技术状态:急性脑炎
Karen C Bloch1, Carol Glaser2, David Gaston3
1Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
概括
脑炎的治疗包括对病毒和自身免疫原因进行检测,用经验性阿西克洛维尔对简单疹病毒 (HSV) 进行检测. 像下一代测序 (NGS) 这样的先进诊断技术可以改善具有挑战性的病例的结果.
科学领域:
- 神经学 神经学
- 传染性疾病 传染性疾病
- 免疫学 免疫学 免疫学
背景情况:
- 脑炎是一种严重的神经疾病,经常导致长期的缺陷.
- 及时诊断和管理对于改善患者的治疗结果至关重要.
- 确定脑炎的具体原因对于有针对性的治疗至关重要.
研究的目的:
- 概述成人脑炎的诊断和管理的最佳实践.
- 突出早期经验性治疗和全面的病因学工作的重要性.
- 强调先进诊断和未来研究方向的作用.
主要方法:
- 核心病因包括简单疹病毒 (HSV) -1,疹子病毒 (VZV),肠道病毒,西尼罗河病毒和抗N-甲基-D-酸盐受体 (anti-NMDAR) 抗体脑炎的普遍测试.
- 经验性阿西克洛维尔治疗在呈现时开始,根据HSV-1聚合酶链反应 (PCR) 结果可能继续.
- 先进的分子测试,如下一代测序 (NGS) 和考虑大脑活检无法解释的情况下.
- 隐藏恶性瘤的成像和自身免疫性脑炎的经验免疫调节治疗.
主要成果:
- 经验性阿西克洛维尔推用于疑似单纯疹病毒 (HSV) 脑炎.
- 对于疹病毒 (VZV) 脑炎,可能需要调整阿西克洛维尔的剂量.
- 支持性护理对于其他病毒原因至关重要.
- 像NGS和脑活检这样的先进诊断技术有助于诊断具有挑战性的,无法解释的脑炎病例.
- 改进的诊断能力提高了患者的治疗结果.
结论:
- 早期的,有针对性的管理策略显著影响脑炎患者的结果.
- 像NGS这样的先进分子诊断的整合正在改变自身免疫性脑炎的诊断.
- 对新型治疗药物的进一步研究是推动脑炎治疗的关键优先事项.
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