65例流行性脑脊髓膜炎患者的临床特征及流行病学分析

Clinical and epidemiological analysis of 65 cases of epidemic cerebrospinal meningitis

目的 总结2003年以来合肥流行性脑脊髓膜炎（流脑）的临床特征，为今后的流脑防治工作积累经验。方法 对65例流脑患者的临床资料进行回顾性分析，统计分析采用卡方检验。结果 患者主要集中在青少年和成人，分别为29例（44．6％）和23例（35．4％），婴幼儿最少，仅4例（6．2％）。临床分型以普通型为主，占72．3％，暴发型占27．7％，死亡5例（7．7％）。共分离出33株脑膜炎奈瑟菌，培养阳性率为50．8％（33／65例），其中，血培养阳性率为44．6％（29／65例），脑脊液培养阳性者占31．4％（16／51例）。药物敏感结果显示，无论是C群脑膜炎奈瑟菌还是其他群，对青霉素、头孢曲松、头孢噻肟等普遍敏感，而对复方磺胺甲略唑、庆大霉素、环丙沙星等耐药率都在80％以上。血清学分类显示，高达82．8％（53／64例）的患者为C群菌株感染，与其他群流脑比较，C群感染者病情重，病死率高。结论 C群脑膜炎奈瑟菌已成为目前安徽省流脑流行的主要菌株，C群感染者多见于青少年和成人。治疗以青霉素、第三代头孢菌素类抗菌药物为佳。

Objective To investigate the clinical and epidemiological features of epidemic cerebrospinal meningitis in recent 3 years, aiming to develop the strategies for controlling this disease. Methods A retrospective analysis was conducted in 65 hospitalized patients with epidemic cerebrospinal meningitis from 2003 to 2006. Chiquare test was used for statistical analysis. Results The majority of these 65 patients were juvenile and adult, accounting for 44.6% （29 cases） and 35.4% （23 cases）, respectively, while the infant patients account for the smallest percentage, only 6. 2% （4 cases）. Most cases occurred in spring（from February to April）. The clinical features of most patients belonged to common type（72.3 %）, followed by fulminant type（27.7 % ）. Five cases（7.7% ） died, all of whom were fulminant cases. Totally 33 strains of Neisseria meningitidis were isolated, with positive culture rate of 50. 8% （33/65 cases）. The positive rate of blood culture was 44. 6% （29/65 cases） and that of cerebrospinal fluid culture was 31.40% （16/51 cases）. Isolates of Neisseria meningitidis were still highly sensitive to penicillin, ceftriaxone and cefotaxime. However, the resistance rates of strains to compound sulfamethoxazole, gentamycin and ciprofloxacin were all above 80%. Results of serological typing revealed that 82.8% （53/64 cases） cases belonged to group C. There were more severe cases and higher death rate in patients infected by group C meningococcus. Conclusions Serogroup C of the meningococcus have become the preponderant strains in Anhui Province. Most of the patients infected by group C are juveniles and adults. Penicillin and the third generation cephalosporins are still highly active against Neisseria meningitidis.