| In order to explore diagnosis and application-specific value of the virus antibody IgM detection of the viral encephalitis in cerebrospinal fluid and serum detection of viral encephalitis, during April 2007 to June 2008 78 cases who attended to our hospital were inrowed, diagnosed as viral encephalitis (46 cases), meningitis (32 cases) patients. After they was admitted to hospital , within 10 days ,all were given blood and cerebrospinal fluid test to detect IgM antibodies, including Coxsackie virus (COXV) antibody IgM, herpes simplex virus (HSV) antibody IgM, EB virus (EBV) antibody IgM, cytomegalovirus (CMV) antibody IgM, adenovirus (ADV) antibody IgM, respiratory syncytial virus (RSV). And most patients had endoscopic cytology classification.From the above work, we got the results as followed:1. Clinical manifestations: 61 cases of the 78 patients presented with clinical symptoms of fever, 48 cases with clinical symptoms of headache, 50 cases with meningeal irritation. 31 cases of 46 cases of viral encephalitis patients with clinical symptoms of fever, 18 cases clinical symptoms of headache, 21 cases with mental disorders, 23 cases with convulsions, 17 cases with disturbance of consciousness, 5 cases with cranial nerve barrier, 2 cases with hemiplegia, 26 cases with meningeal irritation, 16 cases with positive pathological symptoms; 30 cases of 32 viral meningitis patients presented with clinical symptoms of fever, 30 cases clinical symptoms of headache, 24 cases with meningeal irritation. 57 cases of 78 patients had abnormalities in the cerebrospinal fluid biochemical test, 16 cases with intracranial hypertension, 36 cases of 46 viral encephalitis patients presented abnormal EEG, 25 cases presented abnormalities in head CT or MRI.2. Antibody detection: 78 cases were all given serum IgM antibody detection, 48 cases of them were positive. 17 cases of the 48 patients presented postive with the Coxsackie virus, 8 cases with herpes simplex virus, 11 cases with EB virus, 6 cases with cytomegalovirus, 8 cases with adenovirus, 8 cases with respiratory syncytial virus. 52 cases of 78 patients were given cerebrospinal fluid IgM antibody detection, 9 cases of them were positive. 2 cases of the 9 patients presented postive with the Coxsackie virus, 3 cases with herpes simplex virus, 3 cases with EB virus, 0 cases with cytomegalovirus, 1 cases with adenovirus, 2 cases with respiratory syncytial virus. In control group, 3 cases were postive in 39 cases of virus antibodies in the serum IgM detection, respectively,1 cases with Coxsackie virus, 1 cases with adenovirus, 1 cases with respiratory syncytial virus. While in the cerebrospinal fluid IgM antibody detection ,the Control group were negative.3. Statistical treatment(1) Statistical analysis the serum antibody test results between the case group and control group : 48 cases of 78 patients were positive in the serum antibody test, 30 cases were negative; 3 cases of 39 cases in control group were positive in the serum antibody test, 36 cases were negative. After statistical analysis,χ2 = 30.65, P <0.05, the difference of serum IgM in case group compared with the control group is significant.(2) Statistical analysis the cerebrospinal fluid antibody test results between the case group and control group : 9 cases of 52 patients were positive in the cerebrospinal fluid antibody test, 43 cases were negative; 0 cases of 39 cases in control group were positive in the cerebrospinal fluid antibody test, 39 cases were negative. After statistical analysis,χ2 = 5.69 , P< 0.05, the difference of cerebrospinal fluid IgM in case group compared with the control group is significant.(3) The consistent rate analysis of antibody detection in case group: antibody test results of 52 cases (serum IgM and cerebrospinal fluid IgM were both detected), 6 cases presented postive both in the blood and cerebrospinal fluid with the same virus antibody, while 14 cases presented postive both in the blood and cerebrospinal fluid with the same virus antibody, consistent rate of 38.5% (20 / 52). After statistical analysis,χ2 = 0.019, P> 0.05, There was no significant difference on two specimens in the detection rate(4) Cytology: 39 patients of the 78 cases had regular endoscopic cytology classification, 32 cases were predominanced with lymphocyte, 1 cases mainly with mononuclear cells, and 6 cases mainly with neutrophils. From the above results, we got the conclusion as followed:1.Fever and headache are almost common clinical manifestations of viral encephalitis and meningitis. Encephalitis can presented with nerve function disorders such as mental disorders, convulsions, disturbance of consciousness, cranial nerve barriers, hemiplegia, pathological signs,which meningitis don't involved.2. The highest detection rate in serum and CSF is enterovirus virus IgM (mainly COXV) and herpes virus (including CMV, HSV, EBV). Consideringly viral encephalitis and meningitis in this region mainly caused by enterovirus and herpes simplex virus, among them COXV and EBV are the major pathogen. Adenovirus, respiratory syncytial virus may also lead to encephalitis.3. Central nervous system infection could be caused by a variety of virus, the highest rate is enterovirus ,and the sencond is the herpes virus. In addition, some respiratory viruses may also be concerned with viral encephalitis. Therefore, it is concluded that a variety of virus antibody detection can do more to help for clinical diagnosis.4. The results of detecting on serum IgM and cerebrospinal fluid IgM test is , consistent .The consistent rate is 38.5%; by statistical analysis, two specimens on the detection rate had no significant difference ,so serum IgM and cerebrospinal fluid IgM detection have the same value.5. The blood and cerebrospinal fluid antibody test results of case group and control group, after statistical treatment are found significant differences, so the specificity of ELISA method is good; ELISA assay used in virus-specific IgM antibodies testing is the more satisfactory method for early identification of viral encephalitis pathogen, compared to the damage to the brain of the biopsy and the complexity of PCR technology. ELISA method is more suitable for a wide range of application.6. In Central nervous system virus infection, cytological changes happen in the early stage of the disease , particularly helpful to distinguish the central nervous system infection between viral infection and bacterial infection. CSF cytology test is an important laboratory indicators for central nervous system virus infection diagnosis. Especially when other tests are not typical, it is more valuble. 7. Rapid and simple as it is, CSF cytology is one of the important indexes in CNS infection diagnosis. Cerebrospinal fluid cytology is not expensive and easy to carry out.8. ELISA assay teating virus-specific IgM and cytology are helpful for the early diagnosis of viral encephalitis and viral meningitis...
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