病毒性脑炎病例中不同标本肠道病毒检出率分析

Analysis of the detection rate of enterovirus in different specimens from patients with viral encephalitis

目的了解不同类型标本在肠道病毒所致病毒性脑炎病例诊断中的作用。方法采集临床诊断为病毒性脑炎病例标本,采用实时荧光RT-PCR法检测肠道病毒核酸,包括EV71、CA16和其他肠道病毒。结果 143例病例中,脑脊液、肛拭子和咽拭子中的肠道病毒阳性率分别为30.8%、88.1%和71.3%。脑脊液标本中检出率明显低于咽拭子或肛拭子,差异有统计学意义(P<0.01)。肛拭子中检出率高于咽拭子,差异有统计学意义(P<0.01),2种标本检出一致性一般(Kappa=0.420)。有皮疹出现且临床诊断为手足口重症合并脑炎的患者,脑脊液与其他标本组合后检出率均显著提高,差异有统计学意义(P<0.01);脑脊液、肛拭子和咽拭子组合后的检出率同单纯肛拭子和咽拭子组合的肠道病毒检出率之间差异无统计学意义(P>0.05)。结论肛拭子组合咽拭子可获得病毒性脑炎病例中肠道病毒的最大检出率。

Objective To evaluate the role of different samples in the diagnosis of viral encephalitis caused by human enteroviruses（HEVs）.Methods Samples of viral encephalitis cases were collected,and enterovirus nucleic acid was detected by real-time fluorescence RT-PCR method,including EV71,CA16 and other enteroviruses.Results The positive rates of HEVs in cerebrospinal fluid（CSF）,anal swabs and throat swabs from 143 patients were 30.8%,88.1% and 71.3%,respectively.The HEVs positive rates in CSF were lower than in throat swabs and anal swabs,with the differences statistically significant（P〈0.01）.The consistency of the 2 kinds of specimens was normal（Kappa = 0.420）.As for patients with clinical diagnosis of severe hand foot and mouth disease complicated with encephalitis,the detection rate of cerebrospinal fluid and other specimens significantly increased,with the differences statistically significant（P〈0.01）; the combination of CSF and anal swabs/throat swabs can obviously increase the detection rate of HEVs,and the differences compared with the single detection were statistically significant（P〉0.05）.Conclusion The highest HEVs positive rate was obtained in the combination of anal swabs and throat swabs from viral encephalitis cases.