本文選題：單純皰疹病毒性腦炎　切入點(diǎn)：腦電圖　出處：《山東大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的 單純皰疹病毒性腦炎為單純皰疹病毒感染所致。皰疹病毒在成人為I型(非生殖器型),而新生兒則是II型(生殖器型)。HSE(單純皰疹病毒性腦炎)雖可有原發(fā)性感染引起,但大多數(shù)是潛伏病毒(潛伏于三叉神經(jīng)節(jié)或星形細(xì)胞內(nèi))的再活化或由新的病毒珠在感染所致。病毒進(jìn)入腦組織的途徑：II型多經(jīng)血行傳播,I型主要通過(guò)三叉神經(jīng)及嗅神經(jīng)。病變廣泛分布于腦部,主要侵犯顳葉中部、額葉眶面和腦邊緣系統(tǒng)(包括海馬、杏仁核、嗅皮質(zhì)、腦島和扣帶回),有時(shí)枕葉、下丘腦、延髓和腦橋亦可累及,受損程度兩側(cè)常呈不對(duì)稱(chēng)性。病理改變的主要特點(diǎn)是腦組織出血性壞死,神經(jīng)元和膠質(zhì)細(xì)胞核內(nèi)有Cowdry A型包涵體,內(nèi)含皰疹病毒顆粒及抗原；此外還可見(jiàn)神經(jīng)元變形、膠質(zhì)細(xì)胞增生、血管周?chē)馨图?xì)胞及漿細(xì)胞浸潤(rùn)和腦病灶周?chē)乃[等改變。目前主要通過(guò)腦電圖、腦脊液、影像學(xué)等檢查診斷該疾病,我們希望通過(guò)本文章進(jìn)一步研究HSE的早期診斷方法。 腦電圖(electroencephalogram, EEG)是從顱外頭皮或顱內(nèi)記錄到的局部神經(jīng)元電活動(dòng)的總和。腦電活動(dòng)的產(chǎn)生主要來(lái)自突觸后電位。此外,某些神經(jīng)元的內(nèi)源性爆發(fā)電位和神經(jīng)元之間的縫隙鏈接(電突觸)也構(gòu)成腦電活動(dòng)中的某些成分。從40年代起,EEG開(kāi)始進(jìn)入臨床應(yīng)用。發(fā)展到現(xiàn)在,腦電圖已經(jīng)被廣泛應(yīng)用到癲癇、中樞神經(jīng)系統(tǒng)感染性疾病、腦血管疾病、顱內(nèi)腫瘤、神經(jīng)遺傳代謝病和變性病等疾病的相關(guān)診斷中,對(duì)疾病的早期診斷、治療及預(yù)后監(jiān)測(cè)過(guò)程中起到重要作用。 我們希望通過(guò)本文章進(jìn)一步探討單純皰疹病毒性腦炎早期腦電圖診斷的臨床意義。 方法 1.收集2013.01-2014.06期間神經(jīng)內(nèi)科150名腦炎患者。根據(jù)病例納入標(biāo)準(zhǔn),分別將該150名腦炎患者分為81名非HSE患者,69名HSE患者。 2.按腦電圖異常度診斷標(biāo)準(zhǔn),分別將HSE患者、非HSE患者腦電圖分為：輕度異常、中度異常、重度異常、正常四類(lèi)。利用軟件SPSS21.0對(duì)表1數(shù)據(jù)進(jìn)行Ridit分析,觀察HSE患者與非HSE患者腦電圖異常度有無(wú)差別。 3.按150患者腦電圖檢查結(jié)果中出現(xiàn)的主要波形分別將HSE患者及非HSE患者分為：e波為主型(單、雙側(cè))、δ波為主型(單、雙側(cè))、PLEDs(單、雙側(cè))、正常波形。分別對(duì)兩組數(shù)據(jù)進(jìn)行X2檢驗(yàn),通過(guò)統(tǒng)計(jì)學(xué)分析HSE組與非HSE組患者腦電圖波形有無(wú)差異。 4.按病程中出現(xiàn)θ波為主型(單、雙側(cè))、δ波為主型(單、雙側(cè))、PLEDS(單、雙側(cè))為主型的腦電圖對(duì)兩類(lèi)患者進(jìn)行分類(lèi),對(duì)兩組患者早期(≤3天)、急性期(4-14天)各類(lèi)波形腦電圖(單、雙側(cè))出現(xiàn)的次數(shù)進(jìn)行X2檢驗(yàn),分析早期、急性期兩組腦電圖波形有無(wú)統(tǒng)計(jì)學(xué)差異。 結(jié)果 1.HSE組的R1=0.2625,非HSE組R2=0.3436,u=0.207(P0.05),差別沒(méi)有統(tǒng)計(jì)學(xué)意義,即尚不能認(rèn)為HSE組與非HSE組腦電圖異常度有差異。 2.HSE組與非HSE組兩組腦電圖行X2檢驗(yàn),得出兩組單側(cè)的θ波為主型、δ波為主型、PLEDs波為主型形有統(tǒng)計(jì)學(xué)差異,雙側(cè)θ波為主型、δ波為主型、PLEDs波為主型形無(wú)明顯統(tǒng)計(jì)學(xué)差異。 3.病程≤3天HSE組與非HSE組單側(cè)的e波為主型、δ波為主型有統(tǒng)計(jì)學(xué)差異,雙側(cè)θ波為主型、δ波為主型、PLEDs波為主型無(wú)明顯統(tǒng)計(jì)學(xué)差異。病程4-14天HSE組與非HSE組腦電圖比較無(wú)明顯統(tǒng)計(jì)學(xué)差異。 結(jié)論 1.病毒性腦炎腦電圖檢查異常率達(dá)88%,單純皰疹病毒性腦炎早期腦電圖異常率高達(dá)90%。 2.HSE患者單側(cè)的θ波為主型、δ波為主型、PLEDs波為主型腦電圖區(qū)別于非HSE患者。 3.病程早期(≤3天)：HSE患者單側(cè)θ波為主型、δ波為主型腦電圖區(qū)別于非HSE患者。病程急性期(4-14天)：HSE組與非HSE組腦電圖比較無(wú)明顯統(tǒng)計(jì)學(xué)差異。
[Abstract]:objective
Herpes simplex virus encephalitis caused by herpes simplex virus infection. The herpes virus in adult type I (non genital type), but the infant is II type (genital type).HSE (herpes simplex encephalitis) can have primary infection, but most of them are latent virus lurking in the trigeminal ganglion (or star intracellular) reactivation or by a new virus. The virus infection caused by beads in way into the brain tissue: II type hematogenous spread, I mainly through the trigeminal nerve and olfactory nerve. The lesions are widely distributed in the brain, mainly involving middle temporal, frontal orbital surface and limbic system (including hippocampus the entorhinal cortex, amygdala, insula and cingulate), sometimes occipital lobe, hypothalamus, medulla oblongata and pons were involved, the extent of the damage on both sides are asymmetric. The main feature is the pathological changes of cerebral hemorrhage and necrosis of neurons and glial cells with Cowdry A Type inclusion bodies, including herpes virus particles and antigens; in addition, the neurons deformation, the proliferation of glial cells, surrounding perivascular infiltration of lymphocytes and plasma cells and edema. The cerebral lesions mainly through CSF, EEG, imaging examination and diagnosis of the disease, we hope that through the method of early diagnosis of the further study of HSE..
Electroencephalogram (electroencephalogram, EEG) is the sum of the extracranial scalp or intracranial recording to local neuronal activity. EEG activity is derived from the postsynaptic potential. In addition, some endogenous neurons burst gap link between potential and neurons (electrical synapses) also constitute some components of brain electrical activity in the. In 40s, EEG began to enter the clinical application. Until now, the EEG has been widely applied to epilepsy, central nervous system infectious disease, cerebrovascular disease, intracranial tumor, diagnosis of inherited metabolic diseases and neural degeneration diseases, early diagnosis of the disease, which plays an important role in the process of treatment and prognosis.
We hope to further explore the clinical significance of early EEG diagnosis of herpes simplex encephalitis.
Method
1. during the period of 2013.01-2014.06, 150 encephalitis patients in neurology department were divided into 81 non HSE patients and 69 HSE patients according to the inclusion criteria.
2. according to the diagnostic criteria of EEG abnormality, EEG of HSE patients and non HSE patients were divided into four categories: mild, moderate, severe, and normal. The software SPSS21.0 was used for Ridit analysis of Table 1 data to observe the difference of EEG abnormalities between HSE patients and non HSE patients.
There are 3. main waveforms according to 150 patients with EEG findings respectively in HSE patients and non HSE patients were divided into e wave type (single, double), delta wave type (single, double), PLEDs (single, double), normal waveform. X2 test was used for the two groups of data, through the statistics analysis of HSE group had no difference with the non HSE group with EEG waveform.
4. according to the course in theta type (single, double), delta wave type (single, double), PLEDS (single, double) type EEG classification of two patients, two groups of early (less than 3 days), acute period (4-14 days) of EEG waveform (single the number of occurrences of bilateral), X2 test, analysis of early acute stage, two groups have no significant difference in EEG waveforms.
Result
The R1=0.2625 of group 1.HSE, non HSE group R2=0.3436, u=0.207 (P0.05), the difference was not statistically significant, that is, there is no difference between the HSE group and the non HSE group.
2.HSE group and non HSE group two groups of EEG X2 test, we found that the two groups of unilateral theta wave dominated, delta wave dominated, PLEDs wave dominated, there was statistically significant difference, bilateral theta wave dominated, delta wave dominated, PLEDs wave dominated form had no significant difference.
E wave is the main type of unilateral 3. course less than 3 days HSE group and non HSE group, there were significant differences in delta wave type, bilateral theta type, delta wave type, PLEDs wave type has no significant difference in duration of 4-14 days. The EEG HSE group and non HSE group had no significant difference.
conclusion
The abnormal rate of electroencephalogram of 1. viral encephalitis was 88%, and the abnormal rate of early EEG of herpes simplex encephalitis was up to 90%.
The unilateral theta wave of 2.HSE patients was the main type, the delta wave was the main type, and the PLEDs wave based electroencephalogram was different from the non HSE patients.
3. early stage (less than 3 days) in the patients with type:HSE theta, delta wave type EEG differ from non HSE patients. The duration of acute period (4-14 days) of EEG in:HSE group and non HSE group is no significant difference.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R512.3

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