合肥市小儿b型流感嗜血杆菌性脑膜炎的发病调查

Pediatric haemophilus influenzae type bmeninngitis in hefei city:an epidemiologic study

目的了解合肥市小儿ｂ型流感嗜血杆菌（Ｈｉｂ）脑膜炎的流行情况。方法组成１３家医院的小儿化脓性脑膜炎协作组，收集合肥市１９９０～１９９２年３年的资料。监测所有临床诊断为急性细菌性脑膜炎的患儿，收集标本进行病原学研究。对脑脊液（ＣＳＦ）、血作常规细菌学检查，脑脊液、血和浓缩尿标本进行对流免疫电泳（ＣＩＥ）抗原检测，全部资料进行流行病学分析。结果３年中共有经临床确诊的小儿细菌性脑膜炎６０例，其中３１例（５１７％）Ｈｉｂ抗原阳性，而其中仅３例ＣＳＦ细菌培养出Ｈｉｂ。该市Ｈｉｂ脑膜炎年发病率１５岁以下儿童为４８１／１０万，５岁以下儿童为１０．６６／１０万，病死率为９７％，存活患儿２１４％留有精神和神经系统并发症和后遗症。结论用抗原检测结合细菌培养，可为９０％细菌性脑膜炎患儿作出病原学诊断。Ｈｉｂ是化脓性脑膜炎患儿中最常见的病原，但它的发病率较世界其它地区为低。

Objective To obtain epidemiologic information about Hib meningitis from Hefei. Methods Data were collected from 1990 to 1992 by a coordinative group including 13 hospitals. All children with a clinical diagnosis of acute bacterial meningitis were enrolled and specimens were taken for etiologic studies. CSF and blood were tested by standard bacteriologic technique. CSF, blood and concentrated urine were tested directly for detecting antigen by CIE. The data were analysed by epidemiologic methods. Results Of 60 cases of bacterial meningitis clinically diagnosed, 31 (51.7%) were CIE positive for Hib antigen.Only 3 cases of CSF culture were positive for Hib. The annual incidence of Hib meningitis in Hefei was culculated as 4.81 /100 000 children younger than 15 years and 10.66 /100 000 children younger than 5 years. The case fatality rate was 9.7%. 21.4% of survivors suffered from neurological or psychological problems. Conclusions Using antigen detection combined with bacterial culture, we could make etiologic diagnosis in 90% of the cases. Hib is the most common cause of bacterial meningitis, but the incidence is much lower than in most parts of the world.