三种常见细菌性脑膜炎实验室确诊病例误诊分析  

Analysis on misdiagnosis of laboratory confirmed cases of three common bacterial meningitis

作　　者：邹文菁[1] 占建波[1] 吕静[1] 杨红梅[1] 王蕾[2] 高景枝[3] 彭延[1] ZOU Wenjing;ZHAN Jianbo;LYU Jing;YANG Hongmei;WANG Lei;GAO Jingzhi;PENG Yan(Health Inspection and Testing Institute,Hubei Provincial Center for Disease Control and Prevention,Wuhan 430079,Chin)

机构地区：[1]湖北省疾病预防控制中心卫生检验检测研究所,武汉430079 [2]湖北省宜昌市疾病预防控制中心传染病防治研究所 [3]湖北省十堰市疾病预防控制中心检验科

出　　处：《公共卫生与预防医学》2018年第4期24-27,共4页Journal of Public Health and Preventive Medicine

基　　金：国家"十二.五"科技重大专项"湖北及周边省传染病病原谱流行规律研究"(2012ZX 100004-207);湖北省卫计委科研项目"湖北省细菌性脑膜炎病原学与流行病学特征研究"(JX6B23);湖北省十堰市科学技术局项目"细菌性脑膜炎病原谱分子流行病学研究"(17Y69)

摘　　要：目的通过实验室检测,了解3种主要细菌性脑膜炎(脑膜炎奈瑟菌、流感嗜血杆菌和肺炎链球菌)发病情况;分析临床误诊情况及原因,为早期诊断提供依据。方法对2006—2016年宜昌市6所病原学监测医院监测的脑膜炎病例采集脑脊液标本进行3种细菌检测,并对确诊的细菌性脑膜炎病例按出院诊断分组,分析两组在流行特征、临床表现实验室常规检测指标方面的差异。结果共确诊61例细菌性脑膜炎病例(脑膜炎奈瑟菌22例、肺炎链球菌29例、流感嗜血杆菌10例);52.5%的病例出院诊断为细菌性脑膜炎;临床准确诊断组与漏诊组比较发现:两组在流行病学上差异均无统计学意义(P性别=0.06,P年龄=0.3,P时间=0.32);临床症状和体征方面,两组在头痛、恶心、呕吐、抽搐和颈项强直方面有明显差异(P恶心=0.02,P呕吐=0.03,P抽搐=0.04,P颈项强直=0.03);在实验室常规指标方面,两组在血白细胞计数、血中性粒细胞比例、脑脊液蛋白质含量、脑脊液葡萄糖含量和脑脊液外观均有明显差异(P白细胞计数=0.000,P中性粒计数=0.001,P蛋白含量=0.000 1,P葡萄糖含量=0.000 3,P外观=0.001);病例转归比较中,漏诊组病例转归更好。(P=0.02)。结论大部分无细菌性脑膜炎常见症状或体征、脑脊液和血液临床实验室检测指标不典型的轻症病例极易误诊。应提高医疗机构实验室检测水平,尽早明确诊断,高效治疗。Abstract： Objective To understand the status of misdiagnosis of three main bacterial meningitis （Neisseria meningitidis, Haemophilus influenzae and Streptococcus pneumoniae） through laboratmT tests, and analyze the clinical misdiagnosis and reasons for misdiagnosis, so as to provide a basis for early diagnosis. Methods Three kinds of bacteria in cerebrospinal fluid samples were collected from 6 pathogenic surveillance hospitals in Yichang City- during 2006 -2016. According to the discharge diagnosis, the confirmed bacterial meningitis eases were divided into two groups （ accurate clinical diagnosis group and misdiagnosis group ）. The epidemic features, clinical manifestation and laboraton routine indexes were compared between the two groups. Results A total of 61 eases of bacterial meningitis （22 Neisseria meningitidis eases, 29 Streptococcus pneumoniae eases and 10 Haemophilus influenzae cases） were diagnosed. 52. 5% patients discharge diagnosis were bacterial meningitis. The epidemiological characters of the two groups of misdiagnosis eases and accurate diagnosis eases showed no statistical difference（ PSex = 0. 06 ,PAge = 0. 3,PTime = 0. 32）. The clinical symptoms and signs showed statistical differences：headache, nausea, vomiting, convulsions and neck stiffness（Pnausea = 0. 02,Pvomit = 0. 03,PConvulsion = 0. 04 ,PNeck ankylosis= 0. 03 ）. In laboratory test： blood white blood cell count, blood neutrophil proportion, cerebrospinal fluid protein content, cerebrospinal fluid glucose content and cerebrospinal fluid appearance, significant statistical differences were found between the two groups （ PLeucocyte count = 0. 000, PNeutrophils count= 0. 001, Pprotein content= 0. 0001, PGlucose content = 0. 0003, PApp = 0. 001 ）. The prognosis of the misdiagnosis group was better than that of the accurate diagnosis group（P = 0. 02 ）. Conclusion Most non bacterial meningitis common symptoms or signs, atypical cases of cerebrospinal fluid and blood clinical laboratory testing indicators are

关 键 词：细菌性脑膜炎 实验室诊断 误诊 

分 类 号：R378.1[医药卫生—病原生物学]