神经系统感染性疾病的病原学分析与规范化治疗的研究

Etiological analysis of nervous system infectious diseases and standardized treatment

目的研究神经系统感染性疾病的病原学特点及相应的规范化治疗方法,提高临床诊治水平。方法选取2008年1月-2013年1月入院诊治的神经系统感染性疾病患者55例,根据患者有无病原学检查分为试验组30例和对照组25例,对照组根据临床症状经验性诊断,试验组则在对照组基础上应用双抗体夹心ELISA法及真菌培养、细菌培养等鉴定患者病原学种类的方法诊断疾病,观察两组患者的诊断符合率、特异性及治疗效果。结果 55例患者经脑脊液(CSF)检查,检出单纯疱疹病毒、柯萨奇病毒、腺病毒、风疹病毒,分别占21.82%、18.18%、14.55%、12.72%;试验组诊断符合率为91.97%、诊断特异性为80.75%,对照组诊断符合率为55.01%、诊断特异性为39.22%;结核性脑膜炎痊愈14例,死亡1例,总有效率为85.19%;病毒性脑炎痊愈7例,死亡2例,总有效率为66.67%;化脓性脑膜炎痊愈2例,总有效率为100.00%;隐球酵母菌性脑膜炎痊愈3例,死亡1例,总有效率为71.43%。结论神经系统感染性疾病的病原学诊断有利于诊断疾病,防止误诊、漏诊等,并为临床规范化治疗提供可靠依据;规范化治疗在评估患者病情的基础上,施以对症治疗,可一定程度提高临床治疗有效率。

OBJECTIVE To study the etiological characteristics of the nervous system infectious diseases and put forward corresponding standardized treatment measures so as to improve the level of clinical diagnosis and treat‐ment .METHODS A total of 55 patients with nervous system infectious diseases ,who were treated in the hospital from Jan 2008 to Jan 2013 ,were enrolled in the study and divided into the experimental group with 30 cases and the control group with 25 cases according to the status of etiological examination ;the control group was received the empirical diagnosis on the basis of clinical symptoms ,while the experimental group was treated with double antibody sandwich ELISA ,fungal culture ,and bacterial culture to diagnose the diseases ;the accordance rate of di‐agnosis ,specificity ,and curative effect were observed and compared between the two groups .RESULTS The her‐pes simplex virus ,Coxsackie virus ,adenovirus ,and rubella virus were isolated from cerebral spinal fluid （CSF） specimens obtained from the 55 patients ,accounting for 21 .82% ,18 .18% ,14 .55% ,and 12 .72% ,respectively . The accordance rate of diagnosis was 91 .97% in the experimental group ,55 .01% in the control group ;the speci‐ficity of diagnosis was 80 .75% in the experimental group ,39 .22% in the control group .Totally 14 cases of tu‐berculous meningitis were cured ,and 1 case died ,with the total effective rate of 85 .19% ;7 cases of viral meningi‐tis were cured ,and 2 cases died ,with the total effective rate of 66 .67% ;2 cases of purulent meningitis were cured ,with the total effective rate of 100 .00% ;3 cases of cryptococcal meningitis were cured ,and 1 case died , with the total effective rate of 71 .43% .CONCLUSION The etiological diagnosis of the nervous system infectious diseases is conducive to the diagnosis of the disease and the prevention of misdiagnosis ,and it can provide reliable basis for standardized clinical treatment .To conduct the symptomatic treatment based on the evaluation of illness condition can improve the clinical efficacy to a certain degree .