2013-2016年济南市急性细菌性脑膜炎及其常见致病菌流行病学特征分析

Analysis of common pathogens and epidemiological characteristics of acute bacterial meningitis cases in Shandong Province

目的分析山东省济南市急性细菌性脑膜炎(ABM)哨点监测病例及其常见致病菌的流行病学特征。方法收集2013—2016年济南市6家急性脑膜炎脑炎症候群(AMES)哨点监测医院上报的AMES病例的个案调查资料、临床信息,并采集病例血清和(或)脑脊液标本,共3918例;采用实时荧光定量聚合酶链反应、细菌培养和乳胶凝集方法,对标本进行脑膜炎奈瑟菌(Nm)、肺炎链球菌(Sp)和流感嗜血杆菌(Hi)检测。采用χ2检验比较不同特征ABM病例,Nm、Sp和Hi感染病例临床和流行病学特征差异。结果2013—2016年共479例诊断为ABM,其中82例为实验室确诊病例,Nm、Sp和Hi感染病例分别为54、25和3例。不同年龄组ABM病例的病程差异有统计学意义(χ^2=40.95,P<0.001),≤6和7~17岁者病程均以14~28d为主,分别占63.6%(161/253)和55.9%(33/59),≥18岁者以<14d为主(59.9%,100/167))。Nm脑膜炎病例发病时间主要为10月至次年3月(75.9%,41/54);不同年龄组的病程差异有统计学意义(χ^2=8.44,P=0.015),≤6和7~17岁者病程均以<14d为主,分别占81.0%(17/21)和16/18,≥18岁者以14~28d为主(8/15)。Sp脑膜炎病例发病时间主要为12月至次年5月(84.0%,21/25),不同年龄组的病程差异有统计学意义(χ^2=6.62,P=0.037),≤6和7~17岁者病程均为14~28d,≥18岁者以<14d为主(9/17)。ABM病例中,痊愈或好转者占91.0%(436/479),不同年龄组转归情况差异有统计学意义(χ^2=22.77,P<0.001),≤6和7~17岁者痊愈及好转的比例较高,分别为94.9%(240/253)和98.3%(58/59),≥18岁病例较低,为82.6%(138/167)。Nm和Sp感染病例痊愈或好转者分别占87.0%(47/54)和92.0%(23/25),均无死亡病例,而3例Hi感染病例均痊愈或好转。结论山东省济南市ABM发病以<18岁低年龄人群为主,而大年龄组病例预后相对较差;ABM首要致病菌为Nm,其次为Sp和Hi,不同致病菌引起的病例在流行病学特征和病程上具有较大差异。

Objective To analyze epidemiological characteristics of acute bacterial meningitis (ABM) cases and the common pathogens infected in Jinan, Shandong Province. Methods Epidemiological and clinical informations and cerebrospinal fluid (CSF) and blood specimens of acute meningitis/encephalitis syndrome (AMES) cases (total 3 918 cases) were collected in the six sentinel hospitals from 2013 to 2016. neisseria meningitidis (Nm), streptococcus pneumoniae (Sp) and haemophilus influenza (Hi) were detected by the methods of real-time fluorescent quantitative polymerase chain reaction (Real-time PCR), bacterial culture and latex agglutination. χ^2 test was used to compare ABM cases with different feasures, and compare the difference of Nm, Sp and Hi cases in clinical and epidemiological characteristics. Results A total of 479 cases were diagnosed as ABM from 2013 to 2016, 82 cases of which were laboratory confirmed, including 54 cases infected with Nm, 25 cases infected with Sp, and 3 cases infected with Hi. The disease course in different age groups of ABM cases has statistically difference (χ^2=40.95, P<0.001). The disease course of under 6 (63.6%, 161/253) and 7 to 17 (55.9%, 33/59) years old ABM cases mainly required 14-28 days, and over 18 years old cases mainly required less than 14 days (59.9%, 100/167). For Nm cases, there was a main onset period from October to March (75.9%, 41/54);on the disease course, under 6 (81.0%, 17/21) and 7 to 17 (16/18) years old cases mainly required less than 14 days, while over 18 years old cases mainly required 14-28 days (8/15), and there was a statistically difference in different age groups (χ^2=8.44, P=0.015). For Sp cases, the major onset period was from December to May (84.0%, 21/25);on the disease course, all of under 6 and 7 to 17 years old cases were required 14-28 days, while over 18 years old cases mainly required less than 14 days (9/17), and there was a statistically difference in different age groups (χ^2=6.62, P=0.037). 91.0% of the ABM cases (436/479) were healed or improvement, with the relatively higher ratio in under 6 (94.9%, 240/253) and 7 to 17 (98.3%, 58/59) years old groups, and poorer ratio in over 18 years old group (82.6%, 138/167), and the difference was significant in different age groups (χ2=22.77, P<0.001). For Nm, Sp and Hi cases, the ratio of cases that were healed or improvement were 87.0% (47/54), 92.0% (23/25) and 3/3, respectively, and there were no death cases. Conclusion ABM cases were found mostly in under 18 years old group in Jinan, Shandong Province, and the bigger age group had poor prognosis. Nm was the major pathogen causing ABM, followed by Sp and Hi. Distinguished differences of epidemiological characteristics were found on ABM cases suffered with different pathogens infected.