Article(id=1198623859374125874, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198619422425448948, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.1326.2024.0126, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1696694400000, receivedDateStr=2023-10-08, revisedDate=null, revisedDateStr=null, acceptedDate=1700064000000, acceptedDateStr=2023-11-16, onlineDate=1763703797428, onlineDateStr=2025-11-21, pubDate=1716825600000, pubDateStr=2024-05-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1763703797428, onlineIssueDateStr=2025-11-21, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1763703797428, creator=13701087609, updateTime=1763703797428, updator=13701087609, issue=Issue{id=1198619422425448948, tenantId=1146029695717560320, journalId=1189873630562394117, year='2024', volume='49', issue='5', pageStart='489', pageEnd='610', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1763702739578, creator=13701087609, updateTime=1763702927730, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1198620211667628088, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198619422425448948, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1198620211667628089, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198619422425448948, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=534, endPage=541, ext={EN=ArticleExt(id=1198623859642561332, articleId=1198623859374125874, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Epidemiological and clinical characteristics of 954 cases of infectious diseases of central nervous system in Chongqing, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To investigate the epidemiological and clinical characteristics of 954 cases of central nervous system (CNS) infections in Chongqing. Methods A retrospective analysis was conducted on 954 patients with CNS infectious disease diagnosed and treated in the Second Affiliated Hospital of Army Medical University from 2008 to 2021. The analysis encompassed pathogens, patient gender, age of onset, time of onset, urban-rural distribution, education level, occupational distribution, and other epidemiological characteristics. The clinical manifestations, the positive rate of metagenomic next-generation sequencing (mNGS), and prognosis were also analyzed. ResultsAmong the 945 cases of CNS infectious diseases, the pathogens were viruses in 393(41.2%), Mycobacterium tuberculosis in 361(37.8%), other bacteria in 108(11.3%), Cryptococcus in 75(7.9%), Treponema pallidum in 16(1.7%) and parasites in 1(0.1%). The number of CNS infection cases from 2015 to 2021 increased by 85.6% compared with that from 2008 to 2014 (620 vs. 334, P<0.001). There was no significant difference in seasonal distribution of pathogens (P>0.05). CNS infectious diseases were more prevalent in rural areas (58.0%, P<0.001), with a male-to-female ratio of 1.7:1.0, and a higher incidence in individuals aged between 35 and 60 years. The majority of patients were educated at Junior high school level or below (68.7%) and were farmers or workers (68.1%). Clinical symptoms of CNS infectious disease mainly included fever, headache, signs of meningeal irritation, nausea and vomiting, which could be accompanied by consciousness disorder and focal neurological deficits. mNGS significantly improves the accuracy of clinical diagnosis. The rate of good prognosis of CNS infectious diseases was 97.5%, while the mortality rate was 0.3%. Conclusions In Chongqing area, the categories and species of CNS infectious pathogens are diverse, widely prevalent, and the clinical manifestations are complex. Moreover, the number of cases has been increasing in recent years. Understanding the epidemiological and clinical characteristics of CNS infectious diseases can help to recognize the regional differences, promote early accurate diagnosis and treatment, and improve prognosis.

, correspAuthors=Wen Huang, authorNote=null, correspAuthorsNote=
E-mail:
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目的 探讨重庆地区954例中枢神经系统(CNS)感染性疾病的流行病学及临床特征。方法 回顾性分析2008—2021年重庆新桥医院诊治的954例CNS感染性疾病的病原体与患者性别、发病年龄与时间、城乡分布、受教育程度、职业分布等流行病学特点,以及临床表现、宏基因组学第二代测序(mNGS)的阳性率和预后等临床特征。结果 954例CNS感染性疾病的病原体为病毒393例(41.2%)、结核分枝杆菌361例(37.8%)、其他细菌108例(11.3%)、隐球菌75例(7.9%)、梅毒螺旋体16例(1.7%)、寄生虫1例(0.1%);2015-2021年的CNS感染病例数较2008-2014年增加85.6%(620 vs. 334,P<0.001);不同病原体的季节分布差异无统计学意义(P>0.05);CNS感染性疾病好发于农村(58.0%,P<0.001),男女比例为1.7:1.0,35~60岁发病较多;CNS感染性疾病多见于学历为初中及以下(68.7%)和职业为农民或工人(68.1%)的群体;临床症状以发热、头痛、脑膜刺激征及恶心呕吐等脑膜受累症状为主,可伴有意识改变、局灶神经功能缺损症状等表现;mNGS明显提高了临床诊断精准性;疾病良好预后率为97.5%,病死率为0.3%。结论 重庆地区CNS感染病原体类别及种属多样、流行面广、临床表现复杂,且近年来病例数目呈上升趋势。了解当地CNS感染性疾病的流行病学和临床特征有助于了解疾病的区域差异,促进疾病的早期精准诊断、治疗,并改善预后。

, correspAuthors=黄文, authorNote=null, correspAuthorsNote=
黄文,E-mail:
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张兰,硕士研究生,主要从事中枢神经系统感染及血管性认知障碍等方面的研究

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张兰,硕士研究生,主要从事中枢神经系统感染及血管性认知障碍等方面的研究

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张兰,硕士研究生,主要从事中枢神经系统感染及血管性认知障碍等方面的研究

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Clin Infect Dis, 2017, 65(3): 359-363., articleTitle=Epidemiology of meningitis and encephalitis in the United States, 2011-2014, refAbstract=null), Reference(id=1198684441217433977, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, doi=null, pmid=null, pmcid=null, year=2018, volume=209, issue=10, pageStart=449, pageEnd=454, url=null, language=null, rfNumber=[47], rfOrder=46, authorNames=Beaman MH, journalName=Med J Austral, refType=null, unstructuredReference=Beaman MH. Community-acquired acute meningitis and encephalitis: a narrative review[J]. Med J Austral, 2018, 209(10): 449-454., articleTitle=Community-acquired acute meningitis and encephalitis: a narrative review, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1198684432258400514, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, xref=null, ext=[AuthorCompanyExt(id=1198684432266789123, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, companyId=1198684432258400514, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Neurology, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, China), AuthorCompanyExt(id=1198684432275177732, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, companyId=1198684432258400514, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=陆军军医大学第二附属医院神经内科,重庆 400037)])], figs=[ArticleFig(id=1198684435521569079, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=EN, label=Fig.1, caption=Annual distribution of 954 cases with infectious diseases of the central nervous system, figureFileSmall=B5meS1Hv/WAx80aq/LrI4g==, figureFileBig=vHonW5nwju40UOdusX7+IA==, tableContent=null), ArticleFig(id=1198684435601260856, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=CN, label=图1, caption=954例中枢神经系统感染性疾病的年度分布, figureFileSmall=B5meS1Hv/WAx80aq/LrI4g==, figureFileBig=vHonW5nwju40UOdusX7+IA==, tableContent=null), ArticleFig(id=1198684435685146937, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=EN, label=Tab.1, caption=

Annual distribution of 954 cases with infectious diseases of the central nervous system [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体2008-2014年2015-2021年P
病毒(n=393)73(21.9)320(51.6)<0.001
结核分枝杆菌(n=361)200(59.9)161(26.0)
其他细菌(n=108)27(8.1)81(13.1)
隐球菌(n=75)33(9.9)42(6.8)
梅毒螺旋体(n=16)016(2.6)
寄生虫(n=1)1(0.3)0
合计(n=954)334(100.0)620(100.0)
), ArticleFig(id=1198684435790004538, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=CN, label=表1, caption=

954例中枢神经系统感染性疾病年度分布 [例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体2008-2014年2015-2021年P
病毒(n=393)73(21.9)320(51.6)<0.001
结核分枝杆菌(n=361)200(59.9)161(26.0)
其他细菌(n=108)27(8.1)81(13.1)
隐球菌(n=75)33(9.9)42(6.8)
梅毒螺旋体(n=16)016(2.6)
寄生虫(n=1)1(0.3)0
合计(n=954)334(100.0)620(100.0)
), ArticleFig(id=1198684435886473531, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=EN, label=Tab.2, caption=

Seasonal distribution characteristics of 954 cases with infectious diseases of the central nervous system [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体冬季春季夏季秋季P
病毒(n=393)91(40.3)93(41.7)121(43.4)88(38.9)>0.05
结核分枝杆菌(n=361)80(35.4)87(39.0)99(35.5)95(42.0)
其他细菌(n=108)30(13.3)22(9.9)34(12.2)22(9.7)
隐球菌(n=75)22(9.7)15(6.7)22(7.9)16(7.1)
梅毒螺旋体(n=16)3(1.3)6(2.7)3(1.1)4(1.8)
寄生虫(n=1)0001(0.4)
合计(n=954)226(100.0)223(100.0)279(100.0)226(100.0)
), ArticleFig(id=1198684435991331132, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=CN, label=表2, caption=

954例中枢神经系统感染性疾病季节分布特征 [例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体冬季春季夏季秋季P
病毒(n=393)91(40.3)93(41.7)121(43.4)88(38.9)>0.05
结核分枝杆菌(n=361)80(35.4)87(39.0)99(35.5)95(42.0)
其他细菌(n=108)30(13.3)22(9.9)34(12.2)22(9.7)
隐球菌(n=75)22(9.7)15(6.7)22(7.9)16(7.1)
梅毒螺旋体(n=16)3(1.3)6(2.7)3(1.1)4(1.8)
寄生虫(n=1)0001(0.4)
合计(n=954)226(100.0)223(100.0)279(100.0)226(100.0)
), ArticleFig(id=1198684436112965949, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=EN, label=Tab.3, caption=

Distribution characteristics of 954 cases with central nervous system infectious diseases in urban and rural areas [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体城市农村P
病毒(n=393)184(52.9)209(34.5)a<0.001
结核分枝杆菌(n=361)101(29.0)260(42.9)a
其他细菌(n=108)40(11.5)68(11.2)
隐球菌(n=75)17(4.9)58(9.6)a
梅毒螺旋体(n=16)6(1.7)10(1.7)
寄生虫(n=1)01(0.2)
合计(n=954)348(100.0)606(100.0)
), ArticleFig(id=1198684436251377982, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=CN, label=表3, caption=

954例中枢神经系统感染性疾病城乡分布特征 [例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体城市农村P
病毒(n=393)184(52.9)209(34.5)a<0.001
结核分枝杆菌(n=361)101(29.0)260(42.9)a
其他细菌(n=108)40(11.5)68(11.2)
隐球菌(n=75)17(4.9)58(9.6)a
梅毒螺旋体(n=16)6(1.7)10(1.7)
寄生虫(n=1)01(0.2)
合计(n=954)348(100.0)606(100.0)
), ArticleFig(id=1198684436402372927, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=EN, label=Tab.4, caption=

Sexual distribution characteristics of 954 cases with infectious diseases of the central nervous system [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体女性男性P
病毒(n=393)151(42.3)242(40.5)<0.05
结核分枝杆菌(n=361)143(40.1)218(36.5)
其他细菌(n=108)33(9.2)75(12.6)
隐球菌(n=75)29(8.1)46(7.7)
梅毒螺旋体(n=16)1(0.3)15(2.5)
寄生虫(n=1)01(0.2)
合计(n=954)357(100.0)597(100.0)
), ArticleFig(id=1198684436490453312, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=CN, label=表4, caption=

954例中枢神经系统感染性疾病性别分布特征 [例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体女性男性P
病毒(n=393)151(42.3)242(40.5)<0.05
结核分枝杆菌(n=361)143(40.1)218(36.5)
其他细菌(n=108)33(9.2)75(12.6)
隐球菌(n=75)29(8.1)46(7.7)
梅毒螺旋体(n=16)1(0.3)15(2.5)
寄生虫(n=1)01(0.2)
合计(n=954)357(100.0)597(100.0)
), ArticleFig(id=1198684436565950785, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=EN, label=Tab.5, caption=

Age of onset distribution characteristics of 954 cases with infectious diseases of the central nervous system [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体14~35岁35~60岁>60岁χ2P
病毒(n=393)164(49.5)167(39.7)a62(30.7)a20.500<0.05

结核分枝杆菌

(n=361)

115(34.7)153(36.3)93(46.0)a

其他细菌

(n=108)

34(10.3)47(11.2)27(13.4)
隐球菌(n=75)15(4.5)44(10.5)16(7.9)

梅毒螺旋体

(n=16)

3(0.9)9(2.1)4(2.0)
寄生虫(n=1)01(0.2)0
合计(n=954)331(100.0)421(100.0)202(100.0)
), ArticleFig(id=1198684436649836866, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=CN, label=表5, caption=

954例中枢神经系统感染性疾病年龄段分布特征 [例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体14~35岁35~60岁>60岁χ2P
病毒(n=393)164(49.5)167(39.7)a62(30.7)a20.500<0.05

结核分枝杆菌

(n=361)

115(34.7)153(36.3)93(46.0)a

其他细菌

(n=108)

34(10.3)47(11.2)27(13.4)
隐球菌(n=75)15(4.5)44(10.5)16(7.9)

梅毒螺旋体

(n=16)

3(0.9)9(2.1)4(2.0)
寄生虫(n=1)01(0.2)0
合计(n=954)331(100.0)421(100.0)202(100.0)
), ArticleFig(id=1198684436716945731, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=EN, label=Tab.6, caption=

Education level of 639 cases with infectious diseases of the central nervous system

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体

初中

及以下

高中/
专及以上

χ2P
病毒(n=325)200(45.6)125(62.5)21.058<0.05
结核分枝杆菌(n=170)130(29.6)40(20.0)
其他细菌(n=77)52(11.8)25(12.5)
隐球菌(n=55)47(10.7)8(4.0)
梅毒螺旋体(n=11)9(2.1)2(1.0)
寄生虫(n=1)1(0.2)0
合计(n=639)*439(100.0)200(100.0)
), ArticleFig(id=1198684436796637508, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=CN, label=表6, caption=

639例中枢神经系统感染性疾病患者的受教育程度[例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体

初中

及以下

高中/
专及以上

χ2P
病毒(n=325)200(45.6)125(62.5)21.058<0.05
结核分枝杆菌(n=170)130(29.6)40(20.0)
其他细菌(n=77)52(11.8)25(12.5)
隐球菌(n=55)47(10.7)8(4.0)
梅毒螺旋体(n=11)9(2.1)2(1.0)
寄生虫(n=1)1(0.2)0
合计(n=639)*439(100.0)200(100.0)
), ArticleFig(id=1198684436867940677, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=EN, label=Tab.7, caption=

Occupation distribution of 628 cases with infectious diseases of the central nervous system [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体农民工人公务员/专业技术人员商务/服务人员学生P
合计(n=628)286(100.0)142(100.0)64(100.0)47(100.0)89(100.0)
病毒(n=295)100(35.0)73(51.4)a36(56.3)a30(63.8)a56(62.9)a
结核分枝杆菌(n=189)110(38.5)36(25.4)8(12.5)a11(23.4)24(27.0)
其他细菌(n=78)34(11.9)19(13.4)13(20.3)3(6.4)9(10.1)<0.001
隐球菌(n=55)33(11.5)b13(9.2)b6(9.4)b3(6.4)0a
梅毒螺旋体(n=10)8(2.8)1(0.7)1(1.6)00
寄生虫(n=1)1(0.3)0000
), ArticleFig(id=1198684436981186886, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=CN, label=表7, caption=

628例中枢神经系统感染性疾病职业分布 [例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体农民工人公务员/专业技术人员商务/服务人员学生P
合计(n=628)286(100.0)142(100.0)64(100.0)47(100.0)89(100.0)
病毒(n=295)100(35.0)73(51.4)a36(56.3)a30(63.8)a56(62.9)a
结核分枝杆菌(n=189)110(38.5)36(25.4)8(12.5)a11(23.4)24(27.0)
其他细菌(n=78)34(11.9)19(13.4)13(20.3)3(6.4)9(10.1)<0.001
隐球菌(n=55)33(11.5)b13(9.2)b6(9.4)b3(6.4)0a
梅毒螺旋体(n=10)8(2.8)1(0.7)1(1.6)00
寄生虫(n=1)1(0.3)0000
), ArticleFig(id=1198684437086044487, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=EN, label=Tab.8, caption=

Clinical manifestations of 954 cases with infectious diseases of the central nervous system [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体发热头痛恶心呕吐

脑膜

刺激征

病理征

阳性

意识

障碍

精神行

为异常

认知功

能下降

癫痫

颅神经

受损

肢体

无力

感觉

障碍

共济

失调

自主神经功能
合计(n=964)559(58.6)742(77.8)322(33.8)323(33.9)43(4.5)119(12.5)113(11.8)50(5.2)47(4.9)34(3.6)68(7.1)17(1.8)13(1.4)25(2.6)
病毒(n=393)224(57.0)291(74.0 )109(27.7)100(25.4)6(1.5)35(8.9)61(15.5)27(6.9)29(7.4)17(4.3)15(3.8)04(1.0)8(2.0)

结核分枝杆菌

(n=361)

219(60.7)289(80.1)131(36.3)144(39.9)25(6.9)59(16.3)38(10.5)8(2.2)12(3.3)11(3.0)39(10.8)13(3.6)9(2.5)10(2.8)

其他细菌

(n=108)

80(74.1)93(86.1)42(38.9)46(42.6)5(4.6)15(13.9)6(5.6)3(2.8)3(2.8)1(0.9)7(6.5)3(2.8)04(3.7)
隐球菌(n=75)35(46.7)67(89.3)39(52.0)32(42.7)6(8.0)9(12.0)4(5.3)3(4.0)1(1.3)4(5.3)5(6.7)002(2.7)

梅毒螺旋体

(n=16)

01(6.3)00003(18.8)9(56.3)1(6.3)1(6.3)2(12.5)1(6.3)01(6.3)
寄生虫(n=1)1(100.0)1(100.0)1(100.0)1(100.0)1(100.0)1(100.0)1(100.0)01(100.0)00000
), ArticleFig(id=1198684437182513480, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=CN, label=表8, caption=

954例中枢神经系统感染性疾病的临床表现 [例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体发热头痛恶心呕吐

脑膜

刺激征

病理征

阳性

意识

障碍

精神行

为异常

认知功

能下降

癫痫

颅神经

受损

肢体

无力

感觉

障碍

共济

失调

自主神经功能
合计(n=964)559(58.6)742(77.8)322(33.8)323(33.9)43(4.5)119(12.5)113(11.8)50(5.2)47(4.9)34(3.6)68(7.1)17(1.8)13(1.4)25(2.6)
病毒(n=393)224(57.0)291(74.0 )109(27.7)100(25.4)6(1.5)35(8.9)61(15.5)27(6.9)29(7.4)17(4.3)15(3.8)04(1.0)8(2.0)

结核分枝杆菌

(n=361)

219(60.7)289(80.1)131(36.3)144(39.9)25(6.9)59(16.3)38(10.5)8(2.2)12(3.3)11(3.0)39(10.8)13(3.6)9(2.5)10(2.8)

其他细菌

(n=108)

80(74.1)93(86.1)42(38.9)46(42.6)5(4.6)15(13.9)6(5.6)3(2.8)3(2.8)1(0.9)7(6.5)3(2.8)04(3.7)
隐球菌(n=75)35(46.7)67(89.3)39(52.0)32(42.7)6(8.0)9(12.0)4(5.3)3(4.0)1(1.3)4(5.3)5(6.7)002(2.7)

梅毒螺旋体

(n=16)

01(6.3)00003(18.8)9(56.3)1(6.3)1(6.3)2(12.5)1(6.3)01(6.3)
寄生虫(n=1)1(100.0)1(100.0)1(100.0)1(100.0)1(100.0)1(100.0)1(100.0)01(100.0)00000
), ArticleFig(id=1198684437262205257, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=EN, label=Tab.9, caption=

Prognosis of 850 cases with infectious diseases of the central nervous system [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体预后良好预后不良P
病毒(n=326)323(99.1)3(0.9)<0.05
结核分枝杆菌(n=328)315(96.0)13(4.0)
其他细菌(n=107)106(99.1)1(0.9)
隐球菌(n=72)69(95.8)3(4.2)
梅毒螺旋体(n=16)16(100.0)0
寄生虫(n=1)01(100.0)
合计(n=850)829(97.5)21(2.5)
), ArticleFig(id=1198684437329314122, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198623859374125874, language=CN, label=表9, caption=

850例中枢神经系统感染性疾病预后 [例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体预后良好预后不良P
病毒(n=326)323(99.1)3(0.9)<0.05
结核分枝杆菌(n=328)315(96.0)13(4.0)
其他细菌(n=107)106(99.1)1(0.9)
隐球菌(n=72)69(95.8)3(4.2)
梅毒螺旋体(n=16)16(100.0)0
寄生虫(n=1)01(100.0)
合计(n=850)829(97.5)21(2.5)
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重庆地区954例中枢神经系统感染性疾病的流行病学和临床特征分析
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张兰 , 周竹娟 , 程畅 , 王玉涵 , 承文超 , 陈秀英 , 董开元 , 黄文 *
解放军医学杂志 | 临床研究 2024,49(5): 534-541
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解放军医学杂志 | 临床研究 2024, 49(5): 534-541
重庆地区954例中枢神经系统感染性疾病的流行病学和临床特征分析
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张兰, 周竹娟, 程畅, 王玉涵, 承文超, 陈秀英, 董开元, 黄文*
作者信息
  • 陆军军医大学第二附属医院神经内科,重庆 400037
  • 张兰,硕士研究生,主要从事中枢神经系统感染及血管性认知障碍等方面的研究

通讯作者:

黄文,E-mail:
Epidemiological and clinical characteristics of 954 cases of infectious diseases of central nervous system in Chongqing
Lan Zhang, Zhu-Juan Zhou, Chang Cheng, Yu-Han Wang, Wen-Chao Cheng, Xiu-Ying Chen, Kai-Yuan Dong, Wen Huang*
Affiliations
  • Department of Neurology, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
出版时间: 2024-05-28 doi: 10.11855/j.issn.0577-7402.1326.2024.0126
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目的 探讨重庆地区954例中枢神经系统(CNS)感染性疾病的流行病学及临床特征。方法 回顾性分析2008—2021年重庆新桥医院诊治的954例CNS感染性疾病的病原体与患者性别、发病年龄与时间、城乡分布、受教育程度、职业分布等流行病学特点,以及临床表现、宏基因组学第二代测序(mNGS)的阳性率和预后等临床特征。结果 954例CNS感染性疾病的病原体为病毒393例(41.2%)、结核分枝杆菌361例(37.8%)、其他细菌108例(11.3%)、隐球菌75例(7.9%)、梅毒螺旋体16例(1.7%)、寄生虫1例(0.1%);2015-2021年的CNS感染病例数较2008-2014年增加85.6%(620 vs. 334,P<0.001);不同病原体的季节分布差异无统计学意义(P>0.05);CNS感染性疾病好发于农村(58.0%,P<0.001),男女比例为1.7:1.0,35~60岁发病较多;CNS感染性疾病多见于学历为初中及以下(68.7%)和职业为农民或工人(68.1%)的群体;临床症状以发热、头痛、脑膜刺激征及恶心呕吐等脑膜受累症状为主,可伴有意识改变、局灶神经功能缺损症状等表现;mNGS明显提高了临床诊断精准性;疾病良好预后率为97.5%,病死率为0.3%。结论 重庆地区CNS感染病原体类别及种属多样、流行面广、临床表现复杂,且近年来病例数目呈上升趋势。了解当地CNS感染性疾病的流行病学和临床特征有助于了解疾病的区域差异,促进疾病的早期精准诊断、治疗,并改善预后。

中枢神经系统  /  感染  /  流行病学  /  临床特征  /  重庆

Objective To investigate the epidemiological and clinical characteristics of 954 cases of central nervous system (CNS) infections in Chongqing. Methods A retrospective analysis was conducted on 954 patients with CNS infectious disease diagnosed and treated in the Second Affiliated Hospital of Army Medical University from 2008 to 2021. The analysis encompassed pathogens, patient gender, age of onset, time of onset, urban-rural distribution, education level, occupational distribution, and other epidemiological characteristics. The clinical manifestations, the positive rate of metagenomic next-generation sequencing (mNGS), and prognosis were also analyzed. ResultsAmong the 945 cases of CNS infectious diseases, the pathogens were viruses in 393(41.2%), Mycobacterium tuberculosis in 361(37.8%), other bacteria in 108(11.3%), Cryptococcus in 75(7.9%), Treponema pallidum in 16(1.7%) and parasites in 1(0.1%). The number of CNS infection cases from 2015 to 2021 increased by 85.6% compared with that from 2008 to 2014 (620 vs. 334, P<0.001). There was no significant difference in seasonal distribution of pathogens (P>0.05). CNS infectious diseases were more prevalent in rural areas (58.0%, P<0.001), with a male-to-female ratio of 1.7:1.0, and a higher incidence in individuals aged between 35 and 60 years. The majority of patients were educated at Junior high school level or below (68.7%) and were farmers or workers (68.1%). Clinical symptoms of CNS infectious disease mainly included fever, headache, signs of meningeal irritation, nausea and vomiting, which could be accompanied by consciousness disorder and focal neurological deficits. mNGS significantly improves the accuracy of clinical diagnosis. The rate of good prognosis of CNS infectious diseases was 97.5%, while the mortality rate was 0.3%. Conclusions In Chongqing area, the categories and species of CNS infectious pathogens are diverse, widely prevalent, and the clinical manifestations are complex. Moreover, the number of cases has been increasing in recent years. Understanding the epidemiological and clinical characteristics of CNS infectious diseases can help to recognize the regional differences, promote early accurate diagnosis and treatment, and improve prognosis.

central nervous system  /  infection  /  epidemiology  /  clinical characteristics  /  Chongqing
张兰, 周竹娟, 程畅, 王玉涵, 承文超, 陈秀英, 董开元, 黄文. 重庆地区954例中枢神经系统感染性疾病的流行病学和临床特征分析. 解放军医学杂志, 2024 , 49 (5) : 534 -541 . DOI: 10.11855/j.issn.0577-7402.1326.2024.0126
Lan Zhang, Zhu-Juan Zhou, Chang Cheng, Yu-Han Wang, Wen-Chao Cheng, Xiu-Ying Chen, Kai-Yuan Dong, Wen Huang. Epidemiological and clinical characteristics of 954 cases of infectious diseases of central nervous system in Chongqing[J]. Medical Journal of Chinese People’s Liberation Army, 2024 , 49 (5) : 534 -541 . DOI: 10.11855/j.issn.0577-7402.1326.2024.0126
中枢神经系统(central nervous system,CNS)感染性疾病是神经系统的常见疾病,主要包括各类病原体侵犯中枢神经系统引起的脑(膜)炎;其发病率、病死率和住院率均较高[1-2]。目前,脑膜炎仍是一项重大的全球公共卫生挑战[3]。据估计,2017年全世界因脑膜炎损失超过2000万年的健康生命(因过早死亡而丧失的生命年数加上因残疾而丧失的生命年数)[4]。全球疾病负担研究报告显示2019年全世界新发脑膜炎达251万例,死亡病例累计近24万例[5]。与其他疾病类似,CNS感染性疾病流行特征受地域、种族、文化、饮食习惯、经济、医疗水平(诊断技术、疫苗接种、经验性抗生素应用)、人群免疫水平、年代等因素影响,不同地区、不同群体CNS感染性疾病分布特点存在较大差异[5-6]。此外,既往研究多集中在特定病原体感染(如结核性脑膜炎[7]、细菌性脑膜炎[8])及特定人群(如儿童[9]、艾滋病患者[10]等),不利于对疾病整体的把握。重庆地处西南,被称为“山城”“雾都”,目前关于重庆地区CNS感染性疾病的大样本研究报道尚少。陆军军医大学第二附属医院(重庆新桥医院)收治的CNS感染性疾病患者来自重庆市各行政区及周边地区,具有一定的区域代表性。本研究通过回顾性分析新桥医院2008-2021年收治的CNS感染性疾病住院患者的临床资料、流行特点和临床特征,以期为CNS感染性疾病的规范诊疗提供参考。
回顾性收集重庆新桥医院2008-2021年被诊断为CNS感染性疾病的住院患者病例资料,共计954例。纳入标准:(1)年龄≥14岁;(2)临床确诊或疑似诊断为CNS感染性疾病。排除标准:(1)病史资料严重不全(个人史或临床症状缺失占比≥30%);(2)自动出院或转院的诊断不明确的病例。本研究获陆军军医大学第二附属医院医学伦理委员会审批(2023-研第126-01)。
按《国际疾病分类第十次修订本(ICD-10)》[9]进行病例分类,将符合条件的病例按病原体分为病毒、结核分枝杆菌、其他细菌(除结核分枝杆菌以外的细菌)、隐球菌、寄生虫、梅毒螺旋体。采集信息包括患者姓名、性别、年龄、发病日期、临床表现、主要诊断和预后转归等。结核性脑膜炎诊断标准参照Thwaites标准[12],其余诊断标准、临床表现及特征分型等参考《实用神经病学(第4版)》[13]。依据收集的 CNS 感染性疾病病例资料,统计分析其病原体构成、年度分布、季节分布、城乡分布、性别构成、发病年龄、受教育程度、职业分布等流行病学特点,以及临床表现、宏基因组学第二代测序(metagenomic next-generation sequencing,mNGS)的阳性率和预后等临床特点。
采用SPSS 26.0软件进行统计分析。计量资料符合正态分布者以$\bar{x}±s$表示,多组间比较采用单因素方差分析,进一步两两比较采用 LSD-t检验;不符合正态分布者以M(Q1Q3)表示,多组间比较采用秩和检验,进一步两两比较采用Bonferroni 法。计数资料以例(%)表示,多组间比较采用χ2检验或Fisher确切概率法,进一步两两比较采用Bonferroni 法。等级资料组间比较采用秩和检验。P<0.05为差异有统计学意义。
本研究共纳入CNS感染性疾病患者954例,包括临床确诊461例(48.3%),拟诊493例(51.8%)。其中,男597例(62.5%),女357例(37.5%),男女比例1.7∶1.0;年龄14~92(43.9±17.5)岁;注明受教育程度的639例中,小学及以下173例(27.1%),初中266例(41.6%),高中114例(17.8%),大专及以上86例(13.5%)。
954例中,病原体以病毒及结核分枝杆菌居多,分别为393例(41.2%)和361例(37.8%);其他依次为其他细菌108例(11.3%)、隐球菌75例(7.9%)、梅毒螺旋体16例(1.7%)、寄生虫1例(0.1%)。
2008-2021年CNS感染性疾病病例数目总体为逐年增多,多种病原体(例如病毒、其他细菌)感染例数均呈上升趋势,但结核分枝杆菌感染例数减少(图1)。其中,2015-2021年病例总数较2008-2014年增多85.6% (620 vs. 334,P<0.001);2015-2021年共收治病毒感染者320例、其他细菌感染者81例、梅毒螺旋体感染者16例,均较2008-2014年明显增多(P<0.001);结核分枝杆菌感染2015-2021年收治病例数较2008-2014年降低19.5%(161 vs. 200,P<0.001)(表1)。
本组病例季节分布,各病原体间差异无统计学意义(P>0.05,表2)。
各病原体感染者城乡分布差异有统计学意义(P<0.001)。病原体感染者以农村居民居多,其中病毒、结核分枝杆菌及隐球菌感染者居住地农村明显多于城市(P<0.001,表3)。
本组病例中,男女比例为1.7∶1.0[男,597/954(62.6%)]。各病原体感染者均以男性居多,病原体间在性别构成分布上差异有统计学意义(P<0.05)。其中,梅毒螺旋体感染者中男性占93.8%(15/16),男性占比明显高于其他病原体(P<0.05);其他病原体间性别分布差异无统计学意义(P>0.05,表4)。
本组病例发病年龄段以35~60岁[421/954(44.1%)]为多,各病原体间发病年龄段分布差异有统计学意义(P<0.05,表5)。
本组各病原体感染者的受教育程度差异有统计学意义(P<0.05)。其中,病毒[200/325(61.5%)]、结核分枝杆菌[(130/170(76.5%)]、隐球菌[47/55(85.5%)]感染者均以初中及以下学历居多(P<0.05,表6)。
628例具有职业情况,326例未注明职业情况。各病原体感染者职业以农民和工人居多[428(68.1%)]。各病原体感染者的职业分布差异有统计学意义(P<0.001)。其中,病毒[100/295(33.9%)]、结核分枝杆菌[110/189(58.22%)]、隐球菌[33/55(60.0%)]感染者以农民居多(P<0.001,表7)。
954例中,临床表现以头痛(742例,77.8%)、发热(559例,58.6%)、脑膜刺激征(323例,33.9%)及恶心呕吐(322例,33.8%)多见;其次为意识障碍(119例,12.5%)、精神行为异常(113例,11.8%)、肢体无力(68例,7.1%)和癫痫(47例,4.9%)等。此外,意识障碍、肢体无力多见于结核分枝杆菌感染者,其次见于病毒感染者;精神行为异常、癫痫多见于病毒感染者,其次是结核分枝杆菌感染者。梅毒螺旋体感染者以认知功能下降(9/16,56.3%)、精神行为异常(3/16,18.8%)和肢体无力(2/16,12.5%)多见,仅1例(1/16,6.3%)伴头痛;其他病原体感染者均以头痛、发热、脑膜刺激征及恶心呕吐多见(表8)。
本组病例中仅22例脑脊液送检mNGS,其中结核分枝杆菌感染5例,病毒感染17例。22例中,共检出12例致病病原体,阳性率54.5%;其中结核分枝杆菌检测阳性率80.0%(4/5);病毒检测阳性率47.1%(8/17),均为人类疱疹病毒,其中2例分别混合马胃葡萄球菌、铜绿假单胞菌感染。
本组850例具有预后结果,其中痊愈25例,好转804例,无效8例,加重10例,死亡3例(均为脑疝形成)。总预后不良率为2.5%(21/850),各病原体感染者预后不良率差异有统计学意义(P<0.001);其中,隐球菌感染者较高[3/72(4.2%)],其次为结核分枝杆菌感染者[13/328(4.0%)],而病毒 [3/326(0.9%)]、其他细菌[1/107(0.9%)]、梅毒螺旋体[0/16(0%)]感染者预后不良率较低;寄生虫感染者仅1例,未纳入比较(表9)。
CNS感染性疾病是神经系统的常见疾病,具有起病急、进展快、致病因素复杂、临床表现多样、症状重、预后差的特点[14]。根据世界卫生组织的报道,CNS感染性疾病病死率高达5.8%,每年造成全球数十万人死亡[5]
CNS感染的病原体类别及种属复杂多样,早期精准识别病原体对有效诊治、改善患者预后至关重要。本研究对2008-2021年重庆地区954例CNS感染性疾病的分析结果显示,病原体以病毒居首位,占41.2%,与大多数国内外报道一致;Khatib等[15]的前瞻性研究显示,CNS感染性疾病以病毒性脑膜炎较多;高建国等[16]报道,病毒感染在CNS感染性疾病中占比高达73.4%,病毒种类丰富且容易变异可能是其高发原因。本研究中,结核分枝杆菌感染占37.8%,居第二位;邹月丽等[17]关于石家庄及其周边地区CNS感染的现状分析显示,结核分枝杆菌感染占7.5%,与本研究结果存在差异。重庆地区结核病患者基数较大、结核分枝杆菌感染风险较高,可能是本研究中结核分枝杆菌感染比例较高的原因[18]
本组病例中2015-2021年CNS感染性疾病病例较2008-2014年增加85.6%,呈现出明显的上升趋势,多种病原体(如病毒、其他细菌)感染均明显增多,但结核分枝杆菌感染数下降。赵家华等[19]报告解放军总医院第一医学中心2011-2020年CNS感染性疾病病例数较2001-2010 年增加33.1%;杨进孙等[20]针对CNS感染性疾病流行特征的分析也提示近年CNS感染性疾病发病率呈现上升趋势,均与本研究结果类似。究其原因:抗菌药物的不规范使用致细菌耐药增多[21-22];免疫相关疾病如艾滋病的流行,疫苗的不合理使用,免疫抑制剂及激素的广泛应用等,使得群体免疫水平下降,机会性感染的发生风险增加[23];交通的便利增加了人员流动性;实验室诊断水平提高,病原体的检出率增高[24];医疗技术进步,颅脑相关手术开展较多,术后CNS感染发生率相应增高[21,25-26];置入式神经系统设备的使用增多,感染风险随之上升等[27]。本研究中结核分枝杆菌的变化趋势与赵家华等[19]、杨进孙等[20]的报道不一致,可能原因是近年重庆市结核病防治工作加强,使人群的结核分枝杆菌感染风险降低[28]
本研究中CNS感染的季节性不明显,与国内部分研究结果[16,19]一致。高彩云等[29]对2009-2014年西北部分地区的脑(膜)炎监测提示未见明显的发病季节高峰。韩冰等[30]报道,河南省中南部地区的成人CNS感染性疾病四季均可发病,无明显季节差异。非洲某地区的脑膜炎出现明显的季节性发病高峰,为每年的1-4月[31];谭琪琪等[32]报道儿童病毒性CNS感染存在明显的季节分布,以夏季多发;张天翔等[33]发现,结核性CNS感染好发于春冬季。以上结果与本研究结论有所差异,可能原因包括:研究人群存在差异,本研究纳入人群年龄≥14岁,而病毒性感染好发于儿童,可能对结果产生影响;本院收治患者数量有限且较为固定,每月病例数目变化不大;此外,也可能与重庆地区的气候、环境等多种因素有关,因不同地区的病原体种类及种属均可能存在差异。
本研究涉及的954例CNS感染性疾病,流行面广,遍及重庆市各城区及农村,其中农村患者占58.0%,是城市患者的1.6倍,与郭建花等[34]对石家庄地区的相关研究结论类似。这可能与农村地区经济状况、医疗水平相对落后,居民疾病预防意识不足,主动就诊的积极性低等因素有关。
本组病例以男性为主,占62.6%,与广西的一项研究[35]一致。各病原体感染均以男性居多,发病年龄段集中在36~60岁,为44.3%,即中年男性为CNS感染性疾病的好发人群。王兴宇等[14]对包头市中心医院2014-2021年收治的CNS 感染性疾病流行特征的分析显示,男性占58.1%,45~60岁占57.1%,与本研究结果相近。究其原因,此类人群多为家庭及社会主力,工作及生活压力大,更易存在吸烟、酗酒、不良卫生习惯、运动缺乏、超重或肥胖、高血压等危险因素;且相对女性而言,男性发生头部颅脑外伤的概率更大,更易接触病原体。其他人口学特征包括CNS感染性疾病(如病毒、结核分枝杆菌、隐球菌等感染)以农民较多,可能与其作业或生活环境中感染风险较高有关,因此应针对性加强相关的健康宣教[36]
本研究CNS感染性疾病的临床表现以发热、头痛、脑膜刺激征及恶心呕吐等脑膜受累症状为主,可伴意识障碍、精神与行为异常、肢体无力和癫痫等局灶性症状及体征,与国内外多数研究结论基本一致[37-38]。本组病例中,除梅毒螺旋体外,其余病原体感染的临床表现基本符合上述特点,而梅毒螺旋体感染多以认知功能下降、精神行为异常和肢体无力多见,仅6.3%出现头痛;分析原因为本组收集的梅毒螺旋体感染病例主要为≥36岁的男性,是麻痹性痴呆的高发人群,临床症状以认知损害为主[39]
国内外多项研究均显示,脑脊液mNGS检测相较于现有的临床常规检查手段阳性率更高,可达15.7%~74.4%[40-42]。本组送检的脑脊液mNGS总体阳性率为54.5%,其中结核分枝杆菌感染阳性率最高,为80.0%,其次为病毒感染,阳性率为47.1%,且2例为病毒合并细菌感染,提示临床上CNS感染病原体并不单一,可能存在混合感染,诊治过程中需加以重视。mNGS在临床诊断方面具有较大的应用潜力[43-44],但目前临床应用并不广泛。本组感染者mNGS送检率仅为2.3%,可能的原因为部分病例应用传统手段即可确诊;mNGS检测成本较高,给患者造成经济负担;mNGS检测操作步骤复杂,医院内部难以开展。
2015年全球疾病负担研究数据显示,在神经系统疾病死亡原因中,CNS感染性疾病排名第三,仅次于卒中、阿尔茨海默病与其他类型痴呆[45]。美国一项关于脑(膜)炎的大型流行病学研究显示,CNS感染性疾病的病死率为2.9%[46]。有研究报道社区获得性急性脑(膜)炎病死率可高达40%,若未能及时诊治,患者可能会在24 h内死亡[47]。本研究病例总体预后良好,良好预后率为97.5%,病死率仅为0.3%;究其原因:本组病例感染病原体以病毒及结核分枝杆菌为主,文献报道肺炎链球菌是CNS感染中致死率最高的病原体[5];HIV合并感染发生率较低;既往大量应用激素或免疫抑制剂情况较少;患者就医及时;本中心具备较为完整的诊疗体系等。
综上所述,本项单中心回顾性研究显示,近年重庆及周边地区CNS感染性疾病发病率呈上升趋势,病原体类别及种属丰富,流行面广,以农村居民居多,临床症状复杂多样。临床医师诊疗时综合分析CNS感染性疾病的本地流行特征,应用mNGS等先进检测手段,有利于疾病的早期诊断及精准治疗。本研究尚存在不足之处:首先,为单中心回顾性研究,病例来源单一,部分分组样本量少,代表性不足,时间跨度大致数据可能存在混杂因素及偏倚;其次,未对感染病原体分组进一步细分,较为笼统。未来应进一步完善研究设计,并组织大样本、多中心、前瞻性研究加以验证,以期更好地为CNS感染性疾病的防治提供参考依据。
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2024年第49卷第5期
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doi: 10.11855/j.issn.0577-7402.1326.2024.0126
  • 接收时间:2023-10-08
  • 首发时间:2025-11-21
  • 出版时间:2024-05-28
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  • 收稿日期:2023-10-08
  • 录用日期:2023-11-16
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    陆军军医大学第二附属医院神经内科,重庆 400037

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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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