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目的 探讨散发性脑炎患者脑脊液免疫球蛋白G指数 (IgGIndex)和血脑屏障的变化以及MRI异常与IgGIndex的关系及病因。方法 住院患者 4 0例 ,分析其脑脊液IgGIndex、白蛋白比值和 2 6例头颅MRI结果。结果 散发性脑炎患者脑脊液的IgGIndex为 (0 .6 6± 0 .2 0 ) ,高于其他神经性疾病组的 (0 .5 7± 0 .17) ,两者比较有差异 (P <0 .0 5 ) ;但两组的白蛋白比值相比无统计学差异 (P >0 .0 5 ) ;MRI异常患者的IgGIndex高于MRI正常者 (P <0 .0 5 )。结论 多数散发性脑炎患者的血脑屏障无明显破坏 ,而鞘内免疫反应比较明确 ,IgG合成增加 ,提示多数散发性脑炎不是病毒直接感染 ,而是一种免疫学反应性脱髓鞘脑病 ,MRI提示有白质异常者当更明确。
Objective To investigate the changes of cerebrospinal fluid immunoglobulin G index (IgGIndex) and blood-brain barrier in patients with sporadic encephalitis and the relationship between MRI abnormalities and IgGlndex and its etiology. Methods 40 hospitalized patients were enrolled in this study. IgG in CSF, albumin ratio and 26 cranial MRI were analyzed. Results The IgGIndex of cerebrospinal fluid of patients with sporadic encephalitis was (0.666 ± 0.200), which was higher than that of other neuropathies (0.57 ± 0.17) (P <0 .0 5). However, there was no significant difference in albumin ratio between the two groups (P> 0.05). The IgGlndexof MRI abnormalities was higher than that of normal MRI (P <0.05). Conclusions Most of the patients with sporadic encephalitis had no obvious damage to the blood-brain barrier, whereas the intrathecal immune response was clearer and IgG synthesis was increased, suggesting that most sporadic encephalitis were not direct viral infection but an immunological demyelinating encephalopathy MRI showed abnormal white matter when more specific.