脑炎症候群的流行病学监测与病因判别模型的研究

发布时间：2018-05-29 04:37

本文选题：脑炎症候群 + 流行病学　；参考：《广西医科大学》2009年硕士论文

【摘要】： 目的研究脑炎症候群的流行病学监测方法,系统监测广西乙脑高发区(贵港市)脑炎症候群的发生情况、发生特点、发生规律;摸清脑炎症候群的主要病原谱构成;分析脑炎症候群的临床流行病学、现场流行病学特征;提高脑炎症候群的临床鉴别分析与实验室检测能力;提高脑炎的病原学诊断水平;建立脑炎病因临床诊断判别模型;为广西脑炎的临床诊治和预防控制提供科学理论和依据。方法选择监测点,确定监测方法、研究对象、监测病例定义标准、统一资料收集整理分析方法。在广西贵港市12家县级及县级以上的医院开展脑炎症候群监测,对符合监测病例定义的病例采集血清、脑脊液标本,应用ELISA法进行乙脑等10种常见病毒的IgM抗体检测,同时开展流行病学个案调查,收集监测病例的发病情况、临床特征和实验室检查结果等资料,进行流行病学分析,应用Fisher和Bayes判别分析法分别对不同性质脑炎的临床特征、实验室检测结果进行结构分析,筛检诊断指标,建立脑炎病因临床诊断判别模型。结果贵港市监测期内(18个月)脑炎症候群监测系统评估的本地疑似急性脑炎或脑膜炎病例867例,死亡42例,疑似急性脑炎或脑膜炎年均报告发病率为11.52/10万,病死率为4.86%;评估病例以15岁以下儿童为主,占75.68%,散居儿童多见,占53.65%,报告发病率有随年龄增大呈下降的趋势,男性报告发病率高于女性;发病时间集中在夏秋季,5～8月份多见;地区分布以农村病例为主,占93.04%,桂平市病例数最多,占41.52%,平南县占35.99%,贵港市区占22.49%;评估病例以病毒性感染为主,病毒检测阳性率为52.09%,肠道病毒、腮腺炎病毒和乙脑病毒是其主要病原,三种病原占阳性病例数的82.17%;各种病毒性脑炎病例临床诊断的正确率均在50%以下,乙脑漏诊率高,78.49%乙脑病例的发现依赖于实验室检测。Fisher和Bayes病因临床诊断判别模型交叉验证考核的符合率分别为77.5%和67.7%%。结论贵港市脑炎症候群监测系统评估的疑似急性脑炎或脑膜炎病例以病毒性感染为主;肠道病毒、腮腺炎病毒是贵港市较乙脑病毒更为常见的病毒性脑炎的主要病原,与乙脑同期流行;乙脑具有较高的漏诊率;在乙脑流行季节需要加强肠道病毒、腮腺炎病毒和乙脑病毒检测,提高鉴别诊断能力;在乙脑流行季节前加强乙脑疫苗、腮腺炎疫苗的接种工作,是预防和控制脑炎流行的可靠手段;Fisher和Bayes病因临床诊断判别模型在不同性质和不同病原类型脑炎的临床辅助诊断上具有一定的指导意义和现实应用价值。
[Abstract]:Objective to study the epidemiological monitoring method of encephalitis syndrome, to systematically monitor the occurrence, characteristics and regularity of encephalitis syndrome in the high incidence area of encephalitis in Guangxi (Guigang city), and to find out the main pathogenic spectrum of encephalitis syndrome. To analyze the clinical epidemiology and field epidemiological characteristics of encephalitis syndrome, to improve the ability of clinical differential analysis and laboratory detection of encephalitis syndrome, to improve the level of etiological diagnosis of encephalitis, to establish clinical diagnosis model of encephalitis. To provide scientific theory and basis for clinical diagnosis, treatment and prevention and control of encephalitis in Guangxi. Methods selection of monitoring points, determination of monitoring method, study object, monitoring case definition standard, unified data collection and analysis method. Encephalitis syndrome surveillance was carried out in 12 county-level and above hospitals in Guigang, Guangxi. Serum and cerebrospinal fluid (CSF) samples were collected from patients who met the definition of surveillance cases, and IgM antibodies of 10 common viruses, such as encephalitis B, were detected by ELISA method. At the same time, epidemiological case investigation was carried out to collect and monitor the incidence, clinical characteristics and laboratory results of the cases. The epidemiological analysis was carried out. The clinical characteristics of different types of encephalitis were analyzed by Fisher and Bayes discriminant analysis, respectively. The clinical diagnosis model of encephalitis was established by structural analysis and screening of diagnostic indexes. Results during the surveillance period (18 months), 867 suspected cases of acute encephalitis or meningitis were assessed and 42 cases died. The average annual reported incidence of suspected acute encephalitis or meningitis was 11.52% / 100 000. The mortality rate was 4.86.The main cases were children under 15 years old (75.68%), and the scattered children were more common (53.65%). The reported incidence rate decreased with the increase of age, and the reported incidence rate of males was higher than that of females. The distribution of regional cases was mainly rural cases, accounting for 93.04um. Guiping had the largest number of cases, accounting for 41.52%, Pingnan County 35.99m, Guigang city 22.49.The cases assessed were mainly viral infections, the positive rate of virus detection was 52.09, and the intestinal virus. Mumps virus and Japanese encephalitis virus are the main pathogens, the three pathogens account for 82.17% of the positive cases, and the correct rate of clinical diagnosis of all kinds of viral encephalitis cases is below 50%. The rate of missed diagnosis of je was 78.49% and the coincidence rate of cross-validation of clinical diagnosis model of Bayes and Bayes was 77.5% and 67.7%, respectively. Conclusion viral infection is the main cause of suspected acute encephalitis or meningitis in Guigang city, and enterovirus and mumps virus are the main pathogens of viral encephalitis, which is more common than Japanese encephalitis virus in Guigang city. B encephalitis has a high rate of missed diagnosis; the detection of enterovirus, mumps virus and Japanese encephalitis virus should be strengthened in the epidemic season of je to improve the ability of differential diagnosis; and the Japanese encephalitis vaccine should be strengthened before the epidemic season of encephalitis B, Mumps vaccination, It is a reliable method to prevent and control the epidemic of encephalitis. The clinical diagnosis discriminant model of Bayes and Bayes has certain guiding significance and practical application value in the clinical assistant diagnosis of encephalitis of different nature and different pathogenic type.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R512.32;R181.3

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