急性脑膜炎病原学及临床特征  

Etiological and clinical characteristics of acute meningitis

作　　者：许海东[1] 刁红梅[1] 朱晓莉[1] 耿德勤 王皓[1] XU Hai-dong;DIAO Hong-mei;ZHU Xiao-li;GENG De-qin;WANG Hao(Tengzhou Central Peopled Hospital,Tengzhou,Shandong 277599,China;不详)

机构地区：[1]山东省滕州市中心人民医院神经内科,山东滕州277599 [2]徐州医科大学附属医院神经内科,江苏徐州221006

出　　处：《中华医院感染学杂志》2021年第7期1102-1106,共5页Chinese Journal of Nosocomiology

基　　金：国家卫健委临床适宜技术专项计划基金资助项目(GN2018R0009)。

摘　　要：目的分析儿童脑膜炎的临床流行特征及脑脊液病原菌特点,为中枢神经系统感染的诊断和治疗提供证据。方法选取山东省滕州市中心人民医院2014年7月-2019年7月收治的208例急性脑膜炎患者作为研究对象,通过查阅病历信息的方法对患者的临床流行特征、血清病毒特异性抗体和脑脊液病原菌特点进行回顾性分析。结果在纳入患者中,5~9岁年龄段的病例数最多,占45.19%,男性患者数量占63.94%,患者发病季节多为夏秋季,占69.71%。有142例为病毒性脑膜炎,占68.27%,66例为细菌性脑膜炎,占31.73%。细菌性脑膜炎患者出现恶心、精神萎靡、嗜睡、抽搐、颈项强直、角弓反张、瘀斑的比例及脑脊液白细胞计数、蛋白水平高于病毒性脑膜炎患者,脑脊液葡萄糖水平低于病毒性脑膜炎患者,差异均有统计学意义(P<0.05)。103例病毒性脑膜炎患者检出血清单一病毒特异性(Ig)M阳性,占72.54%,其中,以人类肠道病毒(HEV)-IgM阳性例数最多,占30.28%,其次为单纯疱疹病毒(HSV)-IgM阳性病例和流行性腮腺炎病毒(MuV)IgM阳性病例;有39例患者检出血清多种病毒特异性IgM阳性,占27.46%,其中,以HEV+HSV-IgM阳性例数最多,占12.68%;细菌性脑膜炎患者脑脊液样本共检出66株病原菌,其中,革兰阳性菌39株占59.09%,以凝固酶阴性葡萄球菌和肺炎链球菌为主;革兰阴性菌24株占36.36%,以大肠埃希菌和脑膜炎奈瑟菌为主;真菌3株占4.55%。结论急性脑膜炎好发于5~9岁儿童人群,细菌性脑膜炎患者中枢神经系统受累症状更多见,脑脊液指标变化具有特征性,HEV、HSV、MuV是病毒性脑膜炎的主要病原体,凝固酶阴性葡萄球菌、肺炎链球菌等革兰阳性菌是细菌性脑膜炎患者脑脊液中的主要病原菌。OBJECTIVE To analyze the clinical epidemic characteristics of meningitis and the characteristics of pathogenic bacteria in cerebrospinal fluid, so as to provide evidence for the diagnosis and treatment of central nervous system infections. METHODS Total of 208 patients hospitalized for acute meningitis in Tengzhou Central People’s Hospital from Jul. of 2014 to Jul. of 2019 were recruited as the research objects. The clinical epidemic characteristics, the serum virus specific antibodies and the characteristics of pathogenic bacteria in cerebrospinal fluid were analyzed retrospectively by consulting the medical records. RESULTS Among the included patients, patients aged between 5-9 years was the most, accounting for 45.19%, and male patients accounted for 63.94%. The onset seasons were mostly summer and autumn, accounting for 69.71%. There were 142 cases of viral meningitis, accounting for 68.27%, 66 cases of bacterial meningitis, accounting for 31.73%. The proportions of symptoms like nausea, mental malaise, drowsiness, convulsion, neck rigidity, arcuate, ecchymosis and the levels of white blood cell count and protein in cerebrospinal fluid of the patients with bacterial meningitis were higher than those with viral meningitis. And the glucose level in cerebrospinal fluid was lower than that of the patients with viral meningitis, the differences were signficant(P<0.05). In 103 cases of viral meningitis, the detectable rate of single positive virus specific immunoglobulin(Ig) M in serum accounted for 72.54%, in which the positive Human Enterovirus(HEV)-IgM was the most, accounting for 30.28%, followed by Herpes Simplex Virus(HSV)-IgM and Mumps Virus(MUV) IgM. In 39 cases of viral meningitis, the multiple positive virus specific IgM in serum was detected, accounting for 27.46%, among them, the number of cases with positive HEV+HSV-IgM was the most, accounting for12.68%. A total of 66 strains of pathogenic bacteria were detected in cerebrospinal fluid samples of the patients with bacterial meningitis, of which 39 st

关 键 词：脑膜炎 临床流行特征 脑脊液 病原菌 病毒特异性抗体 

分 类 号：R72[医药卫生—儿科]