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目的 探讨单纯疱疹病毒1型(Herpes simplex virus,HSV-1)载量与病毒性脑炎(VE)患者胶质纤维酸性蛋白(GFAP)、神经丝轻链蛋白(NFL)水平的关系，并研究HSV-1载量、GFAP、NFL水平对患者继发癫痫的影响。方法选取我院2021年1月-2025年1月收治的病毒性脑炎患者184例，依据HSV-1载量分为高HSV-1组(103例)和低HSV-1组(81例)。根据患者继发癫痫情况，分为癫痫组(108例)和非癫痫组(76例)。收集患者临床资料，检测患者脑脊液HSV-1载量、GFAP、NFL水平。用Spearman分析HSV-1载量与VE患者脑脊液GFAP、NFL水平的相关性，VE患者继发癫痫与HSV-1载量、脑脊液GFAP、NFL水平的相关性。采用Logistic回归分析VE患者继发癫痫的影响因素。采用受试者工作特征(ROC)曲线分析HSV-1、脑脊液GFAP、NFL水平对VE患者继发癫痫的预测价值。结果 高HSV-1组患者脑脊液GFAP、NFL水平均高于低HSV-1组(P<0.05)。VE患者脑脊液中HSV-1载量与GFAP、NFL水平呈正相关(P<0.05)。癫痫组患者脑脊液GFAP、NFL水平、HSV-1载量及脑电图(EEG)中重度异常比例、颅脑磁共振(MRI)中重度异常比例均高于非癫痫组患者(P<0.05)。VE患者继发癫痫与脑脊液HSV-1载量、GFAP、NFL水平呈正相关(P<0.05)。结果显示EEG中重度异常、MRI中重度异常、脑脊液HSV-1载量≥104拷贝/mL、脑脊液GFAP、NFL水平升高为VE患者继发癫痫的危险因素(P<0.05)。脑脊液HSV-1载量、GFAP、NFL水平及三种指标联合预测VE患者继发癫痫的曲线下面积(AUC)分别为0.741、0.759、0.761、0.896，约登指数分别为0.483、0.506、0.502、0.695。结论 VE患者HSV-1载量与脑脊液GFAP、NFL水平相关，脑脊液HSV-1高载量、脑脊液GFAP、NFL水平升高是VE患者继发癫痫的危险因素，HSV-1载量、脑脊液GFAP、NFL水平具有作为VE患者继发癫痫预测指标的潜力。
Abstract：Object To explore the relationship between herpes simplex virus type 1(HSV-1) viral load and cerebrospinal fluid(CSF) levels of glial fibrillary acidic protein(GFAP) and neurofilament light chain(NFL) in patients with viral encephalitis(VE), and evaluated the predictive value of these biomarkers for secondary epilepsy. Methods A total of 184 VE patients admitted between January 2021 and January 2025 were enrolled. Based on CSF HSV-1 load, patients were categorized into a high–HSV-1 group(n=103) and low–HSV-1 group(n=81). According to whether secondary epilepsy occurred, patients were divided into an epilepsy group(n=108) and a non-epilepsy group(n=76). Clinical data were collected, and CSF HSV-1 load, GFAP, and NFL levels were measured. Spearman's correlation analysis was used to assess associations between HSV-1 viral load and GFAP/NFL levels, as well as their relationship with secondary epilepsy. Logistic regression was applied to identify factors associated with secondary epilepsy. Receiver operating characteristic(ROC) curves were constructed to evaluate the predictive performance of HSV-1 load, GFAP, and NFL. in the cerebrospinal fluid for the secondary epilepsy of VE patients. Results The levels of CSF GFAP and NFL levels were significantly higher in the high– HSV-1 group than in the low – HSV-1 group(P<0.05). CSF HSV-1 load was positively correlated with GFAP and NFL levels(P<0.05). Compared with the non-epilepsy group, the epilepsy group showed significantly higher CSF HSV-1 viral load, elevated GFAP and NFL levels, and higher proportions of severe abnormalities on electroencephalography(EEG) and magnetic resonance imaging(MRI)(all P<0.05). Secondary epilepsy was positively correlated with the HSV-1 viral load, GFAP, and NFL levels(P<0.05). Logistic regression identified severe EEG abnormalities, severe MRI abnormalities, CSF HSV-1 load ≥ 104 copies/mL, elevated GFAP, and elevated NFL as independent risk factors for secondary epilepsy(P<0.05). The area under the ROC curve(AUC) for predicting secondary epilepsy using HSV-1 viral load, GFAP, NFL, and the combined model was 0.741, 0.759, 0.761, and 0.896, respectively, with corresponding Youden indices of 0.483, 0.506, 0.502, and 0.695.Conclusion These findings indicate that CSF HSV-1 viral load is closely associated with GFAP and NFL levels in VE patients. High viral load and elevated GFAP and NFL are important risk factors for secondary epilepsy, and these biomarkers individually and in combination show promising predictive value for epilepsy following VE.
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基本信息:
DOI：10.13242/j.cnki.bingduxuebao.250277
中图分类号:R742.1;R512.3
引用信息:
[1]申冠洋,程舒心.HSV-1载量与病毒性脑炎患者GFAP、NFL的关系及对继发癫痫的评估价值研究[J].病毒学报,2026,42(01):193-199.DOI:10.13242/j.cnki.bingduxuebao.250277.
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