逆转录多聚酶链反应对肠道病毒性脑膜炎、脑炎诊断价值探讨

RT-PCR assay for the diagnosis of enteroviruses meningitis and encephalitis

目的探讨中枢神经系统感染的病原体及其检测方法。方法应用逆转录多聚酶链反应（ＲＴ－ＰＣＲ）检测６４例无菌性脑膜炎及２７例无菌性脑炎患儿脑脊液（ＣＳＦ）中肠道病毒（ＥＶ）ＲＮＡ。结果急性期ＣＳＦ中ＥＶＲＮＡ阳性检出率为：无菌性脑膜炎６０９％，脑炎４８１％；阳性患儿恢复期ＣＳＦ仅个别阳性；对照组全部阴性。起病５天以内阳性率明显高于５天以后（Ｐ＜００５）；５～１０月份较１１～４月份发病率高（Ｐ＜００５）。２５例病毒分离阳性者中２４例ＲＴ－ＰＣＲ阳性，５３例病毒分离阴性者中１９例ＲＴ－ＰＣＲ阳性，ＲＴ－ＰＣＲ敏感性显著高于病毒分离的敏感性（Ｐ＜００１）。结论ＥＶ是引起中枢神经系统感染的重要病原体，ＲＴ－ＰＣＲ技术是诊断ＥＶ感染的有效方法。

Objective To investigate the etiologic agents of central nervous system infection and its diagnostic method.Methods The enteroviral RNA(EV RNA) were determined in cerebrospinal fluid(CSF) of 64 aseptic meningitis and 27 aseptic encephalitis by RT-PCR assay.Results EV-RNA were positive in 39 meningitis(60 9%) and 13 encephalitis(48 1%) .With documented EV infection in CSF,only a few samples were PCR positive in convalescence.All controls were negative.The positive rate within 5 days of onset were higher than that 5 days later(P<0 05).The incidence were significantly higher between May and October than between November and April(P<0 05).With the EV PCR,24 of 25 EV culture positive CSF samples contained EV RNA.19 of 53 EV culture negative CSF samples were PCR positive.Sensitivity of virus culture was less significant than RT-PCR(P<0 01).Conclusion EV is the common etiologic agents of central nervous system infection.RT-PCR is a facilitative method for the diagnosis of EV infection.