1983-2012年154例流行性脑脊髓膜炎临床特征及流行病学分析

目的：了解30年来该院收治的经细菌学确诊的流行性脑脊髓膜炎（简称流脑）临床与流行病学特点，为流脑防治工作积累经验。方法对1983—2012年154例患者的临床资料按发病时间不同分为两组（ A组：1983—2002年，共80例， B组：2003—2012年，共74例），对两组临床资料进行回顾性分析，统计学分析采用t检验和卡方检验。结果近30年来流脑发病呈低水平散发状态，无大规模流行。 A组以0～5岁人群为主，占48．75％，B组以16～20岁人群为主，占41．89％。发病季节均以冬春季为主，其中以3～5月份最多见，占68．18％。 B组患者平均年龄（15．78岁）高于A组（9．87岁），暴发型流脑发生率（18．91％）比A组（7．50％）为高，出现瘀点瘀斑比例（63．51％））低于A组（88．75％），出现意识障碍比例（43．24％）高于A组（26．25％），中性粒细胞百分比值平均值（85．62％）高于A组（78．64％），且均有统计学差异。患者对头孢曲松、头孢噻肟未出现耐药，对青霉素的耐药率为4．44％，对磺胺药由2003年之前的30．67％耐药到2003年之后100％耐药。结论流脑发病总体呈低水平散发状态，两组患者发病季节均以冬春季为主，B组患者临床症状较A组为重，发病年龄高峰上移。治疗上以青霉素、头孢曲松为首选。

Clinical and epidemiological analysis of 154 cases of epidemic cerebrospinal meningitis from 1983 to 2012

Objective To understand the clinical and epidemiological characteristics of epidemic cerebrospinal meningitis diagnosed by bacteriology during the past 30 years in our hospital to guide prevention and cure of this disease.Methods According to the onset date the clinical data of 154 cases from 1983 to 2012 were divided into two groups ( Group A:1983 to 2002, 80 cases;group B:2003 to 2012, 74 cases) and were retrospectively analyzed.T test and Chi square test were used for statistical analysis.Results In the past 30 years, incidence rate of epidemic cerebrospinal meningitis was low.Group A was mainly patients aged 0~5 years , accounting for 48. 75%, whereas group B was mainly patients aged 16~20 years, accounting for 41.89%.Winter and spring were the main onset time, particularly in March~May (accounting for 68.18%).Average age in group B (15.78 years) was more higher than group A (9.87 years), and the incidence rate of fulminant epidemic cerebrospinal meningitis in group B (18.91%) was higher than group A (7.50%), while the proportion of petechia and ecchymosis in group B (63.51%) was lower than group A (88.75%)).Disturbance of conscious-ness in group B (43.24%) was higher than that in group A (26.25%), and the neutrophil percentage value (85.62%) in group B was higher than that in group A (78.64%), and these were statistically significant.Patients didn’t show resistance to ceftriaxone and cefo-taxime, but 4.44%of the patients had resistance to penicillin .30.67%of the patients were resistant to sulfa drugs before 2003, but after 2003 all the patients showed resistance.Conclusion Incidence rate of epidemic cerebrospinal meningitis was generally low.The onset dates of these two groups of patients were mainly in winter and spring.Clinical symptoms of group B patients were more severe than group A, and age at onset increases from younger to older age group.Penicillin and ceftriaxone are the first choice for treatment.