Wang T H, Chen J, Wang G X, Lin X, Bao L J, Zhao Y M, Gu Y Q, Liu N
Department of Neurology, the First Hospital of Lanzhou University, Lanzhou 730000, China.
The First Department of Neurology, the First People's Hospital of Tianshui City, Tianshui 741000, China.
Zhonghua Yi Xue Za Zhi. 2020 Feb 25;100(7):541-545. doi: 10.3760/cma.j.issn.0376-2491.2020.07.013.
To analyze the improvement of clinical symptoms and recovery of neurological function in adult Japanese encephalitis, and study the prognostic factors. Follow-up was conducted for 112 hospitalized patients with Japanese encephalitis (JE) in adults at the Department of Neurology of three hospitals in Gansu province from July to October 2016, from July to October 2017, 6 months and 1 year after onset, respectively. The neurological functional recovery was evaluated by modified Ranking Scale (mRS).The influencing factors were analyzed by logistic regression model. Among the 112 adult patients with JE after 1year follow-up, 57% (64/112) were completely recovered (mRS score=0), and 14%(16/112) had mild neurological dysfunction (mRS score=1 or 2 points), 20% (22/112) had moderate to severe neurological dysfunction (mRS score 3 to 5), and 9% (10/112) died. In 102 survivors, decreased consciousness were fully recovered (100%), 75% of the mental and behavior disorders, 64% of cognitive/memory impairment, 71% of language function disorder, 61% of paralysis, 73% of extrapyramidal symptoms were fully recovered, and 92% of the seizures were controlled. Comparison of clinical data of initial on-set between good prognosis group (mRS score≤2, 80 cases) and poor prognosis group (mRS score>2, 32 cases) showed that initial clinical manifestation with seizures, consciousness (GCS score), cerebrospinal fluid pressure, and lesion of MRI involved in midbrain had statistically significant differences (all 0.05) . Multivariate analysis demonstrated that cerebrospinal fluid (CSF) pressure>250 mmH(2)O and lesion of midbrain in MRI were independent risk factors of poor prognosis in adult patients with JE. JE is an acute and infectious viral encephalitis of the central nervous system with high disability and mortality. Most patients were completely recovered, and some had neurological sequelae. CSF pressure>250 mmH(2)O and lesion of midbrain in MRI are independent risk factors for poor prognosis.
分析成人乙型脑炎临床症状的改善及神经功能恢复情况，并研究预后因素。对甘肃省3家医院神经内科2016年7月至10月、2017年7月至10月收治的112例成人乙型脑炎（JE）住院患者分别在发病后6个月及1年进行随访。采用改良Rankin量表（mRS）评估神经功能恢复情况，通过logistic回归模型分析影响因素。112例成人JE患者随访1年后，57%（64/112）完全恢复（mRS评分=0），14%（16/112）有轻度神经功能障碍（mRS评分=1或2分），20%（22/112）有中度至重度神经功能障碍（mRS评分3至5分），9%（10/112）死亡。102例存活者中，意识障碍完全恢复（100%），精神及行为障碍恢复75%，认知/记忆障碍恢复64%，语言功能障碍恢复71%，瘫痪恢复61%，锥体外系症状恢复73%，癫痫发作控制率92%。预后良好组（mRS评分≤2，80例）与预后不良组（mRS评分>2，32例）起病初期临床资料比较显示，起病初期有癫痫发作、意识（GCS评分）、脑脊液压力及MRI中脑受累病变差异有统计学意义（均P<0.05）。多因素分析表明，脑脊液（CSF）压力>250 mmH₂O及MRI中脑病变是成人JE患者预后不良的独立危险因素。JE是一种中枢神经系统急性感染性病毒性脑炎，致残率和死亡率高。多数患者完全恢复，部分遗留神经后遗症。CSF压力>25
