Các yếu tố tiên lượng xấu và kết quả điều trị bệnh nhân viêm não do Herpes simplex tại Bệnh viện Bệnh Nhiệt đới thành phố Hồ Chí Minh

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Tác giả: Yến Nhi Diệp, Thị Hoài Tâm Đông, Trọng Đức Du, Đặng Trung Nghĩa Hồ, Mỹ Ngọc Nghiêm, Hoan Phú Nguyễn, Thị Hoàng Mai Nguyễn, Văn Vĩnh Châu Nguyễn, Thị Hồng Châu Trần

Ngôn ngữ: vie

Ký hiệu phân loại: 616.921 Dengue

Thông tin xuất bản: Truyền nhiễm Việt Nam, 2023

Mô tả vật lý: 46-54

Bộ sưu tập: Metadata

ID: 502416

Thêm vào giỏ

Herpes simplex encephalitis is one of the few neuroinfectious diseases caused by a virus that has specific antiviral treatment. Accurate diagnosis requires the use of PCR-HSV in cerebrospinal fluid (CSF). Currently, there is limited information about the treatment outcomes of HSV encephalitis and factors associated with adverse outcomes in Vietnam. Objectives: To describe the clinical manifestations, laboratory findings, treatment outcomes, and prognostic factors for adverse outcomes in patients with HSV encephalitis at the Hospital for Tropical Diseases in Ho Chi Minh City. Methods: A retrospective descriptive study of cases was conducted. Results: From January 2010 to December 2016, there were 75 cases of HSV encephalitis (3 cases <
15 years old) at the Hospital for Tropical Diseases in Ho Chi Minh City. All cases had positive PCRHSV in CSF. In adult patients, the most common symptoms were fever (99%), headache (87%), altered consciousness at admission (86%), and seizures (43%). Abnormalities in the brain were found in 56% (24/43) of cases on CT-scan and 91% (21/23) of cases on MRI. There were 93% (70/75) of patients received antiviral treatment (intravenous acyclovir: 62/70, oral valacyclovir: 8/70). In cases of HSV encephalitis treated at the Hospital for Tropical Diseases in Ho Chi Minh City, the mortality rate at discharge was 11.3% (8/71). Multiple regression analysis (for cases treated with antiviral drugs) showed that the Glasgow Coma Scale (GCS) at the start of the¿rst antiviral treatment was independently associated with adverse outcomes of patients at discharge (OR 0.60
95% CI: 0.40 - 0.90
p = 0.013) and at 6 months after discharge (OR 0.47
95% CI: 0.24 - 0.93
p = 0.03). Conclusions: The GCS at the start of the first antiviral treatment is an independent prognostic factor for the poor outcomes of HSV encephalitis patients at discharge and at 6 months after discharge.Viêm não do virus Herpes simplex (HSV) là một trong số ít các bệnh lý nhiễm trùng thần kinh do virus có thuốc điều trị đặc hiệu. Chẩn đoán xác định đòi hỏi phải có công cụ PCR-HSV trong dịch não tủy (DNT). Hiện tại, ở Việt Nam, vẫn chưa có nhiều thông tin về kết quả điều trị viêm não do HSV và các yếu tố liên quan đến kết cục xấu sau điều trị. Mục tiêu: Mô tả đặc điểm lâm sàng, cận lâm sàng, kết quả điều trị và các yếu tố tiên lượng kết cục sau điều trị viêm não do HSV tại Bệnh viện Bệnh Nhiệt đới TP. Hồ Chí Minh. Phương pháp: Thiết kế nghiên cứu mô tả hàng loạt ca. Kết quả: Trong thời gian từ tháng 01/2010 - 12/2016, có tất cả 75 trường hợp viêm não do HSV (3 trường hợp <
15 tuổi) tại Bệnh viện Bệnh Nhiệt đới TP. Hồ Chí Minh. 100% các ca bệnh có PCR-HSV dương tính trong DNT. Các triệu chứng chính ở bệnh nhân là sốt (99%), đau đầu (87%), rối loạn ý thức tại thời điểm nhập viện (86%) và co giật (43%). Có 56% (24/43) trường hợp có bất thường trên CT-Scan sọ não và 91% (21/23) trường hợp bất thường trên MRI sọ não. Có 93% (70/75) bệnh nhân được điều trị với thuốc kháng virus (acyclovir truyền tĩnh mạch: 62/70, valacyclovir uống: 8/70). Trong các trường hợp viêm não HSV được điều trị tại Bệnh viện Bệnh Nhiệt đới TP. Hồ Chí Minh, tỷ lệ tử vong tại thời điểm xuất viện là 11,3% (8/71). Phân tích hồi quy đa biến (đối với các trường hợp có điều trị thuốc kháng virus) cho thấy điểm Glasgow tại thời điểm bắt đầu điều trị loại thuốc kháng virus đầu tiên có liên quan đến kết cục xấu của bệnh nhân tại thời điểm xuất viện (OR 0,60
KTC95%: 0,40 - 0,90
p = 0,013) và thời điểm sau xuất viện 6 tháng (OR 0,47
KTC95%: 0,24 - 0,93
p = 0,03). Kết luận: Điểm Glasgow tại thời điểm bắt đầu điều trị loại thuốc kháng virus đầu tiên là yếu tố tiên lượng độc lập kết cục xấu của bệnh nhân viêm não HSV tại thời điểm xuất viện và sau xuất viện 6 tháng.

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