摘要目的 了解2013—2016年济南市哨点医院急性脑膜炎脑炎症候群(AMES)监测病例的病毒流行特征.方法 收集2013—2016年济南市6家AMES哨点监测医院上报的AMES监测病例的个案调查资料、临床信息等,并选取其血清和(或)脑脊液标本进行实验室检测,共3 577例.采用ELISA方法检测流行性乙型脑炎病毒(JEV)IgM抗体;对JEV IgM抗体阴性者进行人类肠道病毒(EV)、流行性腮腺炎病毒(MuV)和单纯疱疹病毒(HSV)的IgM抗体检测;并进行EV分离与分子定型.比较4种病毒IgM抗体阳性率的差异.结果 2013—2016年JEV IgM抗体检测例数为3 577例,抗体阳性率为9.0%(322例).3 255例JEV IgM抗体阴性者中,EV、MuV和HSV IgM抗体检测例数为2 916例,阳性率分别为22.1%(643例)、9.9%(289例)和26.9%(783例).各年JEV IgM抗体阳性率分别为32.9%(261/794)、1.2%(14/1 175)、1.0%(8/807)和4.9%(39/801),EV IgM抗体阳性率分别为19.5% (91/466)、35.1%(342/974)、15.5%(115/743)和13.0%(95/733),MuV IgM抗体阳性率分别为9.2% (43/466)、14.4%(140/974)、9.0%(67/743)和5.3%(39/733),HSV IgM抗体阳性率分别35.4%(165/466)、38.5%(375/974)、25.7%(191/743)和7.1%(52/733);4种病毒各年份间阳性率差异均有统计学意义(P<0.001).2013—2016年共对1 020例病例脑脊液标本进行了EV分离,检出率为7.9%(81例),各年分别为4.8%(6例)、13.1%(55例)、4.1%(7例)和4.2%(13例);81株EV分为8个血清型,其中柯萨奇病毒(CV)B5型、埃可病毒(E)6和30型较多,分别占46%(37株)、22%(18株)和21%(17株).结论2013—2016年济南市哨点医院AMES病例的病毒病原主要为HSV、EV、MuV、JEV;CV?B5、E6和E30是引致AMES的EV优势血清型.

abstractsObjective To characterize the etiology and epidemiological characteristics of the acute meningitis and encephalitis syndrome (AMES) in Jinan city in 2013-2016. Methods The epidemiological data, clinical diagnosis, serum and cerebrospinal fluid (CSF) specimens were collected from 3 577 AMES cases in 6 sentinel hospitals in Jinan city in 2013-2016. Samples of all cases were made sero?diagnosis for Immunoglobulin (Ig) M antibody to Japanese encephalitis virus (JEV) and negative cases of JEV for enterovirus (EV), mumps virus (MuV) and herpes simplex virus (HSV) by enzyme?linked immunosorbent assay (ELISA). Virus isolation and molecular identification were performed. Positive rates were analyzed by Chi?square test. Results In 2013-2016, the positive rates of JEV, EV, MuV and HSV were 9.0% (322/3 577 cases), 22.1% (643/ 2 916 cases), 9.9% (289/2 916 cases), 26.9% (783/2 916), respectively. Of these, the positive rates of JEV were 32.9% (261/794), 1.2% (14/1 175), 1.0% (8/807) and 4.9% (39/801 cases); EV: 19.5% (91/466), 35.1% (342/974 cases), 15.5% (115/743) and 13.0% (95/733);MuV: 9.2% (43/466), 14.4% (140/974), 9.0% (67/743) and 5.3% (39/733). HSV: 35.4% (165/466), 38.5% (375/974), 25.7% (191/743) and 7.1% (52/733). There were significant differences in positive rates of 4 kinds of viruses in 2013-2016 (P<0.001). A total of 81 EV strains belonging to 8 serotypes were isolated from 1 020 CSF specimens. The positive rates were 4.8% (6 cases), 13.1% (55 cases), 4.1% (7 cases) and 4.2% (13 cases) from 2013 to 2016. Coxsackievirus (CV) B5, echovirus (E) 6 and E30 accounted for 46% (37 isolates), 22% (18 isolates) and 21% (17 isolates) of all strains. Conclusion The AMES cases in Jinan city in 2013-2016 were mainly caused by HSV, EV, MuV, JEV. CVB5, E6 and E30 were the dominant serotypes of EV associated with AMES cases in Jinan city.