2006—2015年宜昌市流行性乙型脑炎监测病例分析

Case analysis of Japanese encephalitis surveillance in Yichang during 2006—2015

目的通过血清学诊断,了解乙脑发病情况;并对确诊的乙脑病例按照入院诊断进行分析,为今后乙脑的防控工作提供依据。方法对2006-2015年宜昌市6所病原学监测医院采集的血液、脑脊液标本进行乙型脑炎检测,了解乙脑发病情况,并对确诊的乙脑病例按入院诊断分为确诊组和漏诊组,分析两组在流行特征、临床表现、临床实验室常规检测指标方面的差异。结果共确诊61例乙脑病例,发病呈逐年下降趋势;确诊病例入院诊断以非乙脑为主;诊断组(n=18)与漏诊组(n=43)比较发现,两组在年龄和季节分布上差异有统计学意义(P<0.05);临床症状和体征方面,嗜睡、意识障碍、抽搐和脑膜刺激征方面发生诊断组高于漏诊组,差异有统计学意义(P<0.05);在实验室常规指标方面,脑脊液白细胞含量漏诊组明显高于诊断组,差异有统计学意义(P<0.05)。结论宜昌地区乙脑发病率逐年降低。但是医疗机构对乙脑病例漏诊严重,特别是大年龄儿童、成人及临床症状和体征较轻者容易发生漏诊,应提高医疗机构的诊断水平,开展乙脑的IgM实验室检测。

Objective To analyze the diagnosable JE cases according to admitting clinical diagnosis by laboratory serum diagnosisand know JE morbidity for providing the proof of JE. Methods Detection of Japanese encephalitis in blood and cerebrospinal fluidsamples collected from 6 pathogenic surveillance hospitals in Yichang city during 2005-2016 to understand the incidence of JE. Toanalyze the diagnosable JE cases according to admitting clinical diagnosis by laboratory serum diagnosis, and know. The differencesbetween the two groups in the epidemiological characteristics, clinical manifestations, clinical laboratory routine testing indicators.Results A total of 61 cases of JE diagnosed. Je incidence decreased year by year. The diagnosis group and missed diagnosis groupin age and season distribution have significant difference（P〈0.05）;There were significant differences in clinical symptoms andsigns,sleepiness,disturbance of consciousness,convulsions and dural irritation（P〈0.05）. Cerebrospinal fluid leukocyte contentalso had obvious difference（P〈0.05）. Conclusions JE incidence decreased year by year in Yichang city. The missed diagnosiswas high in medical institution,especially for older children and adults. Hence in the future,the capability of diagosis andtreatment of JE should be improved and the examination of the JEV specific IgM antibody in serum or CSF specimens should bepaid great attention to in the JE diagnosis.