在脑炎中缺乏脑脊液细胞形成
Ralph Habis1, Anna Kolchinski1, Ashley N Heck2
1Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University, School of Medicine, Maryland, USA.
概括
脑脊液缺失 (CSF) 细胞发生在25.3%的脑炎患者中,包括一些患有HSV-1脑炎的患者. 早期的阿西克洛维尔治疗对于疑似脑炎病例至关重要,即使没有CSF细胞,也是如此.
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:
- 早期脑炎的诊断依赖于神经炎症标志物,如CSF细胞瘤.
- 在一些脑炎病例中,尤其是自身免疫类型中,注意到脑液多细胞化不存在.
- 这项研究调查了与脑膜炎中CSF多细胞形成相关的临床特征和结果.
研究的目的:
- 为了比较脑炎患者的临床特征和结果,有和没有CSF多细胞化.
- 为及时诊断和脑炎的管理策略提供信息.
- 评估CSF多细胞瘤对治疗和患者结果的影响.
主要方法:
- 在597名患有任何原因脑炎的成年患者中,对最初的CSF概况进行了回顾性分析.
- 患有和没有CSF白细胞多细胞化 (≥5细胞/μL) 的患者组的比较.
主要成果:
- 25.3%的患者缺乏CSF多细胞化;这些病例的感染性和自身免疫性脑炎的比例相似.
- 细胞缺失与减少阿西克洛维尔 (47.7%vs. 71.1%) 的使用有关.
- 细胞瘤与初始临床严重程度相关 (FOUR评分≤14) 但不相关死亡率或住院时间.
结论:
- 脑液多细胞化是一个关键的诊断标准,但其缺失发生在所有脑炎的25.3%和HSV-1脑炎病例的23.7%.
- 在怀疑脑炎时,由于缺少细胞瘤,不应停止治疗阿西克洛维尔.
- 及时诊断和管理至关重要,无论CSF的发现如何.
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