儿童病毒性脑炎、脑膜炎92例临床及病毒病原学分析

Clinical Analysis and Pathogenic Study on 92 Cases of Viral Encephalitis and Meningitis in Children

目的:探讨儿童病毒性脑炎、脑膜炎脑脊液病毒病原学特点及临床表现差异。方法:应用酶联免疫吸附(ELISA)方法对92例临床诊断为病毒性脑炎、脑膜炎患儿的脑脊液进行肠道病毒(EV)、单纯疱疹病毒(HSV)I型和II型、EB病毒(EBV)、腺病毒(ADV)及流感病毒(FLuV)特异性IgM抗体检测。结果:脑脊液特异性IgM抗体检测阳性者56例,阳性率为60.8%(56/92)。其中,第一位病原是肠道病毒27例,其次是单纯疱疹病毒I型和II型共14例,单纯疱疹病毒感染致残率及病死率较高。结论:(1)肠道病毒是本地区儿童中枢神经系统病毒感染的主要病原,单纯疱疹病毒感染致残率及病死率较其它病毒高。早期应用阿昔洛韦治疗可明显改善愈后。(2)脑脊液中病毒特异性的IgM抗体检测可作为早期病原诊断的指标之一。

Objective. To investigate pathogenic characteristics in CSF and the difference of clinical manifestation between viral encephalitis and meningitis in children. Methods： The specific IgM antibodies of EV, HSV-Ⅰ, HSV-Ⅱ,EBV, ADV and FluV were determined by enzyme-linked immunosorbent assay （ELISA） in the cerebrospinal fluid （CSF） in 92 viral encephalitis and meningitis cases. Results： There were 56 patients in which the CSF specific IgM antibodies were positive（ 60. 8%）. From them there were 27 patients in which the EV took the first place in all pathogen and the HSV-Ⅰ and HSV-Ⅱ took the second place（there were 14 cases which carried whith them）. The disability and mortality rate of HSV is higher. Conclusion： （1）EV is still the leading cause of central nervous system infections in children in local area. The disability and mortality rate of HSV is higher than that of other virus, and treatment with acyclovir in early encephalitis can improve prognosis obviously. （2）The detections of the viral specific IgM antibodies in CSF may be one of the ways in early diagnosis.