97例成人流行性乙型脑炎的临床表型特征分析  

Clinical phenotypic characteristics of 97 adult patients with epidemic encephalitis B

作　　者：雒夏 马丽娜[1] 刘帅伟[1] 海龙 丁向春[1] Luo Xia;Ma Lina;Liu Shuaiwei;Hai Long;Ding Xiangchun(Department of Infectious Disease,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院感染性疾病科,银川750004

出　　处：《中华地方病学杂志》2022年第12期1019-1024,共6页Chinese Journal of Endemiology

基　　金：宁夏自然科学基金(2021AAC03364);宁夏医科大学校级项目(XM2018113)。

摘　　要：目的分析成人流行性乙型脑炎(乙型脑炎)患者的临床表型,并探讨其病情影响因素。方法收集2018年8-11月宁夏医科大学总医院收治的乙型脑炎确诊患者病历资料,对患者一般资料及血常规、脑脊液常规等实验室指标检查结果进行分析。采用logistic回归及生存曲线分析乙型脑炎病情影响因素。结果共纳入成人乙型脑炎确诊病例97例,其中死亡病例32例,病死率为32.99%;确诊病例包括男性63例、女性34例,发病年龄为(59.13±14.70)岁,不同性别、年龄组间病例分布情况比较差异均有统计学意义(χ^(2)=97.00、291.00,P均<0.001);临床分型以极重型患者最多,为43例,其他依次为轻型(27例)、重型(15例)、普通型(12例)。实验室检测结果显示,患者血液内中性粒细胞、淋巴细胞、单核细胞数均增加;脑脊液内白细胞数重度增加,中性粒细胞比率轻度增加。不同临床分型乙型脑炎患者脑脊液葡萄糖水平、中性粒细胞比率比较差异均有统计学意义(H=4.21、2.74,P均<0.05);死亡情况,合并高血压、脑血管疾病,并发肺部感染情况比较差异也均有统计学意义(χ^(2)=34.22、16.97、9.91、15.59,P均<0.05)。Logistic回归分析结果显示,合并高血压[OR(95%CI)=5.544(1.450~21.191)]及并发肺部感染[OR(95%CI)=6.490(1.887~22.325)]是乙型脑炎患者病情发展的危险因素(P=0.012、0.003)。并发肺部感染是乙型脑炎患者死亡的影响因素(χ^(2)=18.88,P<0.001);生存曲线结果显示,合并脑血管疾病、并发肺部感染的乙型脑炎患者生存状况与无合并症和并发症的患者比较均明显较差(χ^(2)=6.45、20.33,P均<0.05)。结论成人乙型脑炎患者主体为老年人群,患者神经系统存在炎症反应;并发肺部感染是成人乙型脑炎患者病情加重、死亡的重要因素。Objective To analyze the clinical phenotype of adult patients with epidemic encephalitis B(encephalitis B)in Ningxia Hui Autonomous Region,and to explore the influence of related factors of the development of encephalitis B.Methods The medical records of confirmed patients with encephalitis B admitted to the General Hospital of Ningxia Medical University from August to November 2018 were collected,and the general data of patients and the results of laboratory indexes such as blood routine examination and cerebrospinal fluid routine examination were analyzed.Logistic regression analysis and survival curve were used to evaluate the risk factors of the development of encephalitis B.Results Totally 97 patients with encephalitis B were included,32 of them died,with a case fatality rate of 32.99%.There were 63 males and 34 females,and the age of onset was(59.13±14.70)years old.There were statistically significant differences in case distribution rate between different sexes and ages(χ^(2)=97.00,291.00,P<0.001).The most common clinical type was extremely severe(43 cases),followed by mild(27 cases),severe(15 cases)and ordinary(12 cases).The results of laboratory tests showed that the number of neutrophils,lymphocytes and monocytes in the blood of patients increased;and the white blood cells number in cerebrospinal fluid increased significantly,while neutrophils ratio increased slightly.There were significant differences in cerebrospinal fluid glucose level and neutrophil ratio among patients with different clinical types of encephalitis B(H=4.21,2.74,P<0.05).There were statistically significant differences in death,hypertension,cerebrovascular diseases,and pulmonary infection among patients with different clinical types of encephalitis B(χ^(2)=34.22,16.97,9.91,15.59,P<0.05).Logistic regression analysis showed that hypertension[OR(95%CI)=5.544(1.450-21.191)]and pulmonary infection[OR(95%CI)=6.490(1.887-22.325)]were risk factors for the development of encephalitis B patients(P=0.012,0.003).Pulmonary infection was the in

关 键 词：流行性乙型脑炎 临床表型 并发症 

分 类 号：R512.32[医药卫生—内科学]