Hoyer C, Eisele P, Ebert A D, Schneider S, Gass A, Fatar M, Szabo K, Alonso A
Department of Neurology, Medizinische Fakultät Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135 Mannheim, Germany.
Institute for Clinical Chemistry, Medizinische Fakultät Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135 Mannheim, Germany.
J Clin Virol. 2016 Nov;84:82-86. doi: 10.1016/j.jcv.2016.10.006. Epub 2016 Oct 6.
The term "aseptic meningitis" encompasses cases of meningitis with negative bacterial CSF culture, which predominantly are of viral etiology. While the clinical course is usually benign, complications such as encephalitic involvement resulting in a more severe clinical course may occur. Dysfunction of the blood-brain-barrier (BBB), which is a prerequisite for viral entry into the brain parenchyma, can be approximated using the CSF/serum albumin ratio, readily obtainable in routine CSF analysis.
Analysis of CSF patterns in patients with aseptic meningitis/meningoencephalitis with a focus on BBB dysfunction as a marker for encephalitic involvement.
Retrospective chart review of patients admitted to our hospital between 2004 and 2016 with a diagnosis of aseptic meningitis/meningoencephalitis.
Patients with aseptic meningitis displaying clinical, MR-tomographic or electroencephalographic signs of encephalitic involvement were significantly older than patients without these features (47.4 vs. 35.5 yrs., p=0.002). In patients with meningoencephalitis, CSF analysis revealed a more severe disruption of BBB, approximated by the CSF/serum albumin ratio (p=0.002). Compromised BBB function correlated positively with length of hospitalization (p=0.007), indicative of a more severe clinical course. The number of CSF lymphocytes was found to predict the severity of the BBB disruption, which additionally was more frequently observed when herpesviridae were identified as infectious agents.
We suggest that the CSF/serum albumin ratio as an estimate for BBB function should be attended to in the evaluation of patients with aseptic meningitis. Severe BBB dysfunction, older age and infection with herpesviridae appear to raise the risk for encephalitic involvement.
“无菌性脑膜炎”一词涵盖脑脊液细菌培养阴性的脑膜炎病例，其病因主要为病毒感染。虽然临床病程通常为良性，但可能会出现诸如脑实质受累导致更严重临床病程的并发症。血脑屏障（BBB）功能障碍是病毒进入脑实质的前提条件，可通过脑脊液/血清白蛋白比值进行评估，该比值在常规脑脊液分析中很容易获得。
分析无菌性脑膜炎/脑膜脑炎患者的脑脊液特征，重点关注血脑屏障功能障碍作为脑实质受累的标志物。
对2004年至2016年期间我院收治的诊断为无菌性脑膜炎/脑膜脑炎的患者进行回顾性病历审查。
出现脑实质受累临床、磁共振断层扫描或脑电图体征的无菌性脑膜炎患者明显比未出现这些特征的患者年龄大（47.4岁对35.5岁，p = 0.002）。在脑膜脑炎患者中，脑脊液分析显示血脑屏障破坏更严重，通过脑脊液/血清白蛋白比值评估（p = 0.002）。血脑屏障功能受损与住院时间呈正相关（p = 0.007），表明临床病程更严重。发现脑脊液淋巴细胞数量可预测血脑屏障破坏的严重程度，当鉴定为疱疹病毒科感染时，血脑屏障破坏更常见。
我们建议在评估无菌性脑膜炎患者时应关注脑脊液/血清白蛋白比值以评估血脑屏障功能。严重的血脑屏障功能障碍、高龄和疱疹病毒科感染似乎会增加脑实质受累的风险。
