2006—2008年广东省病毒性脑炎监测情况分析

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。

Analysis of the surveillance on the viral encephalitis in Guangdong Province, 2006 - 2008

Objective To find out the characteristics of the pathogens and epidemiology of the viral encephalitis. Methods Three hospitals located in the central, west and east of Guangdong Province were selected as the sentinels to survey the viral encephalitis. The sera, cerebrospinal fluid （CSF） and the related data were collected from the patients diagnosed as the viral encephalitis clinically from September 2006 to September 2008. The samples were detected by ELISA for the antibody against herpes simplex vires （HSV）, Japanese encephalitis virus （JEV）, adenovirus （ADV）, ecohvirus （ECOH）, eoxsaceievirus （COX） and cytomegalovirus （CMV）. RT - PCR（ or PCR） were used to detect the nucleic acid of the flavivirus, enteroviruses, HSV type Ⅰ and type Ⅱ, ADV, CMV and colti virus. The data of the reported cases of JEV in Guangdong at the same time were also collected to analyzed. Results A total of 195 cases of viral encephalitis were surveyed in the three hospitals. The ratio between male and female was 1.6：1 （120/75） The viral encephalitis could be found in all age groups. But the proportion of the age below 10 years was the highest, accounting for 26. 67%. At the same time, 296 cases of Japanese encephalitis were reported in the whole province. The main age groups were below 10 and 11 - 14 years, accounting for 70. 27% and 26. 01%, respectively. Specific IgM antibody was detected in the 152 patients and 47 （30. 92% ） were positive. Among them, the antibody to adenovirus was the highest, followed by HSV. The RT - PCR or PCR were all negative in the 109 CSF samples. There were still 75.90% of cases of viral encephalitis remained unknown. Conclusion Japanese encephalitis mainly occurred in children at 1 - 14 years old. While the other viral encephalitis could be found in all age groups. But the proportion of age below 10 years was the most. Besides JEV, ADV and HSV may be the common pathogens detected in viral encephalitis patients in Guangdong. It is important to develop the rapid and sensitive detection methods to make clear the characteristics of the pathogens of the viral encephalitis.