上海地区儿童1984-2003年流行性脑脊髓膜炎的临床流行病学  

Clinical epidemiology of epidemic cerebrospinal meningitis in children in Shanghai area from 1984 to 2003

作　　者：李月芳[1] 曾玫[1] 王晓红[1] 王岱明[1] 

机构地区：[1]复旦大学附属儿科医院感染科,上海200032

出　　处：《中国抗感染化疗杂志》2004年第6期321-323,共3页Chinese Journal of Infection and Chemotherapy

摘　　要：目的 :了解近 2 0年上海地区儿童流行性脑脊髓膜炎 (流脑 )的流行特征及临床变迁。方法 :对 1984 - 2 0 0 3年复旦大学附属儿科医院收治的 177例流脑患儿作回顾性分析 ,统计分析采用卡方检验。结果 :近 2 0年上海地区儿童流脑主要呈散发流行 ,1985 - 1986年曾发生流行 ,病例数占总数的 4 0 .7% ,以每年 2 - 4月份为流行季节。 1993年后患儿以外来儿童居多(70 .6 % )。临床表现以普通型为主 ,占 78.0 % ,暴发型为 19.8% ,轻型为 2 .2 %。死亡 12例 (6 .8% ) ,以小婴儿为主。共分离出 6 7株脑膜炎奈瑟球菌 ,培养阳性率 37.9% ,脑脊液培养阳性率 31.5 % ,血培养阳性率 18.9%。 2 0世纪 90年代后脑膜炎奈瑟球菌对青霉素耐药率有所上升。 1984 - 1993年脑膜炎奈瑟球菌分群结果为A群 2 6例 ,B群 2 1例 ,未分群 3例。B群流脑与A群临床比较显示 2岁以下患儿病例数及非流行季节病例数所占比率均明显增高 (P <0 .0 0 1,P <0 .0 5 ) ,病情重 ,易并发硬脑膜下积液和或脑室膜炎。结论 :目前流脑在上海地区儿童中呈散发流行 ,以外来儿童发病为主 ,发病者中A群流脑多糖疫苗接种率低 ,因此应重视预防接种。抗菌治疗以第三代头孢菌素为佳。Objective: To investigate the clinical epi demi ology of epidemic cerebrospinal meningitis in children in recent 20 years. Methods: A retrospective analysis was conducted in 177 hospitali z ed children patients with epidemic cerebrospinal meningitis from 1984 to 2003. C hi-square test was used for statistical analysis. Results:T here were sporadic cases of children epidemic cerebrospinal meningitis in Shangh ai area. However, there was an epidemic outbreak in 1985 to 1986, during which t he number of cases accounted for 40.7%. of total patients. Most cases occurred i n spring time (from February to April). Children were predominant moving to Shan ghai from other places (70.6%) since 1993. The clinical features of most patient s belonged to “common type” (78.0%), followed by fulminant type (19.8%) and mi ld type (2.2%). Twelve cases (6.8%) died, most of whom were small infants. Total ly 67 strains of Neisseria meningitidis were isolated,with positive culture rate of 37.9% (67/177). The positive rate of cerebrospinal fluid culture was 31. 5% and that of blood culture was 18.9%.The resistance of N. meningitidis to penicillin was on the rise since 1990s. Result of bacterial typing revealed tha t 26 strains belonged to group A, 21 strains group B and 3 strains untypable. th ere were more patients occurred in children aged less than 2 and in non epidemic seasons, more severe cases and more cases complicated with subdural effusion or ventricalitis in patients with gronp B strains.Conclusion: Epidemic cerebrospinal meningitis in children mainly occurred sporadically in Sh anghai area . The majority of patients were moving to Shanghai from other places . Very few of the patients had been vaccinated with group A epidemic cerebrospin al meningitis. Therefore, prophylactic vaccination should be stressed. The third generation cephalosporins are highly active against N. meningitidis. [

关 键 词：流行性脑脊髓膜炎 儿童 流行病学 

分 类 号：R725.1[医药卫生—儿科]