2013-2016年济南市哨点医院急性脑膜炎脑炎症候群病例病毒学监测分析  

Etiologic surveillance and analysis of acute meningitis and encephalitis syndrome in Jinan city in 2013-2016

作　　者：林小娟 刘桂芳 王敏 陶泽新 王素婷 宋立志 张丽 徐爱强 Lin Xiaojuan;Liu Guifang;Wang Min;Tao Zexin;Wang Suting;Song Lizhi;Zhang Li;Xu Aiqiang(Division of Expanded Immunization Program,Shandong Center,for Disease Control and Prevention,Academy of Preventible Medicine,Shandong University,Shandong Provincial Key Laborntory of Infections Disease Control and Prevention,Jinan 250014,China)

机构地区：[1]山东省疾病预防控制中心免疫预防管理所山东大学预防医学研究院山东省传染病预防控制重点实验室,济南250014

出　　处：《中华预防医学杂志》2019年第2期174-178,共5页Chinese Journal of Preventive Medicine

基　　金：山东省泰山学者工程专项(ts.201511105);国家科技重大专项(2013ZX10004-202);山东预防医学会智飞疾病预防控制技术研究基金(LYH2017-05).

摘　　要：目的了解2013—2016年济南市哨点医院急性脑膜炎脑炎症候群(AMES)监测病例的病毒流行特征。方法收集2013—2016年济南市6家AMES哨点监测医院上报的AMES监测病例的个案调查资料、临床信息等,并选取其血清和(或)脑脊液标本进行实验室检测,共3577例。采用ELISA方法检测流行性乙型脑炎病毒(JEV)IgM抗体;对JEVIgM抗体阴性者进行人类肠道病毒(EV)、流行性腮腺炎病毒(MuV)和单纯疱疹病毒(HSV)的IgM抗体检测;并进行EV分离与分子定型。比较4种病毒IgM抗体阳性率的差异。结果2013—2016年JEVIgM抗体检测例数为3577例,抗体阳性率为9.0%(322例)。3255例JEVIgM抗体阴性者中,EV、MuV和HSVIgM抗体检测例数为2916例,阳性率分别为22.1%(643例)、9.9%(289例)和26.9%(783例)。各年JEVIgM抗体阳性率分别为32.9%(261/794)、1.2%(14/1175)、1.0%(8/807)和4.9%(39/801),EVIgM抗体阳性率分别为19.5%(91/466)、35.1%(342/974)、15.5%(115/743)和13.0%(95/733),MuVIgM抗体阳性率分别为9.2%(43/466)、14.4%(140/974)、9.0%(67/743)和5.3%(39/733),HSVIgM抗体阳性率分别35.4%(165/466)、38.5%(375/974)、25.7%(191/743)和7.1%(52/733);4种病毒各年份间阳性率差异均有统计学意义(P<0.001)。2013—2016年共对1020例病例脑脊液标本进行了EV分离,检出率为7.9%(81例),各年分别为4.8%(6例)、13.1%(55例)、4.1%(7例)和4.2%(13例);81株EV分为8个血清型,其中柯萨奇病毒(CV)B5型、埃可病毒(E)6和30型较多,分别占46%(37株)、22%(18株)和21%(17株)。结论2013—2016年济南市哨点医院AMES病例的病毒病原主要为HSV、EV、MuV、JEV;CV-B5、E6和E30是引致AMES的EV优势血清型。Objective To characterize the etiology and epidemiological characteristics of the acute meningitis and encephalitis syndrome (AMES) in Jinan city in 2013-2016. Methods The epidemiological data, clinical diagnosis, serum and cerebrospinal fluid (CSF) specimens were collected from 3 577 AMES cases in 6 sentinel hospitals in Jinan city in 2013-2016. Samples of all cases were made sero-diagnosis for Immunoglobulin (Ig) M antibody to Japanese encephalitis virus (JEV) and negative cases of JEV for enterovirus (EV), mumps virus (MuV) and herpes simplex virus (HSV) by enzyme-linked immunosorbent assay (ELISA). Virus isolation and molecular identification were performed. Positive rates were analyzed by Chi-square test. Results In 2013-2016, the positive rates of JEV, EV, MuV and HSV were 9.0% (322/3 577 cases), 22.1% (643/2 916 cases), 9.9% (289/2 916 cases), 26.9% (783/2 916), respectively. Of these, the positive rates of JEV were 32.9% (261/794), 1.2% (14/1 175), 1.0% (8/807) and 4.9% (39/801 cases);EV: 19.5% (91/466), 35.1% (342/974 cases), 15.5% (115/743) and 13.0% (95/733);MuV: 9.2% (43/466), 14.4% (140/974), 9.0% (67/743) and 5.3% (39/733). HSV: 35.4% (165/466), 38.5% (375/974), 25.7% (191/743) and 7.1% (52/733). There were significant differences in positive rates of 4 kinds of viruses in 2013-2016 (P<0.001). A total of 81 EV strains belonging to 8 serotypes were isolated from 1 020 CSF specimens. The positive rates were 4.8% (6 cases), 13.1% (55 cases), 4.1% (7 cases) and 4.2% (13 cases) from 2013 to 2016. Coxsackievirus (CV) B5, echovirus (E) 6 and E30 accounted for 46% (37 isolates), 22% (18 isolates) and 21% (17 isolates) of all strains. Conclusion The AMES cases in Jinan city in 2013-2016 were mainly caused by HSV, EV, MuV, JEV. CVB5, E6 and E30 were the dominant serotypes of EV associated with AMES cases in Jinan city.

关 键 词：脑膜炎 脑炎 哨点监测 病原学 

分 类 号：R515.2[医药卫生—内科学] R181.3[医药卫生—临床医学]