Sawyer J, Ellner J, Ransohoff D F
Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio.
Med Decis Making. 1988 Apr-Jun;8(2):95-101. doi: 10.1177/0272989X8800800205.
The authors performed a decision analysis to determine whether a patient suspected to have herpes simplex encephalitis (HSE) should undergo a brain biopsy or be treated empirically with medical therapy. In most cases, empiric treatment with acyclovir would be slightly favored; brain biopsy was not essential in management. However, brain biopsy was found useful for patients who had low CSF glucose at the time of initial lumbar puncture; such patients may have a very high risk to have other treatable conditions such as tuberculosis, brain abscess, toxoplasmosis, or cryptococcosis. The results of the analysis suggest that even with the advent of safe antiviral drug therapy such as acyclovir, brain biopsy is useful in a well-defined subset of patients with possible HSE. The rationale, however, is not to confirm HSE but rather to detect other treatable conditions.
作者进行了一项决策分析，以确定疑似患有单纯疱疹性脑炎（HSE）的患者是应接受脑活检还是接受经验性药物治疗。在大多数情况下，使用阿昔洛韦进行经验性治疗会略占优势；脑活检在治疗中并非必不可少。然而，发现脑活检对初次腰椎穿刺时脑脊液葡萄糖水平低的患者有用；这类患者患其他可治疗疾病（如结核病、脑脓肿、弓形虫病或隐球菌病）的风险可能非常高。分析结果表明，即使出现了如阿昔洛韦这样安全的抗病毒药物治疗，脑活检在明确的可能患有HSE的患者亚组中仍有用处。然而，其基本原理不是为了确诊HSE，而是为了检测其他可治疗的疾病。
