脑炎/脑膜炎症候群患儿病原与临床分析  

Analysis on pathogeny and clinical of encephalitis and meningitis syndrome in children

作　　者：王旭[1] 田玉玲[2] 姜洪波 赵艳玲[2] 黄艳智[2] 贺岩[2] 王伟[1] 刘愉[2] 孙利伟[2] 崔爱利[3] 许文波[3] Wang Xu;Tian Yuling;Jiang Hongbo;Zhao Yanling;Huang Yanzhi;He Yan;Wang Wei;Liu Yu;Sun Liwei;Cui Aili;Xu Wenbo(Department of Neurology, Changchun Children′s Hospital(Jilin Children′s Medical Center), Changchun 130061, China;Scientific Research Laboratory, Changchun Children′s Hospital, Changchun 130061, China;World Health Organization Western Pacific Region Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology of Ministry of Health, Nation Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention Human, Beijing 102206, China)

机构地区：[1]长春市儿童医院(吉林省儿童医学中心)神经内科,130061 [2]长春市儿童医院科研室,130061 [3]中国疾病预防控制中心病毒病预防控制所,卫生部医学病毒学和病毒病重点实验室,世界卫生组织西太平洋区麻疹和风疹参比实验室,北京102206

出　　处：《中华实用儿科临床杂志》2019年第12期926-929,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨小儿脑炎/脑膜炎症候群的临床特点及病原谱。方法研究对象为2012年5月至2015年7月在长春市儿童医院住院,临床诊断为脑炎/脑膜炎的患儿667例。患儿于入院72 h内采集脑脊液标本335份,血液标本530份,粪便标本332份。采用PCR法检测脑脊液标本肠道病毒通用型(EV)、疱疹病毒(HSV)、结核杆菌(TB)、肺炎支原体(MP)核酸;粪便标本EV,肠道病毒71型(EV71),柯萨奇病毒A6(CVA6)、柯萨奇病毒A16(CVA16)、柯萨奇病毒A10(CVA10)核酸;兼并引物扩增埃可病毒30(Echo30)。收集患儿临床资料。结果脑炎/脑膜炎症候群发病高峰季节为6-8月份;年龄分布:0~15岁均有发病,0~6岁儿童占81.41%,0~1岁所占比例最高,为32.38%;男408例,女259例。临床症状以发热(586例)、精神萎靡(337例)、呕吐(307例)和头痛(203例)为主;临床体征包括嗜睡(103例)、颈项强直(71例)、脑膜刺激征(12例)、病理反射(313例)等;临床诊断病毒性脑炎272例,重症手足口病并脑炎332例,细菌性脑膜炎30例,其他33例;病原学检测:脑脊液标本EV、EBV、Echo30阳性检出率分别为59.72%、3.16%和70.00%;粪便标本检出EV71、CVA16、CVA6、EV71+CVA16和EV71+CVA16+CVA6核酸,其中EV71阳性检出率最高(98.96%)。结论长春市儿童医院住院小儿脑炎/脑膜炎症候群主要为病毒性脑炎;临床症状以发热、精神萎靡、嗜睡、呕吐和头痛为主;体征包括颈项强直、脑膜刺激征、病理反射等;病原主要为EV71。Objective To understand the clinical features and pathogenic spectrum of encephalitis and meningitis syndrome in children. Methods A total of 667 cases of children with encephalitis or meningitis diagnosed and documented at Changchun Children′s Hospital from May 2012 to July 2015 were enrolled.A variety of samples in diffe-rent types were collected and presented, including 335 cerebrospinal fluid specimens, 530 blood samples, and 332 stool samples.All the samples were collected from the patients within 72 hours on admission.Moreover, these samples are analyzed and tested, including PCR for enterovirus(EV), herpesvirus(HSV), mycobacterium tuberculosis(TB) and Mycoplasma pneumoniae(MP) nucleic acid in cerebrospinal fluid samples;fecal specimens were tested for EV, enterovirus 71 (EV71), coxsackievirus A6 (CA6), coxsackievirus A16 (CVA16), coxsackievirus A10 (CVA10) nucleic acids;degenerate primers to amplify Echovirus 30 (Echo30). Clinical data of children were collected. Results The peak incidence of encephalitis and meningitis syndrome was from June to August, age distribution was from 0 to 15 years old, the proportion of children aged from 0-6 accounted for 81.41%;the highest proportion was among 0-1 years old infants, occupying 32.38%;408 males and 259 females;the main symptoms were fever(586 cases), apathy(337 cases), vomiting (307 cases) and headache(203 cases). And clinical signs included drowsiness (103 cases), neck stiffness (71 cases), meningeal irritation (12 cases), and pathological reflex (313 cases), etc.The clinical diagnosis included 272 cases of viral encephalitis, 332 cases of severe hand, foot and mouth disease complicated by encephalitis, 30 cases of bacterial meningitis, and 33 other cases;the etiological detection included: the positive rates of EV, EBV and Echo30 in cerebrospinal fluid specimens were 59.72%, 3.16% and 70.00%, respectively.And EV71, CVA16, CVA6, EV71+ CA16 and EV71+ CVA16+ CVA6 nucleic acids were detected in fecal samples, in which the highest detection rate was EV71(98.96%)

关 键 词：儿童 脑炎/脑膜炎症候群 临床特点 病原谱 

分 类 号：R725.1[医药卫生—儿科]