DISTINGUISHING ACYCLOVIR NEUROTOXICITY FROM ENCEPHALOMYELITIS
DISTINGUISHING ACYCLOVIR NEUROTOXICITY FROM ENCEPHALOMYELITIS
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DOI：
10.1111/j.1365-2796.1993.tb00785.x
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发表时间：
1993-11-01
影响因子：
11.1
通讯作者：
WILSON, FM
中科院分区：
文献类型：
--
作者：
RASHIQ, S;BRIEWA, L;WILSON, FM
目标.目的明确阿昔洛韦神经毒性的临床特点，并概述如何与病毒性脑炎鉴别。阿昔洛韦神经毒性病例系列。所有病例均在《医学索引》或无环鸟苷神经毒性的文献综述中报道，加上水痘带状疱疹和单纯疱疹病毒性脑炎的两项代表性研究。35例在阿昔洛韦治疗期间出现神经精神症状的患者。分析患者的人口统计学资料、危险因素、阿昔洛韦的剂量和持续时间、临床和实验室检查结果和结局。主要结局指标。所有临床及实验室检查结果均与病毒性脑炎有统计学差异。中位年龄为53.3岁。最常见的诱发因素是使用其他潜在神经毒性药物（17例）和急性或慢性肾衰竭（15例）。经常发现阿昔洛韦水平高于治疗范围。特征性表现为意识模糊15例，幻觉或谵妄9例，激越8例，嗜睡10例。少数患者伴有震颤（11例）。发烧、头痛、癫痫发作和局灶性神经系统发现明显罕见。除其他中枢神经系统疾病患者外，脑脊液和计算机断层扫描均正常。大多数患者在治疗后2天内出现症状，并在停用阿昔洛韦后数天内完全消退。阿昔洛韦神经毒性是一种自限性、剂量依赖性现象，在老年人、肾衰竭患者或与其他神经毒性药物联合使用时更常见。它与病毒性脑炎的区别在于它突然发作，没有发烧或头痛，缺乏局灶性神经学发现和正常的脑脊液。
Objectives. To define the clinical characteristics of acyclovir neurotoxicity and to outline how to distinguish it from viral encephalitis.Design. Case series of acyclovir neurotoxicity.Setting. All cases reported in Index Medicus or in bibliographic reviews of acyclovir neurotoxicity plus two representative studies of Varicella zoster and Herpes simplex virus encephalitis.Subjects. Thirty-five patients who developed neuropsychiatric symptoms during acyclovir therapy.Interventions. Analysis of the patients' demographics, risk factors, acyclovir dosages and duration, clinical and laboratory findings and outcome.Main outcome measures. All clinical and laboratory findings that were statistically significantly different from viral encephalitis.Results. The median age was 53.3 years. The most common predisposing factors were the use of other potentially neurotoxic medications (17 cases) and acute or chronic renal failure (15 cases). Acyclovir levels were frequently found above the therapeutic range. The characteristic manifestations were confusion (15 cases), hallucination or delirium (9 cases), agitation (8 cases) and lethargy (10 cases). Few patients had associated tremors (11 cases). Fever, headache, seizures and focal neurologic findings were distinctly rare. Cerebrospinal fluid and computed tomography were normal except in patients with other central nervous system disorders. Symptoms appeared within 2 days of therapy in the majority and resolved completely within several days of discontinuing acyclovir.Conclusions. Acyclovir neurotoxicity is a self-limiting, dose-dependent phenomenon which is more common in the elderly, in patients with renal failure or in association with other neurotoxic medications. It is distinguished from viral encephalitis by its sudden onset, absence of fever or headache, lack of focal neurologic findings and normal cerebrospinal fluid.