神經流行病研究-從兒童期神經感染病到神經免疫性疾病相關性

Neuroepidemiology-from Childhood Neuroinfection to Correlations of Neuro-immunology Disorders

蔡政道(Jeng-Dau Tsai)

指導教授 ： 呂克桓

中山醫學大學/醫學院/醫學研究所/博士(2014年)

摘要

為了暸解兒童期神經疾病的流行情形，我們將從事三部分研究加
以探討兒童期神經流行病概況。首先探討腸病毒對兒童中樞神經系統的影響。因兒童期中樞神經感染疾病往往造成神經後遺症，在1998年流行性腸病毒71型腦脊髓炎在台灣造成家長及醫師極大恐慌及負擔。我們描述腸病毒71型腦脊髓炎臨床表現、診斷、腦部磁振造影檢查結果以及併發神經系統後遺症。我們的研究結果顯示，反轉錄-聚合酶反應法的檢出率明顯優於病毒培養，喉嚨/直腸拭子檢體侦測腸病毒率更高。在咽峽炎/手足口病腦脊髓炎中，頻繁的肌躍型抽搐及腦脊髓液細胞增多的神經後遺症風險較高。
其次以健康保險資料庫分析兒童期過敏性疾病和注意力缺損/過
動症有很強的關聯性，因神經免疫疾病涉及神經和免疫系統，但不限
於兩個系統的生理機能或兩個系統導致的其他疾病。本該研究健康保險資料庫呈現過敏性疾病和注意力缺損/過動症有很強的關聯，尤其是過敏性鼻炎。知道這些合併症的可以幫助臨床醫師且提供更好的全面照顧，以降低社會負擔。再其次以健康保險資料庫探討癲癇及紅斑性狼瘡的關係；抽搐和精神病兩種神經疾病是紅斑性狼瘡神經診斷標準。本研究呈現台灣紅斑性狼瘡患者併發癲癇及神經併發症的風險。

關鍵字

腸病毒 ； 脊髓炎 ； 神經系統後遺症 ； 反轉錄-聚合酶反應 ； 病毒培養 ； 磁振造影 ； 肌躍性抽搐 ； 腦脊髓液細胞增多 ； 過敏性疾病 ； 注意力缺損/過動症 ； 癲癇 ； 紅斑性狼瘡 ； 健康保險資料庫

並列摘要

To evaluate the neuroepidemiology in childhood, we underwent three
parts of studies to explor the features of neuroepidemiology in childhood. At first, issues of epidemic enterovirus were assessed for the neurological consquence. Neuroinfection diseases in childhood frequently subsequent neurological sequelae. Since 1998 in Taiwan, enterovirus 71 epidemics have caused encephalomyelitis and placed a significant burden on parents and physicians. We presented clinical manifestations, magnetic resonance imaging findings , laboratory identification and neurological sequelae on epidemic enterovirus -infected patients with neurological involvement. The results shows the detection rates of reverse transcription-polymerase chain reaction were superior to virus culture and identification with specimens from throat/rectal swabs yield higher positive results. Hand-foot-mouth disease carries a higher risk of neurological involvement, and frequent myoclonic jerks and pleocytosis of the CSF are risk factors for subsequent neurological sequelae.
Second, we correlate the association between allergic diseases and attension deficit/ hyperactivity disorder from health insurance database. Many neuroimmunological disorders involve both the nervous and immune systems including but not limited to the physiological functioning of the two systems or both systems that leads to disorders. The study displaysa strong association between allergic diseases with attention-deficit/ hyperactivity disorders, especially allergic rhinitis. Awareness of these comorbidities may help clinicians provide better comprehensive management and reduce the burden of disease. Third, we speculate the risk of epilepsy and neurological comorbidities in patients with systemic lupus erythematous from health insurance database. Seizures and psychosis are the only two neurological diagnostic criteria of systemic lupus erythematous. The study displays the risk of epilepsy and neurological comorbidities among the general population and SLE patients by using the health insurance database in Taiwan.

並列關鍵字

Enterovirus ； Encephalomyelitis ； Neurological sequelae ； Reverse transcription-polymerase chainreaction ； Virus culture ； Magnetic resonance imaging ； Myoclonic jerks ； Pleocytosis ； Allergic diseases ； Attention-deficit/ hyperactivity disorders ； Health insurance database

參考文獻

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