林霞

[摘要] 目的 總结和分析成人流行性乙型脑炎的临床特征及影像学特点，以提高临床医师对乙型脑炎的认知。 方法 选取2017年7月至2019年9月我院住院的成人流行性乙型脑炎患者，对其临床特征及影像学特点进行回顾性分析。 结果 89例确诊成人流行性乙型脑炎患者中发热86例（96.63%），65例（73.03%）患者伴头痛、恶心、呕吐，30例（33.71%）患者出现精神症状，反复抽搐21例（23.60%），运动障碍11例（12.36%），呼吸衰竭18例（20.22%），其中呼吸机辅助呼吸6例，意识障碍43例（48.31%），血常规白细胞、中性粒细胞百分比升高69例（77.53%），腰穿检查颅内压增高31例（34.83%），脑脊液白细胞计数增高30例（33.71%），以单核细胞增高为主，脑脊液糖增高23例（25.84%），氯化物降低24例（26.97%），蛋白质升高22例（24.72%），脑电图异常48例（53.93%），急诊头颅CT检查异常40例（44.94%），头颅核磁共振检查异常71例（79.78%），病灶以中线部位为主，累及双侧丘脑、中脑等部位多见。 结论 成人流行性乙型脑炎临床表现无明显特异性，以急性脑炎综合征为主，其特征性影像学表现是病灶以双侧丘脑、中脑等中线部位受累多见，T2WI、FLAIR像显影更佳。

[关键词] 流行性乙型脑炎;临床特征;脑脊液;头颅核磁;脑电图

[中图分类号] R445.2          [文献标识码] B          [文章编号] 1673-9701（2021）06-0057-03

The clinical characteristics and imaging characteristics of 89 cases of epidemic encephalitis B in adults

LIN Xia

No.1 Department of Neurology， the First People′s Hospital of Tianshui in Gansu Province， Tianshui   741000， China

[Abstract] Objective To summarize and analyze the clinical and imaging characteristics of epidemic encephalitis B in adults， so as to improve clinicians′ cognition of encephalitis B. Methods The adult patients with epidemic encephalitis B who were hospitalized in our hospital from July 2017 to September 2019 were selected， and its clinical and imaging characteristics were retrospectively analyzed. Results Among the 89 adult patients with confirmed diagnosis of epidemic encephalitis B， there were 86 cases（96.63%） with fever， 65 cases（73.03%） with accompanied headache， nausea and vomiting， 30 cases（33.71%） of mental symptoms， 21 cases（23.60%） with repeated convulsions， 11 cases（12.36%） with dyskinesia， 18 cases（20.22%） with respiratory failure， including 6 cases with ventilator assisted respiration， 43 cases（48.31%） with consciousness disorder， 69 cases（77.53%） with elevated white blood cells and neutrophils， 31 cases（34.83%） with increased intracranial pressure by lumbar puncture， 30 cases（33.71%） with increased count of white blood cell in cerebrospinal fluid， with mainly increased count of monocytes， 23 cases（25.84%） with increased cerebrospinal fluid glucose， 24 cases（26.97%） with decreased chloride contents， 22 cases（24.72%） with increased protein contents， 48 cases（53.93%） with abnormal EEG， 40 cases（44.94%） with abnormal cranial CT results in emergency， and 71 cases（79.78%） with abnormal cranial MRI results. The lesions were mainly found in the midline， often involving bilateral thalamus， midbrain and other parts. Conclusion The clinical manifestations of epidemic encephalitis B in adults have no obvious specificity， mainly with acute encephalitis syndrome. The characteristic imaging manifestation is that the lesions are more commonly involved in the midline parts such as the bilateral thalamus and midbrain. The T2WI and FLAIR images are better.

[Key words] Epidemic encephalitis B; Clinical characteristics; Cerebrospinal fluid; Cranial MRI; Electroencephalogram

流行性乙型脑炎以蚊虫叮咬传播为主，是急性病毒性人畜共患传染病，主要流行于亚洲[1]，死亡率高达20%～30%，30%～50%的患者会遗留神经或精神后遗症[2]。随着近年夏季温度升高及降雨量增多，成人流行性乙型脑炎在本地区发病率呈逐年递增趋势，以7～9月显著，起病急，进展快，早期症状不典型，一旦出现呼吸衰竭，治疗棘手，且致死、致残率高，如能在流行性乙型脑炎初期尽早诊断，积极规范治疗，可在最大程度上降低致死、致残率，减轻患者家庭及社会的负担。……