山东地区肠道病毒中枢神经系统感染187例分析

Analysis of 187 children with enteroviral central nervoussystem infection in Shandong area

目的 探讨山东地区中枢神经系统肠道病毒 (EV)感染的实验和临床特点。方法 采用逆转录聚合酶链反应 (RT PCR)和病毒培养技术 ,检测 187例临床诊断为无菌性脑膜炎病人的脑脊液 (CSF)和部分病人的血清及尿液标本中EVRNA。结果 187例无菌性脑膜炎患儿中 ,CSF中RT PCR和病毒培养同时阳性者 62例 (3 3 16% ) ;病毒培养阴性的 12 5例中 ,RT PCR阳性 93例 (74% ) ;此 93例中 ,4例同时在血清或尿分离到EV。本实验中 ,RT PCR检测EV脑膜炎的阳性率为 82 89%(15 5 / 187) ,而病毒培养的阳性率为 3 3 16% (62 / 187)。包括EVRNA的提取 ,RT PCR的全部过程在4小时内可以完成 ,而病毒培养繁杂 ,平均需要 4 6天得出结果。肠道病毒脑膜炎可以散发或局部暴发 ,临床特点在各个年龄组有所不同 ,5岁以内者以发热、呕吐、激惹多见 ,5岁以上者以头痛、畏光、疲劳、肌痛多见。结论 EV是山东地区无菌性脑膜炎最常见的病原体 ,临床症状一般较轻、无特异性 ;RT PCR检测能快速、敏感的诊断EV感染 ;快速确诊可减少抗生素的应用和住院天数 。

Objective To evaluate the diagnostic potential of previously published enterovirus (EV) reverse transcription polymerase chain reaction (RT PCR) assay in detection of EV in CSF samples from children with a diagnosis of aseptic meningitis and to investigate the clinical characteristics of the patients seen in Shandong Methods EV RNA was detected in 187 CSF samples and serum and/or urine samples of a part of patients by RT PCR and viral culture technique Results RT PCR was positive in all 62 CSF specimens which were positive by cell culture (100%) In addition, 93 of 125(74 4%) CSF samples negative by cell culture were RT PCR positive In 4 of these 93 ( 4 3%) patients, viral culture of specimens from other sites (serum or urine) was also positive The sensitivity of CSF RT PCR based on clinical diagnosis in patients with meningitis of negative bacterial culture results was 82 9% (155/187), which was considerably higher than the sensitivity of CSF virus culture 33 2% (62/187) The results of RT PCR can be reported within 4 hours, whereas the viral culture of CSF requires 4 6 days for a cytopathic effect to develop EV meningitis occurred in a sporadic form and in some areas there were outbreaks The clinical characteristics of 155 patients with EV meningitis were defferent in defferent age groups Conclusion EV was one of the most common causes of aseptic meningitis in Shandong area The RT PCR assay was rapid, sensitive and specific for the diagnosis of EV meningitis and may be a potential tests to shorten hospital stay and reduce the use of antibiotics.