Hjalmarsson Anders, Blomqvist Paul, Sköldenberg Birgit
Infectious Diseases Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Clin Infect Dis. 2007 Oct 1;45(7):875-80. doi: 10.1086/521262. Epub 2007 Aug 24.
Herpes simplex encephalitis (HSE) is a devastating disease.
In Sweden, a nationwide retrospective study of the incidence, morbidity, and mortality associated with HSE during the 12-year period 1990-2001 was conducted. The national inpatient register data were used, and diagnostic data from the virus laboratories were validated.
In the study period, 638 patients hospitalized in Sweden received a primary diagnosis of HSE. Of these, 236 patients had a confirmed infection of the central nervous system due to herpes simplex virus type 1. This corresponds to an incidence of confirmed HSE due to herpes simplex virus type 1 of 2.2 cases per million population per year. Of the survivors, 87% were readmitted to the hospital. The most frequent diagnosis at readmission was epilepsy, which was found in 49 patients (21% of the 236 total patients; 24% of 203 survivors), with a median onset 9.3 months after the diagnosis of HSE. This corresponds to a 60- to 90-fold increase in risk, compared with that for the general population. Neuropsychiatric sequelae were evident in 45 (22%) of 203 surviving patients. The incidence of venous thromboembolism, including pulmonary embolism, was 5-14 times higher than that in the general population. Among patients with HSE due to herpes simplex virus type 1, the 1-year mortality was 14% (33 of 236 patients died), which was 8 times higher than expected.
This is, to our knowledge, the first study to report long-term, nationwide follow-up data for patients with virologically confirmed HSE. There is considerable morbidity after HSE, with epilepsy being the most common diagnosis. This demonstrates the need for expanding our knowledge of the pathogenesis of HSE to direct more effective antiviral and antiinflammatory treatments.
单纯疱疹病毒性脑炎（HSE）是一种极具破坏性的疾病。
在瑞典，开展了一项针对1990年至2001年这12年间与HSE相关的发病率、发病率和死亡率的全国性回顾性研究。使用了全国住院患者登记数据，并对病毒实验室的诊断数据进行了验证。
在研究期间，瑞典有638名住院患者被初步诊断为HSE。其中，236名患者确诊因1型单纯疱疹病毒感染中枢神经系统。这相当于每年每百万人口中确诊的1型单纯疱疹病毒所致HSE的发病率为2.2例。在幸存者中，87%再次入院。再次入院时最常见的诊断是癫痫，49例患者（占236例总患者的21%；占203例幸存者的24%）出现癫痫，癫痫发作的中位时间为HSE诊断后9.3个月。与普通人群相比，这相当于风险增加了60至90倍。203例存活患者中有45例（22%）出现神经精神后遗症。静脉血栓栓塞（包括肺栓塞）的发病率比普通人群高5至14倍。在1型单纯疱疹病毒所致HSE患者中，1年死亡率为14%（236例患者中有33例死亡），比预期高8倍。
据我们所知，这是第一项报告病毒学确诊的HSE患者长期全国性随访数据的研究。HSE后存在相当高的发病率，癫痫是最常见的诊断。这表明需要扩大我们对HSE发病机制的认识，以指导更有效的抗病毒和抗炎治疗。
