伴有痫性发作的病毒性脑炎与自身免疫性脑炎的临床特征比较

Viral encephalitis versus autoimmune encephalitis in clinical features of patients with epileptic seizure

  • 摘要:
      目的  比较伴有痫性发作的病毒性脑炎(VE)与自身免疫性脑炎(AE)患者的临床特征。
      方法  收集南京医科大学附属脑科医院住院诊断为VE或AE且在病程急性期有痫性发作的患者的临床资料,电话随访出院1年内癫痫再发情况。比较2组患者的临床资料及预后情况。
      结果  共纳入VE和AE患者各36例,2组患者在起病形式、感染前驱症状、意识障碍、出院后癫痫再发、血白细胞计数、MRI病灶范围、脑电图重度异常等方面的差异有统计学意义(P < 0.05)。AE组患者癫痫复发率高于VE组,差异有统计学意义(P < 0.05)。二元Logistic回归分析发现,起病形式、感染前驱症状和血白细胞计数是VE组和AE组临床特征中有统计学差异的因素(P < 0.05)。
      结论  伴有痫性发作的VE和AE患者在部分临床特征和辅助检查结果方面有显著差异,可为临床上两种脑炎的鉴别诊断及疾病后期癫痫的预防治疗提供一定参考。

     

    Abstract:
      Objective  To compare the clinical features of viral encephalitis (VE) and autoimmune encephalitis (AE) in patients with epileptic seizure.
      Methods  Clinical materials of hospitalized patients diagnosed as VE or AE in the acute epileptic seizure period in Brain Hospital Affiliated to Nanjing Medical University were selected, and all the patients were followed up by telephone for recurrent epilepsy condition within 1 year after discharge. The clinical data and prognosis were compared between two groups.
      Results  A total of 36 VE and 36 AE patients were included in the study, and there were significant differences in the onset form, antecedent infectious symptoms, disturbance of consciousness, recurrent epilepsy after discharge, leukocyte count in peripheral blood, range of lesions by MRI and severe abnormal electroencephalogram between the two groups (P < 0.05). The incidence of relapse of epilepsy in the AE group was significantly higher than that in the VE group (P < 0.05). Binary Logistic regression analysis showed that onset form, antecedent infectious symptoms and leukocyte count in peripheral blood were factors with statistical difference in clinical characteristics between the VE group and the AE group (P < 0.05).
      Conclusion  There are significant differences between VE and AE in some clinical features and auxiliary inspections in patients with epileptic seizure, which can provide reference for the differential diagnosis of the two kinds of encephalitis in clinical practice, and for the prevention and treatment of epilepsy in advanced stage of disease.

     

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