2013-2017年西宁地区肺炎链球菌脑膜炎检出情况及相关流行病学分析

Detection of Streptococcus pneumoniae meningitis and epidemiological analysis in the Xining area from 2013 to 2017

目的了解西宁地区肺炎链球菌(SP)脑膜炎检出情况、相关流行病学及临床表现。方法在西宁地区选取1家城区医院和2家县医院作为监测点,对2013年7月-2017年9月报告的肺炎链球菌脑膜炎病例实施流行病学调查;收集患者脑脊液及急性期血清,进行SP的培养鉴定,并对相关流行病学资料及数据进行统计学分析。结果对2013年7月-2017年9月3家医院报告的疑似脑膜炎例中的482例(男284例,占58.92%;女性198例,占41.08%)进行评估,39例实验室检查SP阳性,阳性率为8.09%。其中0～9岁组SP阳性19例,占实验室确诊病例的48.72%;20～59岁组阳性9例,占23.08%;≥60岁组阳性6例,占15.39%。但各年龄组间SP阳性率差异无统计学意义(P>0.05)。2013-2017年春、冬、夏、秋季SP阳性率分别为9.48%、8.82%、8.33%、5.83%,差异无统计学意义(P>0.05)。各年份SP阳性率差异无统计学意义(P>0.05)。实验室确诊SP脑膜炎病例均无SP疫苗接种史,8例有相关脑膜炎疫苗接种史。SP脑膜炎患者临床表现至少有4项,多者为9项,中位数为6项,主要表现为体温升高、头晕头痛、恶心呕吐、精神萎靡、前囱膨隆、颈项强直、及脑膜刺激征等。结论西宁地区SP易感染人群不再局限于低龄儿童,各年龄人群均有发生;SP脑膜炎全年均有流行,与SP疫苗接种覆盖面较小有关。可为该病的防治提供参考。

Objective To ascertain the prevalence,epidemiology,and clinical manifestations of Streptococcus pneumoniae meningitis in Xining.Methods An epidemiological survey of cases of S.pneumoniae meningitis reported from July 2013 to September 2017 in one urban hospital and two county hospitals in the Xining area was conducted.Cerebrospinal fluid and acute-phase serum were collected to culture and identify S.pneumoniae,and relevant epidemiological data were statistically analyzed.Results Four hundred and eighty-two cases of suspected meningitis involving 284 males(58.92%) and 198 females(41.08%) reported at the three hospitals from July 2013 to September 2017 were evaluated.Thirty-nine patients(8.09%) had laboratory results that were positive for S.pneumoniae.Of patients 0-9 years of age,19(48.72%) tested positive for S.pneumoniae.Of patients 20-59 years of age,9(23.08%) tested positive for S.pneumoniae.Of patients over the age of 60,6(15.39%) tested positive for S.pneumoniae.However,the rate of S.pneumoniae detection did not differ significantly among the different age groups(P>0.05).From 2013 to 2017,S.pneumoniae was detected at a rate of 9.48% in the spring,8.82% in the winter,8.33% in the summer,and 5.83% in the autumn.The rate of detection did not differ significantly(P>0.05).The rate of S.pneumoniae detection did not differ significantly in different years(P>0.05).In laboratory confirmed cases of S.pneumoniae meningitis,patients had not been vaccinated against S.pneumoniae,though 8 patients had been vaccinated against other forms of meningitis.Patients with S.pneumoniae meningitis had at least 4 clinical manifestations;most patients had 9 manifestations,and the median was 6 manifestations.The main manifestations were an elevated body temperature,dizziness,headaches,nausea and vomiting,depression,bulging of the anterior fontanelle,neck stiffness,and signs of meningeal irritation.Conclusion The population susceptible to S.pneumoniae in Xining is no longer confined to young children,and all age groups are affected.S.pneumoniae meningitis is prevalent throughout the year,and this is related to limited vaccination against S.pneumoniae.These findings can provide a reference for the prevention and treatment of this disease.