重庆地区954例中枢神经系统感染性疾病的流行病学和临床特征分析  

Epidemiological and clinical characteristics of 954 cases of infectious diseases of central nervous system in Chongqing

作　　者：张兰 周竹娟 程畅 王玉涵 承文超 陈秀英 董开元 黄文 Zhang Lan;Zhou Zhu-Juan;Cheng Chang;Wang Yu-Han;Cheng Wen-Chao;Chen Xiu-Ying;Dong Kai-Yuan;Huang Wen(Department of Neurology,the Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院神经内科,重庆400037

出　　处：《解放军医学杂志》2024年第5期534-541,共8页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨重庆地区954例中枢神经系统(CNS)感染性疾病的流行病学及临床特征。方法回顾性分析2008—2021年重庆新桥医院诊治的954例CNS感染性疾病的病原体与患者性别、发病年龄与时间、城乡分布、受教育程度、职业分布等流行病学特点,以及临床表现、宏基因组学第二代测序(mNGS)的阳性率和预后等临床特征。结果954例CNS感染性疾病的病原体为病毒393例(41.2%)、结核分枝杆菌361例(37.8%)、其他细菌108例(11.3%)、隐球菌75例(7.9%)、梅毒螺旋体16例(1.7%)、寄生虫1例(0.1%);2015-2021年的CNS感染病例数较2008-2014年增加85.6%(620 vs.334,P<0.001);不同病原体的季节分布差异无统计学意义(P>0.05);CNS感染性疾病好发于农村(58.0%,P<0.001),男女比例为1.7:1.0,35~60岁发病较多;CNS感染性疾病多见于学历为初中及以下(68.7%)和职业为农民或工人(68.1%)的群体;临床症状以发热、头痛、脑膜刺激征及恶心呕吐等脑膜受累症状为主,可伴有意识改变、局灶神经功能缺损症状等表现;mNGS明显提高了临床诊断精准性;疾病良好预后率为97.5%,病死率为0.3%。结论重庆地区CNS感染病原体类别及种属多样、流行面广、临床表现复杂,且近年来病例数目呈上升趋势。了解当地CNS感染性疾病的流行病学和临床特征有助于了解疾病的区域差异,促进疾病的早期精准诊断、治疗,并改善预后。Objective To investigate the epidemiological and clinical characteristics of 954 cases of central nervous system(CNS)infections in Chongqing.Methods A retrospective analysis was conducted on 954 patients with CNS infectious disease diagnosed and treated in the Second Affiliated Hospital of Army Medical University from 2008 to 2021.The analysis encompassed pathogens,patient gender,age of onset,time of onset,urban-rural distribution,education level,occupational distribution,and other epidemiological characteristics.The clinical manifestations,the positive rate of metagenomic next-generation sequencing(mNGS),and prognosis were also analyzed.Results Among the 945 cases of CNS infectious diseases,the pathogens were viruses in 393(41.2%),Mycobacterium tuberculosis in 361(37.8%),other bacteria in 108(11.3%),Cryptococcus in 75(7.9%),Treponema pallidum in 16(1.7%)and parasites in 1(0.1%).The number of CNS infection cases from 2015 to 2021 increased by 85.6%compared with that from 2008 to 2014(620 vs.334,P<0.001).There was no significant difference in seasonal distribution of pathogens(P>0.05).CNS infectious diseases were more prevalent in rural areas(58.0%,P<0.001),with a male-to-female ratio of 1.7:1.0,and a higher incidence in individuals aged between 35 and 60 years.The majority of patients were educated at Junior high school level or below(68.7%)and were farmers or workers(68.1%).Clinical symptoms of CNS infectious disease mainly included fever,headache,signs of meningeal irritation,nausea and vomiting,which could be accompanied by consciousness disorder and focal neurological deficits.mNGS significantly improves the accuracy of clinical diagnosis.The rate of good prognosis of CNS infectious diseases was 97.5%,while the mortality rate was 0.3%.Conclusions In Chongqing area,the categories and species of CNS infectious pathogens are diverse,widely prevalent,and the clinical manifestations are complex.Moreover,the number of cases has been increasing in recent years.Understanding the epidemiological and clinical character

关 键 词：中枢神经系统 感染 流行病学 临床特征 重庆 

分 类 号：R51[医药卫生—内科学] R741[医药卫生—临床医学]