Department of Neurology, The Third People's Hospital of Hangzhou, Hangzhou, Zhejiang, China (mainland).
Med Sci Monit. 2022 Sep 28;28:e938057. doi: 10.12659/MSM.938057.
BACKGROUND The outcomes of varicella zoster virus (VZV) encephalitis/meningitis vary from complete recovery to severe complications. This study aimed to investigate the predictive factors of encephalitis and meningitis caused by VZV reactivation. MATERIAL AND METHODS VZV encephalitis/meningitis patients (n=39) who were treated between January 2019 and December 2021 were included. Patients were followed up for 3 months after discharge and divided into a favorable outcome group (FO, n=18; 46.2%) and an unfavorable outcome group (UO, n=21; 53.8%) according to whether it affects quality of life. The clinical data were retrospectively analyzed and compared between groups. RESULTS As compared to the FO group, patients in the UO group were more likely to have higher body temperature (>38°C) at admission, longer interval from onset of CNS symptoms to initial of antiviral therapy, higher white blood cells (WBC) and adenosine deaminase (ADA) in the cerebrospinal fluid (CSF) and higher CRP in the blood (P<0.05 or P<0.01). Univariate logistic regression analysis showed CSF ADA (OR=1.279, 95% CI: 0.9961.642) and interval from onset of CNS symptoms to initial of antiviral therapy (OR=1.299, 95% CI: 1.0111.669) were independent risk factors for unfavorable outcomes (P<0.05). The sensitivity and specificity of combined CSF ADA and time interval from onset of CNS symptoms to initial of antiviral therapy were 78.8% and 95.2%, respectively, in predicting outcomes. CONCLUSIONS Higher CSF ADA and longer interval from onset of CNS symptoms to initial of antiviral therapy predict an unfavorable outcome, and the combination of both factors can achieve better performance.
水痘带状疱疹病毒（VZV）脑炎/脑膜炎的结局从完全恢复到严重并发症不等。本研究旨在探讨 VZV 再激活引起的脑炎和脑膜炎的预测因素。
纳入 2019 年 1 月至 2021 年 12 月期间治疗的 39 例 VZV 脑炎/脑膜炎患者。患者出院后随访 3 个月，根据是否影响生活质量分为预后良好组（FO，18 例，46.2%）和预后不良组（UO，21 例，53.8%）。对两组的临床资料进行回顾性分析和比较。
与 FO 组相比，UO 组患者入院时体温更高（>38°C）、从 CNS 症状出现到开始抗病毒治疗的时间间隔更长、脑脊液（CSF）中的白细胞（WBC）和腺苷脱氨酶（ADA）更高、血液中的 C 反应蛋白（CRP）更高（P<0.05 或 P<0.01）。单因素 logistic 回归分析显示 CSF ADA（OR=1.279，95%CI：0.9961.642）和从 CNS 症状出现到开始抗病毒治疗的时间间隔（OR=1.299，95%CI：1.0111.669）是预后不良的独立危险因素（P<0.05）。CSF ADA 和从 CNS 症状出现到开始抗病毒治疗的时间间隔联合预测结局的敏感性和特异性分别为 78.8%和 95.2%。
CSF ADA 较高和从 CNS 症状出现到开始抗病毒治疗的时间间隔较长提示预后不良，两者结合可获得更好的效果。
