Objective: To analyze the improvement of clinical symptoms and recovery of neurological function in adult Japanese encephalitis, and study the prognostic factors. Methods: Follow-up was conducted for 112 hospitalized patients with Japanese encephalitis (JE) in adults at the Department of Neurology of three hospitals in Gansu province from July to October 2016, from July to October 2017, 6 months and 1 year after onset, respectively. The neurological functional recovery was evaluated by modified Ranking Scale (mRS).The influencing factors were analyzed by logistic regression model. Results: Among the 112 adult patients with JE after 1year follow-up, 57% (64/112) were completely recovered (mRS score=0), and 14%(16/112) had mild neurological dysfunction (mRS score=1 or 2 points), 20% (22/112) had moderate to severe neurological dysfunction (mRS score 3 to 5), and 9% (10/112) died. In 102 survivors, decreased consciousness were fully recovered (100%), 75% of the mental and behavior disorders, 64% of cognitive/memory impairment, 71% of language function disorder, 61% of paralysis, 73% of extrapyramidal symptoms were fully recovered, and 92% of the seizures were controlled. Comparison of clinical data of initial on-set between good prognosis group (mRS score≤2, 80 cases) and poor prognosis group (mRS score>2, 32 cases) showed that initial clinical manifestation with seizures, consciousness (GCS score), cerebrospinal fluid pressure, and lesion of MRI involved in midbrain had statistically significant differences (all P<0.05) . Multivariate analysis demonstrated that cerebrospinal fluid (CSF) pressure>250 mmH(2)O and lesion of midbrain in MRI were independent risk factors of poor prognosis in adult patients with JE. Conclusion: JE is an acute and infectious viral encephalitis of the central nervous system with high disability and mortality. Most patients were completely recovered, and some had neurological sequelae. CSF pressure>250 mmH(2)O and lesion of midbrain in MRI are independent risk factors for poor prognosis.
目的： 分析成人流行性乙型脑炎临床症状改善、神经功能恢复情况，研究影响患者预后的相关因素。 方法： 对2016年7—10月、2017年7—10月在甘肃省三家医院神经内科住院治疗的112例成人流行性乙型脑炎患者在发病后0.5年和1年分别进行随访，观察临床症状的改善，通过改良Ranking（mRS）评分评价患者神经功能恢复情况，采用Logistic回归分析相关因素对成人乙型脑炎预后的影响。 结果： 1年后随访，112例成人乙脑患者，57%（64/112）患者神经功能完全恢复（mRS评分=0分），14%（16/112）患者遗留有轻度神经功能障碍（mRS评分=1或2分），20%（22/112）患者遗留有中-重度神经功能障碍（mRS评分3~5分），9%（10/112）的患者死亡。102例存活患者中，意识水平下降完全恢复率100%，精神行为异常完全恢复率75%，认知/记忆力下降完全恢复率64%，语言障碍完全恢复率71%，运动瘫痪完全恢复率61%，锥体外系症状和癫痫完全恢复率分别为73%和92%。预后良好组（mRS评分≤2分，80例）和预后不佳组（mRS评分>2分，32例）患者在癫痫发作次数、意识水平（GCS评分）、脑脊液压力和头颅MR平扫中脑病灶有差异（P<0.05）。多因素分析提示脑脊液压力>250 mmH(2)O和头颅MRI中脑病变是预后不佳的独立危险因素。 结论： 乙脑是一种致残、致死率较高的中枢神经系统急性、传染性病毒性脑炎。发病后大部分患者可完全恢复，部分可遗留有神经后遗症。脑脊液压力>250 mmH(2)O和头颅MRI中脑病变是成人乙脑患者预后不佳的独立危险因素。.
Keywords: Cerebrospinal fluid; Encephalitis; Prognosis; Risk factors.