急性脑炎脑膜炎症候群监测在流行性乙型脑炎监测中的应用

An acute meningitisand encephalitis syndrome surveillance program for Japanese encephalitis in Baoji city,Shaanxi Province,China

目的分析2013-2021年宝鸡市急性脑炎脑膜炎症候群(Acute Meningeal and Encephalitis Syndrome,AMES)监测病例中乙型脑炎(乙脑)病例的构成和临床特征,为指导乙脑病例的诊断提供依据。方法按照宝鸡市AMES病例定义开展监测,所有病例进行乙型脑炎病毒IgM抗体检测,对阳性病例按照入院诊断分为乙脑疑似病例组和非乙脑疑似病例组,比较两组病例临床表现与脑脊液生化特征的差异,比较监测实施前后宝鸡地区乙脑病例在陕西省的占比。结果2013-2021年共报告AMES病例2636例,乙脑IgM阳性158例,阳性率为5.99%,其中72例(45.57%)从入院诊断为疑似乙脑病例中检出,86例(54.43%)从AMES其它诊断中检出。临床表现为头痛、恶心、呕吐、抽搐比例在疑似和非疑似乙脑病例中无统计学意义(P>0.05)。发热、意识障碍、颈项强直、脑膜刺激征在疑似乙脑病例组高于非疑似乙脑病例组(P<0.05)。入院诊断为乙脑疑似病例和非乙脑疑似病例的脑脊液外观、蛋白含量、白细胞计数、葡萄糖和氯化物含量无统计学差异(P>0.05)。2005-2012年宝鸡市乙脑病例数占全省的10.65%(134/1258),2013-2021年占16.58%(161/971)。结论急性脑炎脑膜炎症候群监测可提高乙脑检出率,指导临床对乙型脑炎病例的诊断,应继续加强监测。

We analyzed the clinical and biochemical characteristics of Japanese encephalitis(JE),based on acute meningeal and encephalitis syndrome(AMES)surveillancein Baoji from 2013 to 2021.We established the AMES program in Baoji and developed surveillance according to the case definition.JE virus IgM antibody tests were conducted.Positive cases were divided into a probable JE and non-probable JE group according to the initial diagnosis.Clinical manifestations and biochemical characteristics of cerebrospinal fluid were compared between groups.The difference in JE incidence in the Baoji area and Shaanxiprovince before and after the AMES program was compared.Among 2636 AMES cases reported during 2013-2021,the positive rate of JE virus IgM antibody was 5.99%,of which 86 cases(54.43%)lacked an initial JE diagnosis.The proportion of patients with fever,perturbed consciousness,neck rigidity,or meningeal irritation was significantly higher in the group with than without an initial JE diagnosis(P<0.05).Biochemical tests indicated that the differences in cerebrospinal fluid color,white blood cell count,and chloride and glucose levels in the two groups were not statistically significant(P>0.05).Cases of JE in Baoji from 2005 to 2012 accounted for 10.65%(134/1258)vs 16.58%(161/971).This study indicated that the AMES surveillance program increased the detection of JE and has aided in JE diagnosis.Thus,AMES surveillance should be enhanced.