广西急性脑炎脑膜炎症候群的监测与研究

Surveillance and research on acute meningitis,encephalitis syndrome in Guangxi,China

目的 系统监测急性脑炎脑膜炎症候群患者,分析其流行病学特征、病原谱构成,为科学防治脑炎脑膜炎症候群提供依据.方法 在人口约502万的广西贵港市建立急性中枢神经系统感染的症候群监测系统,开展血液和脑脊液标本的细菌学培养、乳胶凝集试验、实时荧光PCR、ELISA 等多种实验室检测,完成患者入院、出院2次流行病调查,按照WHO监测手册的患者定义将疑似患者分为流行性乙型脑炎（简称乙脑）、细菌性脑炎、可能的病毒性脑炎等6个分类,分析其流行病学特征.通过对比临床诊断与实验室检测结果评估症候群监测系统的收益.结果 在30个月的监测期内,共评估急性脑炎脑膜炎症候群患者1424例,报告年均临床发病率、死亡率、病死率分别为11.35/10万（1424/12 546 500人年）、0.43/10万（54/12 546 500人年）、3.79%（54/1424）;病原学确诊154例,其中乙脑103例、细菌性脑炎51例,估算年发病率分别为0.82/10万（103/12 546 500人年）、0.41/10万（51/12 546 500人年）;96.10%（99/103）的乙脑患者为10岁以下儿童,37.30%（19/51）的细菌性脑膜炎发生在5岁以下儿童中.乙脑、细菌性脑膜炎的临床误诊率分别为19.42%（20/103）和15.69%（8/51）.结论 急性脑炎脑膜炎症候群病原以病毒性为主,急性脑炎脑膜炎症候群主要危害10岁以下散居儿童,当前脑炎、脑膜炎的临床诊断存在一定比例的误诊.

Objective To estimate disease burden and epidemiological characteristics of acute meningitis/encephalitis,and provide the basis for the disease control strategy development.Methods A syndrome surveillance system was established in Guigang city with a population of 5 020 000.For the suspected cases, serum and CSF were collected,and bacterial culture,latex agglutination test,real-time PCR and ELISA tests were carried out. All involved cases were identified to 6 categories according to WHO case definition. Results 1424 suspected cases were evaluated in a surveillance of 30 months,yielding the incidence,mortality and mortality of 11.35/100 000（1424/12 546 500 person years）,0.43/100 000（54/12 546 500 person years）,3.79%（54/1424）respectively.A total of 103 and 51 cases were confirmed for JE,bacterial meningitis,with a incidence of 0.82/100 000（103/12 546 500 person years）,0.41/100 000（51/12 546 500 person years）.96.10%（99/103）of JE sases and 37.30%（19/51）bacterial meningitis cages occurred in＜10 years old children and＜5 years old children.A clinical misdiagnosis rate of 19.42%（20/103）and 15.69%（8/51）were obserred for JE and bacterial meningitis.Conclusion Acute encephalitis,meningitis syndrome can cause a higher burden of disease.of which the main components of viral encephalitis.Most of syndrome is occurred in summer and autumn,mainly reported in children of younger than 10 years old.A quite misdiagnosis would be made among meningitis and encephalitis syndrome cases.