨功能磁共振对于病毒性脑炎(VE)及颅内结核(IT)的诊断价值。方法选取我院2021年1月-2022年12月收治的VE患者48例、IT患者41例、亚急性脑梗死患者50例、低级别胶质瘤患者50例纳入研究。所有患者均行常规MRI、三维动脉自旋标记(3D-ASL)、弥散加权成像(DWI)及氢质子MR波谱分析(~1H-MRS)成像扫描。观察比较VE、IT、亚急性脑梗死和低级别胶质瘤四组患者的ADC值、rCBF值和1H-MRS结果。结果IT患者的平均ADC值较正常对照区ADC值升高,而VE患者、亚急性脑梗死和低级别胶质瘤三组的平均ADC值均较正常对照区ADC值减低。IT患者rADC均高于VE患者、亚急性脑梗死患者和低级别胶质瘤患者,以VE患者和亚急性脑梗死患者最为显著(P<0.05)。低级别胶质瘤患者的平均rCBF较正常对照区rCBF升高,而IT患者和亚急性脑梗死患者的平均rCBF均较正常对照区rCBF减低,其中亚急性脑梗死患者降低最明显,而VE患者平均rCBF较正常对照区稍降低。低级别胶质瘤患者rrCBF均高于VE患者.、IT患者和亚急性脑梗死患者,以亚急性脑梗死患者最为显著(P<0.05)。低级别胶质瘤患者的Cho/Cr和Cho/NAA比值明显高于VE患者、IT患者、亚急性脑梗死患者(P<0.05)。VE患者的Cho/Cr和Cho/NAA比值低于IT患者(P<0.05)。结论ADC值、rCBF值、Cho/Cr和Cho/NAA比值对VE和IT的诊断和鉴别诊断能提供重要信息,有助于治疗方案及预后情况的判断。

免疫性血栓性血小板减少性紫癜临床误诊分析

目的分析免疫性血栓性血小板减少性紫癜(iTTP)的临床表现、误诊原因、防范误诊措施。方法回顾性分析2001年1月至2023年12月收治的曾误诊为其他疾病的9例iTTP患者的临床资料。结果9例急性起病,表现为典型“三联征”3例,“三联征”合并发热1例,合并肾功能损害1例,典型“五联征”4例。9例误诊为HELLP综合征、弥散性血管内凝血、Evans综合征、溶血尿毒综合征各1例,病毒性脑炎2例,急性肾功能衰竭3例。9例按初诊疾病治疗效果差而转我院,后根据临床症状、外周血红细胞计数、血涂片找红细胞碎片、乳酸脱氢酶、间接胆红素及骨髓象分析、血管性血友病因子裂解蛋白酶13(ADAMTS13)活性及抑制物检测确诊为iTTP。误诊时间3~7 d。9例确诊后均采用治疗性血浆置换,其中7例联合糖皮质激素治疗、2例联合利妥昔单抗治疗。经治疗死亡1例,8例随访1年,病情稳定,均无复发。结论iTTP发病率低,临床表现多样,极易误诊。加强临床医生对该病的认识、提高警惕性,对于高度可疑病例应尽早行ADAMTS13活性及抗体检测,以提高本病的确诊率。