宜昌市2009-2010年脑炎脑膜炎症候群病原学分析

Etiologic agents of meningitis/encephalitis-syndrome in Yichang,Hubei(2009-2010)

目的探讨湖北省宜昌市脑炎/脑膜炎症候群病原谱构成和人群年龄构成特征,为脑炎/脑膜炎症候群的监测和预防控制提供科学依据。方法对宜昌市监测点2009-2010年报告的脑炎/脑膜炎等相关病例采集急性期血清和脑脊液,采用酶联免疫吸附试验检测乙脑病毒、柯萨奇病毒、埃可病毒、单纯疱疹病毒、腮腺炎病毒抗体;荧光定量PCR方法检测脑膜炎球菌、流感嗜血杆菌B群、肺炎球菌、新型隐球菌。结果共采集611例监测病例的452份血清标本和495份脑脊液标本。实验室确诊病毒性脑炎143例,其中乙脑病毒阳性23例,柯萨奇病毒阳性26例,埃可病毒阳性24例,单纯疱疹病毒阳性33例,腮腺炎病毒阳性37例。实验室确诊细菌性脑膜炎16例,其中脑膜炎球菌阳性9例、肺炎链球菌阳性5例、流感嗜血杆菌B群阳性1例和新型隐球菌阳性2例。结论肠道病毒(埃可和柯萨奇)是引起湖北省病毒性脑炎的主要病原,其次为腮腺炎病毒和单纯疱疹病毒;脑膜炎球菌是引起脑膜炎的主要病原。本研究提示:今后应加强肠道病毒性脑炎、单纯疱疹病毒性脑炎和腮腺炎病毒性脑炎等脑炎病例的监测和防治。

Objective To analyze the etiologic agents of meningitis/encephalitis-syndrome in Yichang,Hubei,and provide guidance for the prevention and control of meningitis and encephalitis.Methods An encephalitis/meningitis syndrome surveillance system was established in 6 hospitals in Yichang city.For the suspected cases,serum and CSF were collected.Enzyme-linked immuno-sorbent assay（ELISA） were used for the detection of lgM antibody to 5 kinds of viruses.Bacterial culture,PCR and ELISA tests were carried out to detect 4 kinds of bacteria.Results 452 serum samples and 495 CSF samples were collected in a total of 611 suspected cases from 2009 to 2010.The laboratory results were as follows：23 cases of JE,26 cases of coxsackie virus,24 cases of ECHO virus,37 cases of mumps,33 cases of herpes simplex virus,9 cases of meningococcus,5 cases of pneumococcal,2 case of cryptococcal and 1 case of haemophilus influenza group B were identified.Conclusions Enterovirus（coxsackie and ECHO） were the major pathogen of viral encephalitis;Herpes simplex virus,and mumps virus were also important pathogens for viral encephalitis.Epidemic cerebrospinal meningitis was the main component of bacterial meningitis.It is suggested that the surveillance and control of Enterovirus encephalitis,herpes simplex virus encephalitis and mumps virus encephalitis,etc,should be strengthened.