中华传染病杂志
中華傳染病雜誌
중화전염병잡지
CHINESE JOURNAL OF INFECTIOUS DISEASES
2013年
11期
663-666
,共4页
杨进孙%王文节%葛宗成%喻艳林
楊進孫%王文節%葛宗成%喻豔林
양진손%왕문절%갈종성%유염림
中枢神经系统感染%结核,脑膜%脑膜炎,隐球菌性%预后
中樞神經繫統感染%結覈,腦膜%腦膜炎,隱毬菌性%預後
중추신경계통감염%결핵,뇌막%뇌막염,은구균성%예후
Central nervous system infections%Tuberculosis,meningeal%Meningitis,cryptococcal%Prognosis
目的 探讨近两个10年中枢神经系统感染患者的病因构成、发病年龄、误诊率、住院时间和预后的变化.方法 回顾对比分析1993年1月至2002年12月(A组,共346例)与2003年1月至2012年12月(B组,共412例)皖南医学院附属弋矶山医院收治的中枢神经系统感染者中,化脓性脑膜炎、结核性脑膜炎、隐球菌性脑膜炎、病毒性脑(膜)炎的构成比;根据患者的年龄、性别、基础疾病、入院前免疫抑制剂的应用等,分析其变迁的原因.并比较两组组中和组间各病因的入院前误诊率、住院时间和预后.计量资料行方差分析或t检验,计数资料行x2检验.结果 两组化脓性脑膜炎、结核性脑膜炎、隐球菌性脑膜炎、病毒性脑(膜)炎的构成比分别为24.3％比20.1％、29.5％比35.7％、6.6％比11.4％、39.6％比32.8％(x2=10.61,均P＜0.05).与A组相比,B组患者年龄较大[(38.8±8.9)岁比(43.8±11.4)岁,t=6.73,P＜0.05];基础疾病较多[(1.21±0.34)个比(1.72±0.41)个,t=18.41,P＜0.05];免疫抑制剂应用时间较长[(7.76±3.58)d比(12.43±5.96)d,t=12.77,P＜0.05].两组性别比较,差异无统计学意义(x2=0.97,P＞0.05).A组化脓性脑膜炎、结核性脑膜炎、隐球菌性脑膜炎、病毒性脑(膜)炎入院前误诊率分别为9.5％、42.2％、69.6％和12.4％;平均住院时间分别为(11.02±5.13)、(19.18±8.34)、(21.12±9.26)和(8.24±3.17)d;好转率分别为88.1％、60.8％、34.8％和80.3％.B组化脓性脑膜炎、结核性脑膜炎、隐球菌性脑膜炎、病毒性脑(膜)炎入院前误诊率分别为8.4％、29.3％、42.6％和11.1％;平均住院时间分别为(10.13±4.25)、(17.26±5.82)、(23.05±7.97)和(7.05±2.94)d;好转率分别为90.4％、72.8％、61.7％和84.4％.两组间结核性脑膜炎、隐球菌性脑膜炎入院前误诊率和好转率比较,差异均有统计学意义(均P＜0.05).结论 随着机体基础疾病的增多和免疫抑制剂广泛应用,中枢神经系统感染病种存在变迁,其中结核性脑膜炎和隐球菌性脑膜炎有增多趋势,且易被误诊、预后较差.
目的 探討近兩箇10年中樞神經繫統感染患者的病因構成、髮病年齡、誤診率、住院時間和預後的變化.方法 迴顧對比分析1993年1月至2002年12月(A組,共346例)與2003年1月至2012年12月(B組,共412例)皖南醫學院附屬弋磯山醫院收治的中樞神經繫統感染者中,化膿性腦膜炎、結覈性腦膜炎、隱毬菌性腦膜炎、病毒性腦(膜)炎的構成比;根據患者的年齡、性彆、基礎疾病、入院前免疫抑製劑的應用等,分析其變遷的原因.併比較兩組組中和組間各病因的入院前誤診率、住院時間和預後.計量資料行方差分析或t檢驗,計數資料行x2檢驗.結果 兩組化膿性腦膜炎、結覈性腦膜炎、隱毬菌性腦膜炎、病毒性腦(膜)炎的構成比分彆為24.3％比20.1％、29.5％比35.7％、6.6％比11.4％、39.6％比32.8％(x2=10.61,均P＜0.05).與A組相比,B組患者年齡較大[(38.8±8.9)歲比(43.8±11.4)歲,t=6.73,P＜0.05];基礎疾病較多[(1.21±0.34)箇比(1.72±0.41)箇,t=18.41,P＜0.05];免疫抑製劑應用時間較長[(7.76±3.58)d比(12.43±5.96)d,t=12.77,P＜0.05].兩組性彆比較,差異無統計學意義(x2=0.97,P＞0.05).A組化膿性腦膜炎、結覈性腦膜炎、隱毬菌性腦膜炎、病毒性腦(膜)炎入院前誤診率分彆為9.5％、42.2％、69.6％和12.4％;平均住院時間分彆為(11.02±5.13)、(19.18±8.34)、(21.12±9.26)和(8.24±3.17)d;好轉率分彆為88.1％、60.8％、34.8％和80.3％.B組化膿性腦膜炎、結覈性腦膜炎、隱毬菌性腦膜炎、病毒性腦(膜)炎入院前誤診率分彆為8.4％、29.3％、42.6％和11.1％;平均住院時間分彆為(10.13±4.25)、(17.26±5.82)、(23.05±7.97)和(7.05±2.94)d;好轉率分彆為90.4％、72.8％、61.7％和84.4％.兩組間結覈性腦膜炎、隱毬菌性腦膜炎入院前誤診率和好轉率比較,差異均有統計學意義(均P＜0.05).結論 隨著機體基礎疾病的增多和免疫抑製劑廣汎應用,中樞神經繫統感染病種存在變遷,其中結覈性腦膜炎和隱毬菌性腦膜炎有增多趨勢,且易被誤診、預後較差.
목적 탐토근량개10년중추신경계통감염환자적병인구성、발병년령、오진솔、주원시간화예후적변화.방법 회고대비분석1993년1월지2002년12월(A조,공346례)여2003년1월지2012년12월(B조,공412례)환남의학원부속익기산의원수치적중추신경계통감염자중,화농성뇌막염、결핵성뇌막염、은구균성뇌막염、병독성뇌(막)염적구성비;근거환자적년령、성별、기출질병、입원전면역억제제적응용등,분석기변천적원인.병비교량조조중화조간각병인적입원전오진솔、주원시간화예후.계량자료행방차분석혹t검험,계수자료행x2검험.결과 량조화농성뇌막염、결핵성뇌막염、은구균성뇌막염、병독성뇌(막)염적구성비분별위24.3％비20.1％、29.5％비35.7％、6.6％비11.4％、39.6％비32.8％(x2=10.61,균P＜0.05).여A조상비,B조환자년령교대[(38.8±8.9)세비(43.8±11.4)세,t=6.73,P＜0.05];기출질병교다[(1.21±0.34)개비(1.72±0.41)개,t=18.41,P＜0.05];면역억제제응용시간교장[(7.76±3.58)d비(12.43±5.96)d,t=12.77,P＜0.05].량조성별비교,차이무통계학의의(x2=0.97,P＞0.05).A조화농성뇌막염、결핵성뇌막염、은구균성뇌막염、병독성뇌(막)염입원전오진솔분별위9.5％、42.2％、69.6％화12.4％;평균주원시간분별위(11.02±5.13)、(19.18±8.34)、(21.12±9.26)화(8.24±3.17)d;호전솔분별위88.1％、60.8％、34.8％화80.3％.B조화농성뇌막염、결핵성뇌막염、은구균성뇌막염、병독성뇌(막)염입원전오진솔분별위8.4％、29.3％、42.6％화11.1％;평균주원시간분별위(10.13±4.25)、(17.26±5.82)、(23.05±7.97)화(7.05±2.94)d;호전솔분별위90.4％、72.8％、61.7％화84.4％.량조간결핵성뇌막염、은구균성뇌막염입원전오진솔화호전솔비교,차이균유통계학의의(균P＜0.05).결론 수착궤체기출질병적증다화면역억제제엄범응용,중추신경계통감염병충존재변천,기중결핵성뇌막염화은구균성뇌막염유증다추세,차역피오진、예후교차.
Objective To explore the changes of etiological factors,age of onset,misdiagnosis rates,length of stay and prognosis in central nervous system (CNS) infections between the near 2 decades.Methods A retrospective analysis was conducted between hospitalized patients with CNS infections in affiliated Yijishan Hospital of Wannan Medical College from January 1993 to December 2002 (group A,n =346) and from January 2003 to December 2012 (group B,n =412).The proportions of bacterial infections,Mycobacterium tuberculosis infections,Cryptococcus infections and viral infections between the 2 groups were comparable.Age,gender,underlying diseases and prehospitalization applications of immunosuppressant in two groups were analyzed.The data of prehospitalization misdiagnosis rates,length of stay and prognosis of the two groups were also compared.Measurement data were analyzed by variance analysis or t test,and enumeration data were analyzed by x2 test.Results The proportions of bacterial infections,Mycobacterium tuberculosis infections,Cryptococcus infections and viral infections in two groups were 24.3％ vs 20.1％,29.5 ％ vs 35.7 ％,6.6％ vs 11.4％ and 39.6％ vs 32.8％,respectively (x2 =10.61,P＜0.05).Compared with group A,patients in group B were older [(38.8±8.9) years vs (43.8±11.4) years,t=6.73,P＜0.05],with greater numbers of underlying diseases (1.21 ± 0.34 vs 1.72 ± 0.41,t=18.41,P＜ 0.05) and longer pre-use of immunosuppressants [(7.76 ± 3.58) d vs (12.43 ± 5.96) d,t =12.77,P＜ 0.05].There was no significant difference in sex distributions between the two groups (x2 =0.97,P＞0.05).In group A,the misdiagnosis rates for bacterial infections,Mycobacterium tuberculosis infections,Cryptococcus infections and viral infections were 9.5％,42.2％,69.6％ and 12.4％,respectively; average length of stay was (11.02±5.13) d,(19.18±8.34) d,(21.12±9.26) d and (8.24±3.17) d,respectively; and remission rates were 88.1％,60.8％,34.8％ and 80.3％,respectively.In group B,the misdiagnosis rates for bacterial infections,Mycobacterium tuberculosis infections,Cryptococcus infections and viral infections were 8.4％,29.3％,42.6％ and 11.1％,respectively; average length of staywas (10.13±4.25) d,(17.26±5.82) d,(23.05±7.97) d and (7.05±2.94) d,respectively; and remission rates were 90.4％,72.8％,61.7％ and 84.4％,respectively.The misdiagnosis rates and remission rates of Mycobacterium tuberculosis infections and Cryptococcus infections between group A and group B were of statistical significance (both P ＜ 0.05).Conclusions With the increase of underlying diseases and wide use of immunosuppressants,the causes of CNS infections are changing,among which Mycobacterium tuberculosis infections and Cryptococcus infections are increasing,with a tendency of misdiagnosis and poor prognosis.
