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肝移植术后人疱疹病毒6B型脑炎的多学科综合诊疗

郭亚飞 王继洲 朱泽斌 陈翠 刘国岩 群森 邓克学 黄德好 刘连新

郭亚飞, 王继洲, 朱泽斌, 等. 肝移植术后人疱疹病毒6B型脑炎的多学科综合诊疗[J]. 器官移植, 2021, 12(4): 465-471. doi: 10.3969/j.issn.1674-7445.2021.04.014
引用本文: 郭亚飞, 王继洲, 朱泽斌, 等. 肝移植术后人疱疹病毒6B型脑炎的多学科综合诊疗[J]. 器官移植, 2021, 12(4): 465-471. doi: 10.3969/j.issn.1674-7445.2021.04.014
Guo Yafei, Wang Jizhou, Zhu Zebin, et al. Multi-disciplinary team of human herpes virus-6B encephalitis after liver transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(4): 465-471. doi: 10.3969/j.issn.1674-7445.2021.04.014
Citation: Guo Yafei, Wang Jizhou, Zhu Zebin, et al. Multi-disciplinary team of human herpes virus-6B encephalitis after liver transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(4): 465-471. doi: 10.3969/j.issn.1674-7445.2021.04.014

肝移植术后人疱疹病毒6B型脑炎的多学科综合诊疗

doi: 10.3969/j.issn.1674-7445.2021.04.014
基金项目: 

安徽省学术和技术带头人及后备人选科研活动经费资助项目 2020H224

2019年度“科大新医学”联合基金 WK9110000055

详细信息
    作者简介:

    郭亚飞,男,1982年生,硕士,主治医师,研究方向为肝胆外科与肝移植,Email: guoyafei_2008@163.com

    通讯作者:

    黄德好,男,1972年生,博士,副主任医师,研究方向为肝胆外科与肝移植,Email: zssyhdh@126.com

  • 中图分类号: R617, R752.1

Multi-disciplinary team of human herpes virus-6B encephalitis after liver transplantation

More Information
  • 摘要:   目的  通过多学科综合诊疗(MDT)模式提高肝移植术后人疱疹病毒6B(HHV-6B)型脑炎诊治的效果。  方法  对1例罕见的肝移植术后HHV-6B型脑炎的病人进行MDT讨论,以制定有效的个体化治疗方案。  结果  肝移植术后第16日,病人出现头痛症状,第18日突然出现反应迟钝、神志不清、昏迷,伴不自主的四肢抽搐。血氨升高,头颅CT检查提示脑缺血性改变,脑电图检查提示癫痫发作。经MDT讨论,考虑肝移植术后神经系统感染,予以药物控制癫痫发作,行腰椎穿刺进行脑脊液检查,提示颅内压升高,脑脊液实时荧光定量聚合酶链反应(RT-qPCR)检测到HHV-6B核酸阳性,证实为HHV-6B型脑炎。调整免疫抑制剂,静脉给予更昔洛韦抗病毒治疗,同时积极防治并发症。4 d后癫痫发作症状消失,2周后神经系统症状明显改善。抗病毒治疗4周后病毒学检测结果为阴性,病人神经功能恢复正常。  结论  成人肝移植术后HHV-6B型脑炎罕见,多与免疫抑制剂使用后的病毒再激活有关,通过MDT模式可更全面了解病人的病情,制定更有效的个体化治疗方案,提高治疗的有效性及安全性。

     

  • 图  1  本例病人肝移植术前和术后头颅CT表现

    注:A图示术前未见明显异常; B图示术后脑缺血性改变。

    Figure  1.  Head CT findings of the patient before and after liver transplantation

    图  2  本例病人肝移植术后第1次头颅MRI表现

    注:A图为T2WI显示颞叶皮层下白质长T2信号,尤以左侧为甚; B图为DWI显示两侧颞下极灰质下白质信号受限; C图示ADC呈对称性低信号。

    Figure  2.  The first head MRI findings of the patient after liver transplantation

    图  3  本例病人诊断HHV-6B型脑炎时的头颅MRI表现

    注:A图为DWI显示两侧颞下极弥漫性受限,呈对称性,向上累及双侧基底节及颞叶内侧面灰质下白质区域; B图示ADC呈高信号。

    Figure  3.  The head MRI findings of the patient at the diagnosis of HHV-6B encephalitis

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出版历程
  • 收稿日期:  2021-03-23
  • 网络出版日期:  2021-07-13
  • 刊出日期:  2021-07-15

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