2009-2011年甘肃省病毒性脑炎流行病学及主要临床症状分析

Analysis on epidgmiology and the main clinical symptoms of viral encephalitis in Gansu, 2009 -2011

目的了解甘肃省病毒性脑炎流行病学特征及主要临床症状。方法于2009--2011年，以甘肃省各监测哨点医院中监测到的322例病毒性脑炎患者为调查对象，收集患者基本信息，并采集其血液标本和脑脊液标本。其中，296例患者采集到合格标本，纳入研究。结合患者疾病流行特征和临床特征，确定进行检测的病毒种类（均至少检测1种病毒）。应用ELISA法检测患者血液和脑脊液标本中乙型脑炎（简称乙脑）病毒（JEV）、肠道病毒（EV；包括柯萨奇病毒、埃可病毒、肠道病毒71型）、腮腺炎病毒、单纯疱疹病毒（HSV）等的IgM抗体。对各病毒检测阳性率之间的差异，不同地区、不同时间、不同年龄段患者各病毒检测阳性率的差异，以及乙脑患者和其他病毒性脑炎患者各临床症状发生情况的差异进行比较。结果296例患者病毒检测阳性率27．03％（80／296）。JEV、EV、腮腺炎病毒、HSV检测阳性率分别为7．53％（22／292）、8．75％（23／263）、13．84％（22／159）、15．09％（40／265），各病毒检测阳性率不同，差异有统计学意义（X^2=10．849，P〈0．05）。90．91％（20／22）的JEV检测阳性患者分布于天水、陇南、平凉市，且主要于7-9月发病，占95．45％（21／22）。23例EV检测阳性患者均于4-12月发病，且年龄分布为1～44岁。腮腺炎病毒、HSV检测阳性患者各月均有发病。logistic回归分析发现，出现意识障碍（OR=15．487，95％CI：2．266—105．852）、嗜睡（OR=11．659，95％CI：1．783～76．242）、抽搐（OR=11．062，95％CI：1．687—72．530）等症状的病毒性脑炎患者感染JEV的可能性较大。结论HSV是甘肃省病毒性脑炎的最主要病原；JEV感染在时间和地区分布上有明显集中趋势，且乙脑患者的临床症状较重。

Objective To understand the epidemiological characteristics and the main clinical symptoms of vi/al encephalitis in Gansu. Methods A total of 322 viral encephalitis patients were recruited from province sentineled hospitals in Gansu province from 2009 to 2011, and their basic information were collected as well as their serum samples and cerebrospinal fluid samples. 296 out of the 322 cases were qualified for our study. Based on the patients＇ epidemiological characteristics and clinical features, we determined the detection of the virus types （ at least one kind of virus detection was carried out for each case）. ELISA was applied to test the IgM antibody of Japanese encephalitis （JE） virus （JEV）, enterovirus （EV：including Coxsackie virus, echovirus, enterovirus 71 ）, mumps virus and herpes simplex virus （HSV） in cerebrospinal fluid and serum specimen. The difference of positive detected rate between types of virus, among patien!s from different regions, time, or at different ages, as well as the different clinical symptoms between JE patients and other viral encephalitis patients, were analyzed and compared. Results The positive detected rate of virus in the 296 patients was 27.03% （80/296） ; the positive rate of JEV, EV, mumps virus, HSV detected was separately 7.53% （22/292）, 8.75% （23/263）, 13.84% （22/159） and 15.09% （40/265）, and the difference was statistically significant （X2 = 10. 849, P 〈 0.05 ）. 90.91% （20/22） of the JEV positive cases were distributed in Tianshui, Longnan and Pingliang, and 95.45% （21/22） patients were infected from July to September. All the 23 EV detected positive patients were infected from April to December, while the ages of patients ranged from 1 to 44 years old. Mumps virus, HSV testing positive cases had onset every month. Logistic regression analysis showed that the patients who had the symptoms as disturbance of consciousness （ OR = 15.487, 95% CI： 2. 266 - 105. 852）, somnolence （OR = 11. 659, 95% CI： 1. 783 - 76. 242）, convulsions （ OR = 11. 062, 95% CI： 1. 687 - 72. 530） were more likely to infect JEV. Conclusion HSV was the principal pathogen of viral encephalitis in Gansu. An obvious central tendency in the regional and time distribution was found in JEY infection; and the clinical symptoms of JE patients were more severe.