宜昌市2006-2015年急性脑炎及脑膜炎症候群病原谱分析

Pathogen spectrum analysis of acute meningitis/encephalitis syndrome in Yichang during 2006-2015

目的分析宜昌市2006-2015年近10年急性脑炎/脑膜炎病例病原谱构成,为疾病防控提供依据。方法对湖北省宜昌市6所监测医院符合监测病例定义的患者采集血液和(或)脑脊液标本,使用酶联免疫吸附试验(ELISA)和荧光定量PCR反应进行病原体检测,得出急性脑炎/脑膜炎病例病原谱构成,并进行统计学分析。结果共采集血清标本1 958份,脑脊液标本1 867份。2 504例病例开展乙脑病毒学检测,1 545例病例开展其他四种病毒学检测,1 867例病例开展细菌学检测。实验室确诊病毒性感染955例,肠道病毒、单纯疱疹病毒、腮腺炎病毒和乙脑病毒感染阳性率分别为20.84%、20.00%、17.02%和2.44%,;确诊细菌性感染52例,检测出的脑膜炎奈瑟菌、肺炎链球菌和b型流感嗜血杆菌阳性率分别为42.31%、42.31%和15.38%。时间分布上病毒性感染病例主要集中在5~8月份,占总数的55.92%;细菌性感染病例呈全年散发。人群分布上病毒性感染病例以<15岁青少年为主,细菌性感染病例以>15岁较大年龄组为主,分别占总数的51.83%和67.31%。性别分布上病毒性感染病例男女比为1.09:1;细菌性感染病例男女比为2.06:1。结论肠道病毒和单纯疱疹病毒是引起宜昌市病毒性脑炎/脑膜炎的主要病原体;脑膜炎球菌和肺炎链球菌是引起宜昌市细菌性脑炎/脑膜炎的主要病原体,应该重点进行防控。

Objective To analyze the pathogen spectrum of acute meningitis/encephalitis syndrome（AMES）,and to provide reference for control and prevention of AEMS. Methods The samples of blood and cerebrospinal fluid（CSF） were collected from six hospitals in Yichang city, which were detected for pathogens using enzyme-linked immunosorbent assay（ELISA） and fluorescence quantitative PCR. The pathogen spectrum of AMES were drawn and analyzed statistically. Results A total of 1 958 serum samples and 1 867 CSF samples were collected, of which 2 504 were detected for Japanese encephalitis（JE） virus, 1 545 for four kinds of viruses, and 1 867 for bacteriological pathogens. A total of 955 samples were confirmed as viral infection, and the positive rates of enterovirus, herpes simplex virus,mumps virus, JE were 20.84%, 20.00%, 17.02%, 2.44%, respectively. A total of 52 samples were diagnosed as bacterial infection, and the positive rates of Neisseria meningitides, Streptococcus pneumoniae and Haemophilus influenzae type B were 42.31%, 42.31%, 15.38%, respectively. Viral infection cases mainly occurred between May and August（accounting for 55.92%）, in young people under 15 years old（51.83%）, with male to female ratio of 1.09, while bacterial infections occurred sporadically throughout the year, mostly in people 〉15 years old（67.31%）, with the male to female ratio of2.06：1. Conclusion Enteric viruses and herpes simplex virus were the main pathogens of viral meningitis/encephalitis in Yichang. Neisseria meningitides and Streptococcus pneumoniae were the main pathogens of bacterial meningitis/encephalitis. We should pay more attention to prevention of these pathogens.