Yin Ping, Tian Pingping, Zhang Xinyue, Zhang Dongqing, Yang Xiaofan, Yang Lu, Wang Yang, Lei Gefei, Li Baomin
Department of Pediatrics, Qilu Hospital of Shandong University, # 107 Wenhuaxi Road, Jinan, 250012, Shandong, China.
Department of Pediatrics, Qilu Children's Hospital of Shandong University, Shandong, Jinan, China.
Sci Rep. 2025 Feb 22;15(1):6471. doi: 10.1038/s41598-025-91438-6.
The high rate of postencephalitic epilepsy (PE) contributes to the unfavorable clinical outcome of herpes simplex virus-1 encephalitis (HSE). We aimed to identify the risk factors and explore possible mechanisms of PE in childhood following HSE. We conducted a retrospective review of children diagnosed with HSE and patients were categorized into two groups based on the presence or absence of PE. Multivariate logistic regression analysis was used to analyze factors associated with PE. Furthermore, cytokine and albumin levels in paired cerebrospinal fluid (CSF) and blood samples during acute HSE were also retrospectively reviewed. 97 HSE patients were included in the study and PE was diagnosed in 46. On multivariate analysis, the features predictive of PE (presented as odds ratio [OR] with confidence intervals [CIs]) were status epilepticus (OR 9.38, CI 1.71-10.37), focal seizures (7.41, 1.42-16.97), and restricted diffusion on MRI (6.15, 1.16-20.31). The median QAlb value (CSF to serum albumin ratio, a marker of blood-brain-barrier [BBB] integrity), levels of interleukin (IL)-6 and IL-6:IL-10 ratio in CSF were higher in children with PE during acute HSE. However, CSF levels of IL-10 were higher in non-PE patients. Furthermore, greater CSF IL-6 levels were associated with higher QAlb. These results demonstrated that enhanced BBB impairment and exaggerated proinflammatory response may play a role in the pathogenesis of PE following HSE.
脑炎后癫痫（PE）的高发生率导致单纯疱疹病毒1型脑炎（HSE）的临床预后不佳。我们旨在确定儿童HSE后PE的危险因素并探索其可能机制。我们对诊断为HSE的儿童进行了回顾性研究，并根据是否存在PE将患者分为两组。采用多因素logistic回归分析来分析与PE相关的因素。此外，还对急性HSE期间配对的脑脊液（CSF）和血液样本中的细胞因子和白蛋白水平进行了回顾性研究。97例HSE患者纳入本研究，其中46例诊断为PE。多因素分析显示，预测PE的特征（以比值比[OR]及可信区间[CI]表示）为癫痫持续状态（OR 9.38，CI 1.71 - 10.37）、局灶性发作（7.41，1.42 - 16.97）以及MRI上的扩散受限（6.15，1.16 - 20.31）。急性HSE期间，PE患儿的脑脊液白蛋白商值（CSF与血清白蛋白比值，血脑屏障[BBB]完整性的标志物）中位数、脑脊液白细胞介素（IL）-6水平及IL - 6:IL - 10比值较高。然而，非PE患者的脑脊液IL - 10水平较高。此外，脑脊液IL - 6水平升高与较高的脑脊液白蛋白商值相关。这些结果表明，血脑屏障损伤加剧和促炎反应过度可能在HSE后PE的发病机制中起作用。
