2005年广州市29例流脑临床表现与实验室检测结果分析

目的 了解2005年春季广州地区局部暴发流行的流行性脑脊髓膜炎（流脑）的临床表现与实验室检查结果的特点，为临床诊治提供参考。方法 2004年12月～2005年3月收治的29例确诊流脑患者的临床表现与实验室资料作回顾性分析。结果 29例流脑患者绝大多数（89．6％）为成年患者，以外来人员及民工为主（75．9％），多数患者（62．1％）在同一暴发点，均未接种过流脑疫苗。临床表现典型，轻型2例（6．9％），普通型21例（72．4％），暴发型6例（20．7％）。所有患者均出现发热、头痛，呕吐23例（79．3％），瘀点瘀斑23例（79．3％），脑膜刺激征阳性22例（75．9％），意识障碍13例（44．8％）。发病早期外周血及脑脊液WBC、血清LDH、CK、CKMB、ALT、AST、CHE、ALB、BUN、CREAT、GLU、TRIG、CHOL、K、Na、Ca等有不同比例的异常，暴发型尤其显著．治疗后逐渐恢复。并发心肌损害12例，肝损害10例，肾损害3例，7例发生关节炎，关节腔积液4例。普通型和暴发型患者的外周血白细胞计数及凝血酶原时间异常例数的比较有显著性差异（P〈0．05）。脑膜炎奈瑟氏菌检出率为65．5％（19例），病原菌对青霉素、氯霉素、复方磺胺及头孢曲松均敏感。29例全部治愈出院。结论 本次流行以成人民工为主，临床表现典型，暴发型比例高，关节炎发生率较高，多脏器损害比例高，病原体检出率高，常用抗生素敏感，抢救成功率高。

Clinical Manifestation and Laboratory Examination Results Analysis of 29 Cases of Epidemic Cerebrospinal Meningitis of Guangzhou in 2005

Objective To analyze the clinical manifestation and laboratory examination results of epidemic cerebrospinal meningitis in Guangzhou in 2005. Method 29 cases of epidemic cerebrospinal meningitis, which were hospitalized in our hospital from Dec. 2004 to March 2005, were retrospectively analyzed of the clinical manifestation and laboratory results. Results In 29 cases of epidemic cerebrospinal meningitis, most of the patients were adults (89.6%), and mainly immigrants (75.9%). Many of the patients (62.1%) were found in the same epidemic area and had not been vaccinated for epidemic cerebrospinal meningitis before. They all had the typical clinical manifestations as fever and headache. Patients also showed other symptoms, 23 cases of vomiting (79.3%), 23 cases of petechia (79.3%), 22 cases of meningitis pathologic reflex (75.9%), and 13 cases of disturbance of consciousness (44.8%). 21 cases were of common type (72.4%) and 6 cases of fulminant type (20.7%). There were abnormal changes in the count of WBC, serum LDH, CK, CK-MB, ALT, AST, CHE, ALB, BUN, CREAT, GLU, TRIG, CHOL, K, Na, and Ca both in the peripheral blood and cerebrospinal fluid in the early phase of the disease. And the changes were much obvious in the fulminant cases. All the clinical parameters gradually came back to normal after treatment. There were still some complications of other organs, such as 12 cases of cardiac damage, 10 cases of liver dysfunction, 3 cases of kidney dysfunction, 7 cases of arthritis and 4 cases of articular cavity effusion. There were significant differences in the WBC count and abnormal rate of PT between the common group and the fulminant group(P<0.05). The positive detecting rate of Neisseria meningitides was 65.5% (19 cases). The pathogen was sensitive to penicillin, chloramphenicol, compound sulfanomides and ceftriaxone. 29 cases all fully recovered and discharged from our hospital. Conclusion The epidemic cerebrospinal meningitis in this period in Guangzhou was mainly occurred in the immigrated workers. Its clinical manifestation was typical. The rates of fulminant type, arthritis and multiple organ dysfunctions were high. The detecting positive rate of pathogen was high. Neisseria meningitides was sensitive to most common antibiotics. The rescue rate was also high.