病毒性脑炎临床特征分析及临床诊断质量评价

目的 分析不同类别病毒性脑炎的临床特征和目前诊断现状,为病毒性脑炎的临床诊治提供参考依据。 方法 通过在广西壮族自治区贵港市建立涵盖市辖区、桂平市和平南县的急性脑炎、脑膜炎流行病学监测网络,通过流行病学个案调查和标本检测,获取10种常见病毒性脑炎的发病资料,对各种病毒性脑炎病例进行分析比较。 结果 病毒性脑炎的主要临床表现为发热、抽搐、精神萎靡,部分病例伴有头痛、呕吐、恶心和嗜睡等症状,大部分病例颈项强直、前囟膨隆、脑膜刺激征等临床体征均为阴性,脑脊液外观清晰/无色透明、蛋白质定性阴性、葡萄糖和氯化物正常或增高。临床医生对急性脑炎/脑膜炎的诊断较为笼统,60.04%的评估病例以其他脑炎作为入院诊断收治入院,流行性乙型脑炎(乙脑)临床诊断的正确率为35.71%,漏诊率为78.49%,乙脑以外的其他病毒性脑炎病例中,临床医生最终判断为脑炎或脑膜炎病例的只有44.77%。 结论 乙脑以及其他病毒性脑炎的临床诊断存在较大漏洞,误诊率和漏诊率高,有必要加强常见病毒性脑炎的实验室检测。

Clinical features and evaluation of clinical diagnosis of viral encephalitis

Objective To understand the clinical features of different types of viral encephalitis and the quality of clinical diagnosis of viral encephalitis,and provide evidence for the prevention and control of the disease.MethodsThe incidence data of 10 types of viral encephalitis were collected through case survey,clinical sample detection and network epidemiological surveillance of encephalitis/meningitis in Guigang in Guangxi.The comparison of clinical features among different viral encephalitis was conducted.Results The main clinical manifestations of viral encephalitis cases included fever,seizures,listlessness,some cases were accompanied with headache,vomit,nausea,lethargy and other symptoms.In most cases the clinical sign indicators and cerebrospinal fluid(CSF) test results were normal,and the glucose and chloride indicators were normal or elevated.The clinical doctors didn’t make the type specific diagnosis for acute encephalitis/meningitis cases,up to 60.04% of the cases were diagnosed with encephalitis unspecified.The correct diagnosis rate of Japanese encephalitis(JE) was only 35.71%,the missed diagnosis rate was 78.49%.Among the encephalitis cases other than JE,only 44.77% were diagnosed as encephalitis or meningitis.Conclusion The misdiagnosis and missed diagnosis rates of JE and other viral encephalitis were high only on the basis of clinical symptoms or signs,it is necessary to strengthen the laboratory detection of common viral encephalitis.