2015-2016年病毒性脑炎流行病学分析

Epidemiological characteristics of viral encephalitis from 2015-2016

目的分析2015-2016年病毒性脑炎流行病学特征,为临床疾病防控提供指导。方法收集2015-2016年311例病毒性脑炎患者血清、脑脊液标本,检测病毒IgM抗体。采用RD和Hep-2细胞分离肠道病毒,经序列分析后鉴定其亚型。结果 311例病毒性脑炎患者中,2015年137例,2016年174例。2015-2016年1~3月、4~6月、7~9月、10~12月患者分别为39例(12.54%)、79例(25.40%)、141例(45.34%)、52例(16.72%),7~9月显著高于其他月份(χ2=5.4084,P<0.05)。0~岁103例(33.12%),13~岁71例(22.83%),19~岁39例(12.54%),39~岁43例(13.83%),≥58岁55例(17.68%),0~岁与其他各年龄组比较,差异有统计学意义(χ2=70.9003,P<0.05)。311例病毒性脑炎中,男性183例,女性128例,2015年男性患者76例(55.47%),女性患者61例(44.53%);2016年男性患者105例(60.34%),女性患者69例(39.66%),2015和2016年男、女患者发病差异有统计学意义(χ2=14.8966,P<0.05)。临床表现为发热、恶心、呕吐、上呼吸道感染、头痛、病理性脑膜刺激症阳性、咽部充血和扁桃体肿大患者分别有264例(84.89%)、124例(39.87%)、239例(76.85%)、198例(63.67%)、257例(82.64%)、37例(11.90%)、241例(77.49%);葡萄糖异常、蛋白定量异常、CSF白细胞异常、EEG异常、心肌酶升高、CSF压力增高患者分别有21例(6.75%)、88例(28.30%)、223例(71.70%)、269例(86.50%)、146例(24.95%)、240例(77.17%)。共分离出102株病毒,其中埃可病毒、柯萨奇病毒、脊髓灰质炎病毒、腮腺炎病毒、巨细胞病毒分别为42、27、16、11和6株;埃可病毒亚型33型27株,30型11株,51型4株;27株柯萨奇病毒均为B5型。结论 2015-2016年间发病高峰为7~9月,儿童患者常见,临床表现以发热、头痛、呕吐为主,常规检查中EEG异常和CSF压力增高居多。肠道病毒是病毒性脑炎致病的主要流行毒株,且以埃可病毒33亚型常见。

Objective To analyze the epidemiological characteristics of viral encephalitis from 2015--2016 in order to guide the prevention and control of the disease in clinical settings. Methods Serum and cerebrospinal fluid specimens were collected from 311 patients with viral encephalitis from 2015 2016. IgM antibodies to viruses were detected. En- teroviruses were isolated using RD and Hep-2 cells, and the subtype of virus was identified using sequencing. Results Of the 311 cases of viral encephalitis, 137 occurred in 2015 and 174 occurred in 2016. Thirty nine cases （12.54%） oc- curred from January-March, 79 （25.40%） occurred from April-June, 141 （45.34%） occurred from July-September, and 52 （16.72%） occurred from October-December. Significantly more cases occurred from July-September than in other months （X2=5.4084, P〈0.05）. One hundred and three patients （33.12%） were ages 0--12, 71 （22.83%） were ages 13--18, 39 （12.54%） wereages19--38, 43 （13.83%） wereages39--57, and 55 （17.68%） were age 58 or older. Sig- nificantly more patients were ages 0--12 （X2= 70. 9003, P〈0.05）. Of the 311 patients with viral encephalitis, 183 were males and 128 were females. In 2015, 76 patients （55.47%） were males and 61 （44.53%） were females. In 2016, 105 patients （60.34%） were males and 69 （39.66%） were females. Incidence differed significantly by sex （X2 =14. 8966, P 〈0.05）. Two hundred and sixty-four patients （84.89%） had a fever, 124 （39.87%） had nausea or vomiting, 239 （76.85%） had an upper respiratory tract infection, 198 （63.67%） had headaches, 257 （82. 640/00） had signs of meningeal irritation, 37 （11.90%） had congestion of the throat, and 241 （77.49%） had tonsillitis. Twenty-one patients （6.75%） had an abnormal glucose ratio, 88 （28.30%） had abnormal protein levels, 223 （71.70%） had an abnormal WBC count in CSF, 269 （86.50%） had an abnormal EEG, 146 （24.95%） had elevated myocardial enzymes, and 240 （77.17%） had increased CSF pressure. One hundred and two strains of viruses were isolated; of those, 42 were echovirus strains, 27 were coxsackievirus strains, 16 were poliovirus strains, 11 were mumps virus strains, and 6 were cytomegalovirus strains. Twenty-seven strains were echovirus type 33, 11 were echovirus type 30, and 4 were echovirus type 51. Twenty-seven strains were coxsackievirus type B5. Conclusion From 2015--2016, incidence peaked from July-September, and viral encephalitis was common in pediatric patients. Clinical manifestations were primarily a fever, headaches, and vomiting. Routine testing often revealed an abnormal EEG and increased CSF pressure. Enteroviruses were the prevalent pathogens causing viral encephalitis, and those enteroviruses were often echovirus type 33.