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西北地区脑炎脑膜炎症候群病原谱分析
作者:张晓曙 王旭霞 于德山 蒋建祥 张广业 王芳 李慧
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摘要:

   目的了解西北地区脑炎脑膜炎症候群病原谱及分布特征。方法于2009年1月1日至2011年3月31日,在甘肃省、青海省、内蒙古自治区、新疆维吾尔自治区的相关医疗机构,选择569例具有脑炎脑膜炎症候群相关临床症状患者作为研究对象。其中,有515例采集到标本,共计1514份。检测患者血液和脑脊液标本中乙型脑炎病毒(JEV)、肠道病毒(包括柯萨奇病毒、埃可病毒、肠道病毒71型)、腮腺炎病毒、单纯疱疹病毒(HSV)等的IgM抗体;同时,检测患者血液和脑脊液标本中脑膜炎奈瑟菌(Nm)、b型流感嗜血杆菌(Hib)、葡萄球菌、肺炎链球菌、猪链球菌、大肠杆菌、隐球菌等。分析各类病原在不同地区、时间、年龄段的检出情况。结果在报告的患者中有16例检出病原细菌,检出率为3.65%,其中以肺炎链球菌为主(7例,占43.75%);有132例检出病毒,检出率为27.05%,以肠道病毒和HSV为主,分别为44例(33.33%)、42例(31.82%);病毒检出率呈季节趋势,均在每年6—11月为高峰,肠道病毒检出集中在7—9月,检出24例;HSV集中在6—8月,检出11例;腮腺炎病毒集中在7—12月,检出25例;未发现检出细菌具有明显的时间分布;肠道病毒和HSV主要分布在甘肃和青海,检出70例;腮腺炎病毒主要分布在甘肃,检出24例;JEV仅在甘肃有分布,检出20例;病毒病原在各年龄阶段均有检出,其中肠道病毒和腮腺炎病毒均以0~14岁人群检出为主,分别检出42和17例;JEV主要在15岁以上人群中检出,在20例中检出13例。结论我国西北地区急性脑炎及脑膜炎的主要病原体是病毒,15岁以下儿童脑炎脑膜炎患者的主要病原为HSV、腮腺炎病毒。

关键词:脑炎;脑膜炎;病原谱

Abstract:

   ObjectiveTo learn the characteristics of pathogen spectrum of Encephalitis /Meningitis in northwestern area of China. MethodsBetween January 1st 2009 and March 31st 2011, a total of 569 patients with clinical symptoms of Encephalitis/Meningitis were selected from the hospitals in Gansu, Qinghai,Inner Mongolia and Xinjiang province. 1514 samples of specimen were collected from the 515 patients, to detect the IgM of Japanese encephalitis virus (JEV), enterovirus (EV, including Coxsackie virus, ECHO virus and enterovirus 71), Mumps virus, Herpes simplex virus (HSV) in blood and cerebrospinal fluid. Meanwhile, Neisseria meningitis (Nm), Haemophilus influenzae Type B (Hib), Staphylococcus, Streptococcus pneumonia, Streptococcus Suis, E. Coli and Cryptococci were also identified. The detection results were analyzed by different region, time and age range. ResultsPathogenic bacteria were identified in the specimen from 16 patients, with the rate at 3.65%, of which the dominant ones were Streptococcus pneumonia (7 patients, 43.75%). Virus were identified in the specimen from 132 patients, with the rate at 27.05%, of which the dominant types were EV and HSV, accounting for 33.33% (44 cases) and 31.82% (42 cases) respectively. The detection rate of virus showed a significant seasonal trend, with the peak appearing between June and November each year. The peak of EV detection was between July and September, with 24 cases detected out; the peak of HSV was between June and August (11 cases detected out); mumps virus was mainly found between July and December (25 cases). There was no significant timedistribution found in the detection of bacteria. The EV and HSV were mainly distributed in Gansu and Qinghai province(70 cases);most of mumps virus were found in Gansu province (24 cases);and JEV were only found in Gansu province (20 cases). The viral pathogen spectrum was identified in all ages, and the EV and mumps virus were mainly found in children aged 0-14 years old(42 and 17 cases respectively); JEV were identified in people over 15 years old, with 13 detected out of the 20 patients. ConclusionThe main pathogen of acute encephalitis and meningitis in northwestern area of China was virus, and the main pathogens of encephalitis and meningitis in children under 15 years were Herpes simplex virus and Mumps virus.

Key words: Encephalitis;Meningitis;Pathogen spectrum

发表日期:2013/10

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