本文選題：腦炎癥候群 + 流行病學(xué)��； 參考：《廣西醫(yī)科大學(xué)》2009年碩士論文

【摘要】： 目的研究腦炎癥候群的流行病學(xué)監(jiān)測(cè)方法,系統(tǒng)監(jiān)測(cè)廣西乙腦高發(fā)區(qū)(貴港市)腦炎癥候群的發(fā)生情況、發(fā)生特點(diǎn)、發(fā)生規(guī)律;摸清腦炎癥候群的主要病原譜構(gòu)成;分析腦炎癥候群的臨床流行病學(xué)、現(xiàn)場(chǎng)流行病學(xué)特征;提高腦炎癥候群的臨床鑒別分析與實(shí)驗(yàn)室檢測(cè)能力;提高腦炎的病原學(xué)診斷水平;建立腦炎病因臨床診斷判別模型;為廣西腦炎的臨床診治和預(yù)防控制提供科學(xué)理論和依據(jù)。 方法選擇監(jiān)測(cè)點(diǎn),確定監(jiān)測(cè)方法、研究對(duì)象、監(jiān)測(cè)病例定義標(biāo)準(zhǔn)、統(tǒng)一資料收集整理分析方法。在廣西貴港市12家縣級(jí)及縣級(jí)以上的醫(yī)院開展腦炎癥候群監(jiān)測(cè),對(duì)符合監(jiān)測(cè)病例定義的病例采集血清、腦脊液標(biāo)本,應(yīng)用ELISA法進(jìn)行乙腦等10種常見病毒的IgM抗體檢測(cè),同時(shí)開展流行病學(xué)個(gè)案調(diào)查,收集監(jiān)測(cè)病例的發(fā)病情況、臨床特征和實(shí)驗(yàn)室檢查結(jié)果等資料,進(jìn)行流行病學(xué)分析,應(yīng)用Fisher和Bayes判別分析法分別對(duì)不同性質(zhì)腦炎的臨床特征、實(shí)驗(yàn)室檢測(cè)結(jié)果進(jìn)行結(jié)構(gòu)分析,篩檢診斷指標(biāo),建立腦炎病因臨床診斷判別模型。 結(jié)果貴港市監(jiān)測(cè)期內(nèi)(18個(gè)月)腦炎癥候群監(jiān)測(cè)系統(tǒng)評(píng)估的本地疑似急性腦炎或腦膜炎病例867例,死亡42例,疑似急性腦炎或腦膜炎年均報(bào)告發(fā)病率為11.52/10萬,病死率為4.86%;評(píng)估病例以15歲以下兒童為主,占75.68%,散居兒童多見,占53.65%,報(bào)告發(fā)病率有隨年齡增大呈下降的趨勢(shì),男性報(bào)告發(fā)病率高于女性;發(fā)病時(shí)間集中在夏秋季,5～8月份多見;地區(qū)分布以農(nóng)村病例為主,占93.04%,桂平市病例數(shù)最多,占41.52%,平南縣占35.99%,貴港市區(qū)占22.49%;評(píng)估病例以病毒性感染為主,病毒檢測(cè)陽性率為52.09%,腸道病毒、腮腺炎病毒和乙腦病毒是其主要病原,三種病原占陽性病例數(shù)的82.17%;各種病毒性腦炎病例臨床診斷的正確率均在50%以下,乙腦漏診率高,78.49%乙腦病例的發(fā)現(xiàn)依賴于實(shí)驗(yàn)室檢測(cè)。Fisher和Bayes病因臨床診斷判別模型交叉驗(yàn)證考核的符合率分別為77.5%和67.7%%。 結(jié)論貴港市腦炎癥候群監(jiān)測(cè)系統(tǒng)評(píng)估的疑似急性腦炎或腦膜炎病例以病毒性感染為主;腸道病毒、腮腺炎病毒是貴港市較乙腦病毒更為常見的病毒性腦炎的主要病原,與乙腦同期流行;乙腦具有較高的漏診率;在乙腦流行季節(jié)需要加強(qiáng)腸道病毒、腮腺炎病毒和乙腦病毒檢測(cè),提高鑒別診斷能力;在乙腦流行季節(jié)前加強(qiáng)乙腦疫苗、腮腺炎疫苗的接種工作,是預(yù)防和控制腦炎流行的可靠手段;Fisher和Bayes病因臨床診斷判別模型在不同性質(zhì)和不同病原類型腦炎的臨床輔助診斷上具有一定的指導(dǎo)意義和現(xiàn)實(shí)應(yīng)用價(jià)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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2009
【分類號(hào)】：R512.32;R181.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 雷仁宇,羅耀星,邵曉萍,蔡漢港,陸碧茹,張吉?jiǎng)P,林永杰,疏俊,吳承剛;疫苗應(yīng)急接種對(duì)控制流行性乙型腦炎流行的作用[J];華南預(yù)防醫(yī)學(xué);2005年01期

2 余俊龍,劉水平,羅敏華,姚孟暉,王莉莉,李聞文;中樞神經(jīng)系統(tǒng)感染性疾病的病原學(xué)研究[J];湖南醫(yī)科大學(xué)學(xué)報(bào);2003年04期

3 趙宇紅,申昆玲;兒童病毒性腦炎病原學(xué)分析[J];實(shí)用兒科臨床雜志;2003年10期

4 陸惠芬,趙勤英,吳泉;262例兒童病毒性腦炎流行病學(xué)調(diào)查分析[J];實(shí)用預(yù)防醫(yī)學(xué);2004年01期

5 王曉軍,張彥平,張榮珍,陳圓生,梁曉峰;中國(guó)1998～2002年流行性乙型腦炎流行趨勢(shì)分析[J];中國(guó)計(jì)劃免疫;2004年04期

6 陳園生;梁曉峰;王曉軍;李藝星;楊俊峰;李軍宏;尹遵棟;胡苑笙;陸偉;;中國(guó)2000～2004年流行性乙型腦炎流行病學(xué)特征分析[J];中國(guó)計(jì)劃免疫;2006年03期

7 尹遵棟;梁曉峰;李藝星;王華慶;翟如芳;梁國(guó)棟;稅鐵軍;迮文遠(yuǎn);李興旺;呂新軍;楊慧軍;光明;陳淑珍;;運(yùn)城市2006年流行性乙型腦炎疫情調(diào)查分析[J];中國(guó)計(jì)劃免疫;2007年03期

8 董柏青,唐振柱,林玫,李翠云,譚冬梅,梁大斌,廖和壯,劉先知,權(quán)怡,方錦嵩,吳興華,秦衛(wèi)文,Kilgore PE,Kennedy WA,徐志一,ClemensJD;廣西南寧地區(qū)5歲以下兒童細(xì)菌性腦膜炎的流行病學(xué)監(jiān)測(cè)[J];中華流行病學(xué)雜志;2004年05期

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