本文選題：中樞神經(jīng)系統(tǒng)感染 + 病毒性腦炎　； 參考：《河北醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的：病毒性腦炎（Viral Encephalitis, VE）是由病毒侵入中樞神經(jīng)系統(tǒng)所致腦實(shí)質(zhì)和腦膜炎癥。病毒有著生物界結(jié)構(gòu)極其簡(jiǎn)單的生命形式，完全依賴(lài)宿主細(xì)胞的能量和代謝系統(tǒng)，獲取生命活動(dòng)所需的物質(zhì)和能量，以此來(lái)維持其生物體特征及侵襲力。病毒侵入中樞神經(jīng)系統(tǒng)后常常引起神經(jīng)細(xì)胞的炎癥、水腫、壞死等改變，從而造成腦組織的損傷。近年來(lái)，作為腦損傷后的生物化學(xué)標(biāo)志物，神經(jīng)元特異性烯醇化酶(Neuron-SpecificEnolase, NSE)引起了人們的極大關(guān)注，并成為研究的熱點(diǎn)之一。本文通過(guò)①測(cè)定病毒性腦炎患者入院時(shí)和治療后腦脊液中NSE含量，探討NSE含量變化對(duì)病毒性腦炎病情監(jiān)測(cè)及預(yù)后評(píng)估價(jià)值；②本文同時(shí)還設(shè)立臨床上與病毒性腦炎早期不易鑒別的其他中樞神經(jīng)系統(tǒng)感染組作對(duì)照，結(jié)核性腦膜炎和化膿性腦膜炎與病毒性腦炎在早期的臨床表現(xiàn)方面有很多相似的特點(diǎn)，不易鑒別，，分別測(cè)定它們腦脊液中NSE含量，探討NSE在早期對(duì)臨床上常見(jiàn)中樞神經(jīng)系統(tǒng)感染疾病的輔助鑒別意義。 方法：收集2010年6月～2011年12月河北醫(yī)科大學(xué)第二醫(yī)院住院的患者90例。將90例患者嚴(yán)格按照相應(yīng)疾病的診斷標(biāo)準(zhǔn)分組：病毒性腦炎組40例、結(jié)核性腦膜炎組15例、化膿性腦膜炎組15例和正常對(duì)照組20例。 入院后24~48小時(shí)內(nèi)對(duì)入組病例均進(jìn)行腰椎穿刺術(shù)（病毒性腦炎組需要在住院治療7~10天后復(fù)查腰椎穿刺術(shù)，我們定義為病毒性腦炎組治療后），腦脊液送常規(guī)、生化、細(xì)胞學(xué)檢查，同時(shí)留取腦脊液0.5ml置-70℃冰箱，低溫保存，分批檢測(cè)。應(yīng)用由武漢優(yōu)爾生科技股份有限公司提供的神經(jīng)元特異性烯醇化酶（NSE）酶聯(lián)免疫吸附測(cè)定試劑盒測(cè)定腦脊液NSE含量。同時(shí)對(duì)病腦組患者行血常規(guī)、腦電圖、頭顱CT/MRI等臨床輔助檢查。 使用SPSS13.0統(tǒng)計(jì)軟件包進(jìn)行統(tǒng)計(jì)學(xué)分析實(shí)驗(yàn)數(shù)據(jù)，計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(x±s)表示，并對(duì)各組觀察數(shù)值進(jìn)行正態(tài)檢驗(yàn)及方差齊性檢驗(yàn)，兩個(gè)樣本均數(shù)比較采用兩樣本t檢驗(yàn)方法，多個(gè)樣本均數(shù)比較采用完全隨機(jī)設(shè)計(jì)資料的方差分析進(jìn)行比較，P＜0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果：1病腦組腦脊液中NSE水平范圍是10.63～20.02μg/L，平均含量值為14.71±2.37μg/L；正常對(duì)照組中NSE水平范圍為2.17~8.85μg/L，平均含量值為6.26±2.34μg/L，經(jīng)比較兩組t=13.092，P＝0.000＜0.05，差異有統(tǒng)計(jì)學(xué)意義。 2病腦組治療后腦脊液中NSE水平為7.18～14.68μg/L，平均含量為12.12±2.38μg/L，明顯低于病腦組腦脊液中平均含量，兩者比較，t=3.701，P＝0.001＜0.05，差異有顯著統(tǒng)計(jì)學(xué)意義；但是含量明顯高于正常對(duì)照組，兩者比較，t=-7.414，P＝0.000＜0.05，差異有顯著統(tǒng)計(jì)學(xué)意義。 3結(jié)腦組腦脊液中NSE水平為9.32~15.66μg/L，平均值含量為12.80±1.70μg/L，低于病腦組平均含量，兩者比較，t=2.858，P＝0.006＜0.05，差異有統(tǒng)計(jì)學(xué)意義；但高于正常對(duì)照組平均含量，兩者比較，t=-9.152,P＝0.000＜0.05，差異有統(tǒng)計(jì)學(xué)意義； 4化腦組腦脊液中NSE水平為10.42~16.59μg/L，平均值含量為12.99±1.91μg/L。低于病腦組平均含量，兩組比較，t=2.527，P＝0.015＜0.05，差異有統(tǒng)計(jì)學(xué)意義；但高于正常對(duì)照組平均含量，兩者比較，t=-9.092,P＝0.000＜0.05，差異有統(tǒng)計(jì)學(xué)意義； 5結(jié)腦組和化腦組比較，t=-0.284，P＝0.778＞0.05，差異無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)論：1病毒性腦炎患者腦脊液中NSE含量顯著高于正常對(duì)照組，有統(tǒng)計(jì)學(xué)意義，說(shuō)明病毒感染中樞神經(jīng)系統(tǒng)后，使腦神經(jīng)細(xì)胞變性、死亡，對(duì)患者神經(jīng)系統(tǒng)功能造成不可逆性的損傷。 2病毒性腦炎患者治療后腦脊液中NSE水平明顯低于治療前，差異有統(tǒng)計(jì)學(xué)意義，動(dòng)態(tài)觀察其含量變化對(duì)病毒性腦炎患者的病情監(jiān)測(cè)及預(yù)后評(píng)估有重要意義。 3病毒性腦炎患者腦脊液中NSE含量顯著高于結(jié)腦組和化腦組，比較差異有統(tǒng)計(jì)學(xué)意義，說(shuō)明病毒感染后對(duì)腦部的損傷較其他感染重，具有一定的輔助鑒別價(jià)值。在臨床表現(xiàn)方面，結(jié)腦、化腦和病腦有很多相似的特點(diǎn)以致容易誤診，然而，這3種疾病在治療方面完全不同，以致容易誤治。因此，對(duì)它們進(jìn)行鑒別診斷具有重要的臨床意義。但是本實(shí)驗(yàn)設(shè)置的結(jié)核性腦膜炎組和化膿性腦膜炎組例數(shù)較少，需增大樣本量進(jìn)一步探討結(jié)腦與化腦對(duì)腦部損傷的不同情況。
[Abstract]:Objective : Viral encephalitis ( VE ) is caused by the invasion of viral encephalitis ( VE ) into the brain parenchyma and meningitis caused by the invasion of the central nervous system . The virus has a very simple form of life , which depends on the energy and metabolic system of the host cell , so as to maintain its biological characteristics and invasion ability .
In this paper , we also set up other central nervous system infection groups which are not easy to be identified in the early stage of viral encephalitis , tuberculous meningitis and pyogenic meningitis and viral encephalitis have many similar characteristics in the early clinical manifestation . It is difficult to identify the NSE in their cerebrospinal fluid , and to discuss the significance of NSE in the early diagnosis of common central nervous system infection diseases .

Methods : 90 patients who were hospitalized in Second Hospital of Hebei Medical University from June 2010 to December 2011 were collected . Ninety patients were divided into two groups : viral encephalitis group ( 40 cases ) , tuberculous meningitis group ( 15 cases ) , pyogenic meningitis group ( 15 cases ) and normal control group ( 20 cases ) .

The NSE contents of cerebrospinal fluid were measured by NSE enzyme linked immunosorbent assay ( NSE ) enzyme linked immunosorbent assay ( NSE ) enzyme linked immunosorbent assay ( NSE ) enzyme linked immunosorbent assay ( NSE ) enzyme linked immunosorbent assay ( NSE ) enzyme linked immunosorbent assay ( NSE ) enzyme linked immunosorbent assay ( NSE ) .

SPSS 13.0 was used for statistical analysis of experimental data . The measurement data was expressed by mean 鹵 standard deviation ( x 鹵 s ) , and the positive and variance tests were carried out on the observation values of each group . Two sample t - test methods were used to compare the mean numbers of the two samples .

Results : The level of NSE in cerebrospinal fluid of 1 disease group was 10.63 锝

本文編號(hào)：1752155