PDF(Pubmed)
Abstract：
Acute necrotizing encephalopathy (ANE) is a rare but deadly complication with an unclear pathogenesis. We aimed to elucidate the immune characteristics of H1N1 influenza virus-associated ANE (IANE) and provide a potential therapeutic approach for IANE. Seven pediatric cases from a concentrated outbreak of H1N1 influenza were included in this study. The patients\' CD4+ T cells from peripheral blood decreased sharply in number but highly expressed Eomesodermin (Eomes), CD69 and PD-1, companied with extremely high levels of IL-6, IL-8 in the cerebrospinal fluid and plasma. Patient 2, who showed high fever and seizures and was admitted to the hospital very early in the disease course, received intravenous tocilizumab and subsequently showed a reduction in temperature and a stable conscious state 24 h later. In conclusion, a proinflammatory cytokine storm associated with activated CD4+ T cells may cause severe brain pathology in IANE. Tocilizumab may be helpful in treating IANE.
摘要：
急性坏死性脑病（ANE）是一种罕见但致命的并发症，发病机制尚不清楚。我们旨在阐明H1N1流感病毒相关ANE（IANE）的免疫特征，并为IANE提供潜在的治疗方法。本研究包括7例H1N1流感集中爆发的儿科病例。患者外周血CD4+T细胞数量急剧下降，但高表达Eomesodermin（Eomes），CD69和PD-1在脑脊液和血浆中伴有极高水平的IL-6，IL-8。患者2表现出高烧和癫痫发作，并在病程早期入院。接受静脉托珠单抗治疗,随后24小时后体温降低,意识状态稳定.总之,与活化的CD4+T细胞相关的促炎细胞因子风暴可能在IANE中引起严重的脑部病理。Tocilizumab可能有助于治疗IANE。
