泸州市2013-2014年流行性乙型脑炎临床特征分析

Clinical features analysis of epidemic encephalitis B in Luzhou during 2013-2014

目的分析泸州市近两年流行性乙型脑炎的临床特征及差异,为诊治乙脑提供参考。方法回顾分析44例乙脑患者的临床资料,总结2013年组28例和2014年组16例的年龄、发病季节和地域分布特点,分别比较两组的预防接种率、临床表现、实验室检查、疗效及死亡率。结果 2013年均为儿童患者,2014年乙脑发病例数减少,并出现成人患者,发病月份为7~9月,所有患者均来自农村,仅34.1%的患者接种过乙脑疫苗,两组乙脑疫苗接种率比较,差异无统计学意义（P〉0.05）。临床表现常见发热、抽搐、意识障碍,2014年组头痛、呼吸衰竭、脑膜刺激征阳性的发生率较2013年组高（P〈0.05）,2014年极重型患者比例高于2013年（P〈0.05）。实验室检查可有外周血白细胞增高、贫血、血小板升高及生化学改变,34例患者入院时肌酐值降低,2013年肌酐下降比例明显高于2014年（P〈0.001）;两组脑脊液细胞数及蛋白改变差异无统计学意义（P〉0.05）;血清乙脑特异性IgM抗体阳性率为65.8%,2013年乙脑IgM抗体阳性率高于2014年（P〈0.01）。经过治疗44例患者痊愈26例,好转10例,死亡8例。两组疗效比较差异有统计学意义（P〈0.001）,2014年死亡率高于2013年（P〈0.05）。结论泸州市乙脑发病有明显季节性,患者以儿童居多,近年成人乙脑增多,病情重,疗效预后差,尤其是农村应该重视预防接种,临床警惕成人乙脑的发病,早诊断早治疗可降低病死率。

Objective To comprehend the clinical features and differences of Luzhou epidemic encephalitis B nearly two years for the diagnosis and treatment of epidemic encephalitis B.Methods Clinical information of 44 epidemic encephalitis B patients were collected to retrospectively analyze.The characteristics of age,seasonal and regional distribution between 2013 and 2014group were analyzed.In addition,the immunization rates,clinical manifestation,laboratory examination,efficacy and mortality in two groups were compared.Results Compared with 2013 group,the incidence of epidemic encephalitis B of the 2014 group decreased.The cases occurred from July to September.All these patients were from the countryside.Only 34.1% patients inoculated encephalitis B vaccine.There was no statistically significant difference in the vaccination of two groups（P0.05）.The patients usually presented with fever,convulsions,consciousness obstacle.The incidences of headache,respiratory failure and positive meningeal stimulation of 2014 group were higher than that of 2013 group.The proportion of extremely serious patients of 2014 group was higher than that of 2013group（P0.05）.Increased peripheral white blood cells,anemia,thrombocytosis and biochemical changes may be found in laboratory examination.34patients′creatinine value was decreased on admission.The proportion of creatinine decrease of2013 group was significantly higher than 2014group（P0.001）.There was no statistically significant difference in the cell count and protein level changes in cerebrospinal fluid of two groups（P0.05）.The positive rate of specific serum epidemic encephalitis B IgM antibody was 65.8%,the positive rate of IgM antibody of 2013 group was higher than 2014group（P0.01）.26 cases were recovered,10 cases improved and 8cases died after treatment.There was statistically significant difference in comparison of curative effect of two groups（P0.001）.The mortality rate of 2014 group was higher than 2013group（P0.05）.Conclusion The incidence of epidemic encephalitis B in Luzhou has distinct seasonal,and majority patients were children.The adult patients increased in recent years with more serious illness,worse curative effect and prognosis.Strengthen the immunization,concern adult JE patients,early diagnosis and active treatment could reduce the mortality rate.