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目的了解广东省病毒性脑炎的病原学特征和流行病学特点。方法分别选择位于广东省中部、西部和东部的各1家三甲医院为监测点,以临床诊断为病毒性脑炎的病例为监测对象,于2006年9月至2008年9月收集有关病例信息,并采集病例的血清和脑脊液,分别采用ELISA和RT-PCR(或PCR)的方法进行病原学检测,ELISA法检测单纯疱疹病毒(HSV)、乙脑病毒(JEV)、腺病毒(ADV)、埃可病毒(ECOH)、柯萨奇病毒(COX)、巨细胞病毒(CMV)IgM抗体;RT-PCR(或PCR)法检测黄病毒(包括乙脑病毒和西尼罗病毒WNV)、肠道病毒(包括埃可病毒和柯萨奇病毒)、单纯疱疹病毒I和II型、腺病毒、巨细胞病毒和Colti病毒的病毒核酸。同时收集同期广东省报告乙脑病例资料进行比较分析。结果2006年9月至2008年9月3家监测医院共收治病毒性脑炎病例195例,男女性别比为1.6∶1(120/75),各年龄段均有发病,但以10岁及以下儿童为多,占26.67%;同期广东省共报告乙脑发病例数296例,其中以10岁及以下和11~14岁儿童为主,分别占70.27%、26.01%。对3家监测医院收集的152例病毒性脑炎病例的血清进行病毒IgM抗体检测,共有47例病毒IgM抗体阳性,阳性率为30.92%。其中腺病毒IgM抗体阳性的最多,共有20例,占血清阳性病例数的42.55%,其次是单纯疱疹病毒IgM抗体阳性15例,占31.91%,乙脑病毒、巨细胞病毒、埃可病毒、柯萨奇病毒IgM抗体检测阳性数分别为5、3、3、1例;检测109例脑脊液,均未检测到病毒核酸;75.90%的监测病例未能检测出病毒抗体或病毒核酸。结论乙脑病例主要以1~14岁儿童为主,而其他病毒性脑炎在各年龄组均有发病;除乙脑外,腺病毒、单纯疱疹病毒是广东省病毒性脑炎常见的病原体。应建立快速敏感的检测方法以进一步明确病毒性脑炎的病原学特征。
Objective To understand the etiological and epidemiological characteristics of viral encephalitis in Guangdong Province. Methods One of the top three hospitals in the central, western and eastern part of Guangdong Province were selected as the monitoring points. The patients with clinical diagnosis of viral encephalitis were monitored. From September 2006 to September 2008, the cases were collected. Serum and cerebrospinal fluid (CSF) of the patients were collected. Pathogenicity was detected by ELISA and RT-PCR (or PCR), respectively. Herpes simplex virus (HSV), Japanese encephalitis virus (JEV), adenovirus ECV, COX and CMV IgM antibodies were detected by RT-PCR (or PCR) method, including flavivirus (including JE and WNV), enterovirus (Including Echovirus and Coxsackie virus), herpes simplex virus types I and II, adenovirus, cytomegalovirus and Colti virus. At the same time collect the same period Guangdong Province reported JE cases data for comparative analysis. Results A total of 195 cases of viral encephalitis were admitted to the three surveillance hospitals from September 2006 to September 2008 with a male-to-female ratio of 1.6: 1 (120/75), with incidence of all age groups. However, at 10 years of age and below Children accounted for 26.67%. In the same period, 296 cases of Japanese encephalitis were reported in Guangdong Province, of which 10 years old and below and 11 to 14 years old were the majority, accounting for 70.27% and 26.01% respectively. Virus IgM antibody was detected in sera of 152 cases of viral encephalitis collected by 3 monitoring hospitals. A total of 47 cases were positive for IgM antibody, the positive rate was 30.92%. Among them, adenovirus IgM antibody was the most positive, with a total of 20 cases, accounting for 42.55% of the seropositive cases, followed by herpes simplex virus IgM antibody positive in 15 cases (31.91%), JE virus, cytomegalovirus, echovirus, The positive numbers of IgM antibodies to SSR were 5, 3, 3 and 1 cases respectively. No detectable viral nucleic acid was detected in 109 cases of cerebrospinal fluid and 75.90% of the surveillance cases failed to detect virus or viral nucleic acid. Conclusion The cases of Japanese encephalitis are mainly children aged from 1 to 14 years old, while other viral encephalitis occur in all age groups. In addition to the Japanese Encephalitis, adenovirus and herpes simplex virus are common pathogens of viral encephalitis in Guangdong Province. Rapid and sensitive detection should be established to further clarify the etiological characteristics of viral encephalitis.