Analysis Of Therapeutic Effect Of Immunotherapy On Acute Severe Viral Encephalitis And Meningoencephalitis

Background:Viral encephalitis and meningoencephalitis are the most common types of central nervous system infections,which are inflammatory and reactions caused by viruses directly invading the nervous system and related tissues.Patients often have fever,headache,abnormal mental behavior,epilepsy,focal nerve defect symptoms.Viral encephalitis occurs rapidly and progresses rapidly,severe patients may have disturbance of consciousness or even life-threatening due to the rapid increase of intracranial pressure.Patients with viral encephalitis has a high mortality.After definite diagnosis,starting antiviral therapy as early as possible can improve the prognosis.At present,the recommended antiviral therapy should last at least 14 days,and for patients with immunosuppression,it should be extended to 21 days,while appropriate antiepileptic,intracranial pressure reduction,electrolyte balance and other symptomatic support treatment should be given.For patients with severe brain edema,corticosteroids and intravenous immunoglobulin(IVIG)are often used empirically.However,there is no clear conclusion on the efficacy and safety of glucocorticoid and IVIG,and more research is needed on the dosage and timing of graded treatment for mild and severe patients.Objective:To explore the effect of immunotherapy on the short-term prognosis of severe viral encephalitis and meningoencephalitis.Methods:A total of 193 patients with viral encephalitis and meningoencephalitis treated with antiviral therapy for at least 14 days from January 1,2016 to December 31,2021 in the Department of Neurology of Shandong Provincial Hospital were collected.The peak modified Rankin Score(mRS)of all patients were≥3.The clinical features,laboratory examinations and imaging data were analyzed retrospectively.All patients were divided into two groups according to whether immunotherapy was added or not:1.Antiviral treatment only,38 cases;2.Antiviral combined with glucocorticoid and/or IVIG group,155 cases.The reduction of mRS score and the incidence of nosocomial infection between the two groups were analyzed in order to evaluate the efficacy and safety of immunotherapy.Results:(1)The average age of 193 patients was 39.24 years old,and the median hospital stay was 14.06 days.There were 39 cases(20.2%)with infectious inducement.Fever and headache were the most common first symptoms in 86 cases(45%)and epilepsy in 14 cases(7.3%).(2)Viral encephalitis/meningoencephalitis had a good prognosis:The average mRS score of all patients decreased by 2.42 points at discharge,and the average improvement rate was 73%.The Δ mRS of patients with chronic diseases was lower(P<0.05).(3)Imaging examination,electroencephalograph(EEG)and cerebrospinal fluid analysis are all important auxiliary means for diagnosis:The next-generation sequencing of cerebrospinal fluid was positive in 9 patients,of which Herpes simplex virus type 1(3 cases)was the most common pathogen.Imaging examination showed that 74 cases(38.3%)had signs of inflammation,mostly unilateral involvement.The most common areas involved were frontal lobe,temporal lobe and insular lobe.EEG abnormalities occurred in 100 cases(52.0%),mainly with diffuse slow wave or background rhythm changes.There were 172(89.12%)patients had at least one abnormal cerebrospinal fluid examination(pressure,cell counts and protein quantity).In peripheral blood,neutrophil-to-lymphocyte ratio(NLR),erythrocyte sedimentation rate,C-reactive protein and lactate dehydrogenase were increased.(4)The addition of immunotherapy can improve the short-term prognosis of patients:After adjusting confounding factors,binary Logistic regression analysis showed that Δ mRS in immunotherapy group was higher than that in antiviral treatment group(P=0.03,OR=2.868,95%CI:1.129～7.284).ROC curve shows that the area under the curve was 0.617.(5)The addition of immunotherapy was safe:A total of 26 cases of nosocomial infection occurred during hospitalization,including 23 cases of pulmonary infection and 3 cases of urinary tract infection.There were 23 cases in immunotherapy group and 3 cases in antiviral therapy group.There was no significant difference in the incidence of nosocomial infection between the two groups(P=0.62).Conclusion:The addition of immunotherapy can improve the short-term prognosis of patients without increasing the incidence of nosocomial infection.