2017年夏季陕甘两省流行性乙型脑炎临床特征分析

Analysis of the clinical features of epidemic encephalitis B patients occured in Shaanxi and Gansu provinces in the summer of 2017

目的:通过调查分析2017年夏季陕西和甘肃两省局部地区爆发的流行性乙型脑炎患者临床特征,进一步提高医务人员对疾病的认识,为早期诊治早期隔离提供科学依据。方法:为回顾性调查研究,纳入我院急诊科2017-07—2017-09期间收治的陕西和甘肃两省的病毒性脑炎患者,分为流行性乙型脑炎组(31例)和其他类型病脑组(12例)。描述两组患者的流行病学资料(年龄、性别、发病月份、确诊天数、ICU住院天数及最终预后),临床特点(最高体温、头痛、呕吐、抽搐及神志状态),血液及脑脊液检验结果(肝功肾功和脑脊液白细胞数、蛋白质、免疫球蛋白)和MRI影像学特点,分析组间差异探究乙脑患者临床特征。结果:(1)乙型脑炎患者平均年龄(44.9±5.3)岁,男13例(41.9%),80.6%患者8月发病,其次为9月(12.9%);其他病脑常见于7月(41.7%)和8月(50.0%),两组月份构成比存在显著差异(χ2=7.87,P<0.05);(2)乙脑患者最高体温平均(39.4±0.7)℃,61.3%患者伴有头痛,48.4%伴有呕吐,54.8%有肢体抽搐。乙脑组昏迷患者比率较其他病脑患者显著升高(61.3%vs.25%,P<0.05);(3)乙脑患者脑脊液蛋白质含量(1.06±0.45)g/L和免疫球蛋白IgM(15.61±8.13)mg/L较其他病脑患者显著增高(均P<0.05)。45.2%乙脑患者颅脑MRI检查提示典型炎症改变,显著高于其他病脑组(16.7%);(4)乙脑患者确诊(10.7±6.2)d,ICU救治(18.1±7.6)d,均显著高于其他病脑患者(均P<0.05)。乙脑患者仅19.3%痊愈,45.2%好转,病死率高达35.5%,预后显著差于其他病脑(P<0.05)。结论:流行性乙型脑炎多见于8月和9月,常伴有肢体抽搐和不同程度的意识障碍,脑脊液蛋白质含量和免疫球蛋白IgM较其他病脑患者显著增高,确诊和ICU住院天数更久,最终预后较一般病脑更差,提示临床医师必须提高乙脑的诊治能力,通过分析病脑患者的临床症状和检查结果,及时鉴别出乙脑患者,早期诊治早期隔离提高患者预后。

Objective：Investigation and analysis of the clinical features of epidemic encephalitis B patients in the two provinces of Shaanxi and Gansu in the summer of 2017,further to provide scientific basis for early diagnosis,early isolation and to improve the prognosis of patients.Method：A retrospective analysis was carried out from July2017 to September 2017 in our Emergency department.31 epidemic encephalitis B patients and 12 patients with other types of viral encephalitis were included in the survey,whose basic information and clinical data were investigated,including age,sex,month of onset,number of confirmed days,length of stay in ICU and final prognosis,liver and kidney function,leukocyte count,protein,immunoglobulin of cerebrospinal fluid and MRI.We compare the differences between groups to explore the clinical characteristics of patients with encephalitis B.Result：（1）The average age of epidemic encephalitis B was（44.9±5.3）years old,13 cases were male（41.9%）,80.6% of patients occured in August,which was followed by September（12.9%）.The patients with other types of viral encephalitis were common in July（41.7%）and August（50%）.There were significantly differences in the month constitution ratio between two gropes（χ^2=7.87,P〈0.05）.（2）The average highest body temperature in patients with epidemic encephalitis B was（39.4±0.7）℃,61.3% cases had headache,48.4% had vomiting,and 54.8% had limb twitch.The rate of coma in the epidemic encephalitis B group was significantly higher than that of the other patients（61.3% vs.25%,P〈0.05）.（3）The protein content in the cerebrospinal fluid of epidemic encephalitis B was（1.06±0.45）g/L and immunoglobulin of IgM was（15.61±8.13）mg/L,which were significantly higher than those in the patients with other types of viral encephalitis（P〈0.05）.The brain MRI examination of 45.2% patients with encephalitis B showed typical inflammatory changes,which was significantly higher than that of other brain groups（16.7%）.（4）The diagnosis of patients with encephalitis B consumed（10.7±6.2）days,and their ICU treatment time was（18.1±7.6）days,which were significantly higher than those of other types of viral encephalitis（P〈0.05）.Only 19.3% of encephalitis B patients recovered,45.2%cases improved,the mortality rate was 35.5%.The prognosis of encephalitis B patients was significantly worse than that of other types of viral encephalitis（P〈0.05）.Conclusion：Epidemic encephalitis B was commonly seen in August and September,which often was accompanied by limb convulsions and varying degrees of consciousness disorder.The protein content of cerebrospinal fluid and immunoglobulin IgM were significantly higher than those of other types of viral encephalitis.Compared with other types of viral encephalitis,The diagnosis and ICU stay were longer,and the prognosis was wors.We must pay attention to improve the diagnosis and treatment ability.Through the analysis of the clinical symptoms and results of the check,the patients with encephalitis B will be identified in time,and the early diagnosis and treatment can be carried out,which will improve the prognosis of the patients.