摘要：

目的: 分析单纯疱疹病毒1型（HSV-1）脑炎的临床特点及预后影响因素。方法: 纳入2018年1月至2023年9月河南省人民医院诊断与治疗的51例HSV-1脑炎患者，记录其临床资料、实验室和影像学检查结果。采用改良Rankin量表（mRS）评估患者预后及脑损伤后神经功能恢复情况，单因素和多因素逐步法Logistic回归分析筛查HSV-1脑炎预后不良的危险因素。结果: 共51例患者主要症状为发热、头痛；血清学检查可见血常规白细胞计数增加（14例），中性粒细胞计数增加（14例），淋巴细胞计数减少（8例），血清钠水平降低（17例）；腰椎穿刺脑脊液压力升高（18例），白细胞计数增加（28例），蛋白定量升高（32例），葡萄糖水平升高（15例）；有48例患者进行头部MRI检查，43例（89.58%）MRI显示有明显的脑区受累，其中35例（72.92%）MRI阳性病例均表现为典型的HSV-1脑炎单侧或双侧颞叶、额叶受累，软脑膜强化影增多8例（16.67%）。出院后6个月内有66.67%（34/51）患者完全康复，21.57%（11/51）遗留后遗症，病死率为11.76%（6/51）；34例（66.67%）患者预后良好，17例（33.33%）患者预后不良。多因素Logistic回归分析显示，年龄增大（OR=1.090，95% CI：1.020~1.200；P=0.023）和脑脊液葡萄糖水平升高（OR=23.800，95% CI：23.800~1250.000；P=0.030）是HSV-1脑炎患者预后不良的危险因素。结论: 年龄增大和脑脊液葡萄糖水平升高是HSV-1脑炎患者预后不良的危险因素。临床实践中须掌握HSV-1脑炎的临床特点，做到早发现、早诊断、早治疗。

关键词: 脑炎，单纯疱疹, 预后, 危险因素, Logistic模型

Abstract:

Objective: To analyze the clinical features and prognostic factors of herpes simplex virus type 1 (HSV-1) encephalitis. Methods: A total of 51 patients with HSV-1 encephalitis hospitalized in He'nan Provincial People's Hospital from January 2018 to September 2023 were selected, and their clinical data, laboratory and imaging examination results were recorded. The modified Rankin Scale (mRS) was used to evaluate the prognosis of patients and the recovery of neurological function after brain injury. Univariate and multivariate stepwise Logistic regression analyses were screened for risk factors of adverse prognosis of HSV-1 encephalitis. Results: The main symptoms of 51 cases were fever and headache. The serological examination results showed increased white blood cell count (14 cases), increased neutrophil count (14 cases), decreased lymphocyte count (8 cases), and decreased serum sodium level (17 cases). Cerebrospinal fluid (CSF) examination by lumbar puncture showed increased CSF pressure (18 cases), increased white blood cell count (28 cases), increased protein (32 cases), and increased glucose (15 cases). There were 48 patients who underwent head MRI examination, and 43 patients (89.58%) showed obvious brain region involvement on head MRI, among which 35 patients (72.92%) with positive MRI showed typical unilateral or bilateral temporal and frontal lobe involvement, and 8 cases (16.67%) with increased cerebral pia mater enhancement. 66.67% (34/51) of the patients recovered completely within 6 months after discharge, 21.57% (11/51) of the patients had sequelae, and the fatality rate was 11.76% (6/51). There were 34 (66.67%) patients with good prognosis and 17 (33.33%) patients with adverse prognosis. Multivariate Logistic regression analysis showed age increased (OR = 1.090, 95%CI: 1.020-1.200; P = 0.023) and increased CSF glucose level (OR = 23.800, 95%CI: 23.800-1250.000; P = 0.030) were risk factors for adverse prognosis in HSV-1 encephalitis patients. Conclusions: Increased aging and CSF glucose level are risk factors for the adverse prognosis in HSV-1 encephalitis patients. In clinical practice, it is necessary to master the clinical characteristics of patients with HSV-1 encephalitis, so as to achieve early detection, diagnosis and treatment.

Key words: Encephalitis, herpes simplex, Prognosis, Risk factors, Logistic models