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Article(id=1199340583031501633, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199337298941804946, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2453.2023.0417, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1669132800000, receivedDateStr=2022-11-23, revisedDate=null, revisedDateStr=null, acceptedDate=1679241600000, acceptedDateStr=2023-03-20, onlineDate=1763874677665, onlineDateStr=2025-11-23, pubDate=1706371200000, pubDateStr=2024-01-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1763874677665, onlineIssueDateStr=2025-11-23, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1763874677665, creator=13701087609, updateTime=1763874677665, updator=13701087609, issue=Issue{id=1199337298941804946, tenantId=1146029695717560320, journalId=1189873630562394117, year='2024', volume='49', issue='1', pageStart='1', pageEnd='120', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1763873894677, creator=13701087609, updateTime=1763874094669, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1199338137823572576, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199337298941804946, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1199338137823572577, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1199337298941804946, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=43, endPage=49, ext={EN=ArticleExt(id=1199340583274771267, articleId=1199340583031501633, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Analysis of epidemiological and clinical characteristics of 1247 cases of infectious diseases of the central nervous system, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To summarize the epidemiological and clinical features of infectious diseases of the central nervous system (CNS) by a single-center analysis. Methods A retrospective analysis was conducted on the data of 1247 cases of CNS infectious diseases diagnosed and treated in the First Medical Center of PLA General Hospital from 2001 to 2020. Results The data for this group of CNS infectious diseases by disease type in descending order of number of cases were viruses 743(59.6%), Mycobacterium tuberculosis 249(20.0%), other bacteria 150(12.0%), fungi 68(5.5%), parasites 18(1.4%), Treponema pallidum 18(1.4%) and rickettsia 1(0.1%). The number of cases increased by 177 cases (33.1%) in the latter 10 years compared to the previous 10 years (P<0.05). No significant difference in seasonal distribution pattern of data between disease types (P>0.05). Male to female ratio is 1.87︰1, mostly under 60 years of age.Viruses are more likely to infect students, most often at university/college level and above, farmers are overrepresented among bacteria and Mycobacterium tuberculosis, and more infections of Treponema pallidum in workers. CNS infectious diseases are characterized by fever, headache and signs of meningeal irritation, with the adductor nerve being the more commonly involved cranial nerve. Matagenomic next-generation sequencing improves clinical diagnostic capabilities. The median hospital days for CNS infectious diseases are 18.00(11.00, 27.00) and median hospital costs are ¥29,500(¥16,000, ¥59,200). The mortality rate from CNS infectious diseases is 1.6%. Conclusions The incidence of CNS infectious diseases is increasing last ten years, with complex clinical presentation, severe symptoms and poor prognosis. Early and accurate diagnosis and standardized clinical treatment can significantly reduce the morbidity and mortality rate and ease the burden of disease.

, correspAuthors=Jia-Tang Zhang, authorNote=null, correspAuthorsNote=
E-mail:
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目的 总结单中心中枢神经系统(CNS)感染性疾病的流行病学及临床特征。方法 回顾性分析2001-2020年解放军总医院第一医学中心诊治的1247例CNS感染性疾病患者的病原体、性别、发病年龄与时间、受教育程度、职业分布等流行病学特点，以及临床表现、住院天数、住院费用、宏基因组学测序的阳性率和预后等临床特征。结果 1247例CNS感染性疾病患者的病原体依次为病毒743(59.6%)、结核分枝杆菌249(20.0%)、其他细菌150(12.0%)、真菌68(5.5%)、寄生虫18(1.4%)、梅毒螺旋体18(1.4%)和立克次体1(0.1%)；2011-2020年的病例数较2001-2010年增加177例(33.1%，P<0.05)；病原体的季节分布差异无统计学意义(P>0.05)；男女比例为1.87︰1，多在60岁以下发病；病毒以学生人群易感，尤以大学(大专)及以上学历者较多；结核分枝杆菌和其他细菌感染以农民偏多，梅毒螺旋体感染多见于工人；临床表现以发热、头痛及脑膜刺激征多见，脑神经受累以展神经居多；宏基因组学第二代测序明显提高了临床诊断的精准性；患者中位住院天数为18.00(11.00，27.00) d，中位住院费用2.95(1.60，5.92)万元；疾病病死率1.6%。结论 CNS感染性疾病发病率近年有升高趋势，临床表现复杂、症状重、预后差。早期精准诊断及临床规范治疗有利于降低病死率，减轻疾病负担。

, correspAuthors=张家堂, authorNote=null, correspAuthorsNote=
张家堂，E-mail：
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赵家华，硕士研究生，主要从事中枢神经系统感染的相关研究

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赵家华，硕士研究生，主要从事中枢神经系统感染的相关研究

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赵家华，硕士研究生，主要从事中枢神经系统感染的相关研究

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Lancet Infect Dis, 2017, 17(8): 873-881., articleTitle=Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis, refAbstract=null)], funds=[Fund(id=1199379099111224231, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, awardId=2020YFC2005403, language=EN, fundingSource=National Key Research and Development Program of China(2020YFC2005403), fundOrder=null, country=null), Fund(id=1199379099169944488, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, awardId=2020YFC2005403, language=CN, fundingSource=国家重点研发计划(2020YFC2005403), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1199379092102542135, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, xref=1, ext=[AuthorCompanyExt(id=1199379092115125048, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, companyId=1199379092102542135, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1 Graduate School, Medical School of Chinese PLA, Beijing 100853, China), AuthorCompanyExt(id=1199379092123513657, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, companyId=1199379092102542135, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1 解放军医学院研究生院， 北京 100853)]), AuthorCompany(id=1199379092190622522, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, xref=2, ext=[AuthorCompanyExt(id=1199379092199011131, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, companyId=1199379092190622522, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2 Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China), AuthorCompanyExt(id=1199379092207399740, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, companyId=1199379092190622522, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2 解放军总医院第一医学中心神经内科医学部， 北京 100853)])], figs=[ArticleFig(id=1199379097177650061, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=EN, label=Fig.1, caption=Annual distribution of 1247 cases of infectious diseases of the central nervous system, figureFileSmall=C+u3N4CtplDQV1siUmO6TA==, figureFileBig=K+4S56tU75Wzps4bND0Pew==, tableContent=null), ArticleFig(id=1199379097236370318, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=CN, label=图1, caption=1247例中枢神经系统感染性疾病的年度分布, figureFileSmall=C+u3N4CtplDQV1siUmO6TA==, figureFileBig=K+4S56tU75Wzps4bND0Pew==, tableContent=null), ArticleFig(id=1199379097316062095, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=EN, label=Tab.1, caption=

Pathogens composition of 1247 cases of infectious diseases of the central nervous system [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 构成
合计 1247(100.0)
病毒 743(59.6)
结核分枝杆菌 249(20.0)
其他细菌 150(12.0)
真菌 68(5.5)
寄生虫 18(1.4)
梅毒螺旋体 18(1.4)
立克次体 1(0.1)
), ArticleFig(id=1199379097387365264, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=CN, label=表1, caption=

1247例中枢神经系统感染性疾病病原体构成 [例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 构成
合计 1247(100.0)
病毒 743(59.6)
结核分枝杆菌 249(20.0)
其他细菌 150(12.0)
真菌 68(5.5)
寄生虫 18(1.4)
梅毒螺旋体 18(1.4)
立克次体 1(0.1)
), ArticleFig(id=1199379097454474129, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=EN, label=Tab.2, caption=

Annual distribution of 1247 cases of infectious diseases of the central nervous system [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 2001-2010年 2011-2020年 P
病毒 331(61.9) 412(57.9) 0.013
结核分枝杆菌 117(21.9) 132(18.6)
其他细菌 55(10.3) 95(13.3)
真菌 18(3.3) 50(7.0)
寄生虫 9(1.7) 9(1.3)
梅毒螺旋体 5(0.9) 13(1.8)
立克次体 0 1(0.1)
合计 535(100.0) 712(100.0)
), ArticleFig(id=1199379097529971602, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=CN, label=表2, caption=

1247例中枢神经系统感染性疾病的年度分布 [例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 2001-2010年 2011-2020年 P
病毒 331(61.9) 412(57.9) 0.013
结核分枝杆菌 117(21.9) 132(18.6)
其他细菌 55(10.3) 95(13.3)
真菌 18(3.3) 50(7.0)
寄生虫 9(1.7) 9(1.3)
梅毒螺旋体 5(0.9) 13(1.8)
立克次体 0 1(0.1)
合计 535(100.0) 712(100.0)
), ArticleFig(id=1199379097605469075, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=EN, label=Tab.3, caption=

Seasonal distribution of 1247 cases of infectious diseases of the central nervous system [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 春 夏 秋 冬 P
病毒 165(55.7) 188(59.9) 218(63.0) 172(59.1) 0.893
结核分枝杆菌 66(22.3) 55(17.5) 65(18.8) 63(21.7)
其他细菌 38(12.8) 43(13.7) 35(10.1) 34(11.7)
真菌 19(6.4) 16(5.1) 19(5.5) 14(4.8)
寄生虫 4(1.4) 6(1.9) 3(0.9) 5(1.7)
梅毒螺旋体 4(1.4) 5(1.6) 6(1.7) 3(1.0)
立克次体 0 1(0.3) 0 0
合计 296(100.0) 314(100.0) 346(100.0) 291(100.0)
), ArticleFig(id=1199379097668383636, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=CN, label=表3, caption=

1247例中枢神经系统感染性疾病的季节分布 [例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 春 夏 秋 冬 P
病毒 165(55.7) 188(59.9) 218(63.0) 172(59.1) 0.893
结核分枝杆菌 66(22.3) 55(17.5) 65(18.8) 63(21.7)
其他细菌 38(12.8) 43(13.7) 35(10.1) 34(11.7)
真菌 19(6.4) 16(5.1) 19(5.5) 14(4.8)
寄生虫 4(1.4) 6(1.9) 3(0.9) 5(1.7)
梅毒螺旋体 4(1.4) 5(1.6) 6(1.7) 3(1.0)
立克次体 0 1(0.3) 0 0
合计 296(100.0) 314(100.0) 346(100.0) 291(100.0)
), ArticleFig(id=1199379097735492501, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=EN, label=Tab.4, caption=

Gender composition of 1247 cases of infectious diseases of the central nervous system [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 男 女 P
病毒 486(59.9) 257(59.1) 0.284
结核分枝杆菌 158(19.5) 91(20.9)
其他细菌 100(12.3) 50(11.5)
真菌 41(5.0) 27(6.2)
寄生虫 10(1.2) 8(1.8)
梅毒螺旋体 16(2.0) 2(0.5)
立克次体 1(0.1) 0
合计 812(100.0) 435(100.0)
), ArticleFig(id=1199379097798407062, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=CN, label=表4, caption=

1247例中枢神经系统感染性疾病的性别构成 [例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 男 女 P
病毒 486(59.9) 257(59.1) 0.284
结核分枝杆菌 158(19.5) 91(20.9)
其他细菌 100(12.3) 50(11.5)
真菌 41(5.0) 27(6.2)
寄生虫 10(1.2) 8(1.8)
梅毒螺旋体 16(2.0) 2(0.5)
立克次体 1(0.1) 0
合计 812(100.0) 435(100.0)
), ArticleFig(id=1199379097861321623, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=EN, label=Tab.5, caption=

Age of onset of 1247 cases of infectious diseases of the central nervous system [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 14~30岁 31~40岁 41~50岁 51~60岁 61~70岁 >70岁 H P
病毒 370(71.2) 149(63.4) 94(48.0) 78(45.9) 40(41.2) 12(41.4) 72.633 <0.001
结核分枝杆菌 82(15.8) 42(17.9) 50(25.5) 35(20.6) 34(35.1) 6(20.7)
其他细菌 45(8.7) 23(9.8) 28(14.3) 32(18.8) 16(16.5) 6(20.7)
真菌 20(3.8) 9(3.8) 13(6.6) 18(10.6) 4(4.1) 4(13.8)
寄生虫 1(0.2) 6(2.6) 6(3.1) 3(1.8) 2(2.1) 0
梅毒螺旋体 2(0.4) 5(2.1) 5(2.6) 4(2.4) 1(1.0) 1(3.4)
立克次体 0(0.4) 1(0.4) 0 0 0 0
合计 520(100.0) 235(100.0) 196(100.0) 170(100.0) 97(100.0) 29(100.0)
), ArticleFig(id=1199379097928430488, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=CN, label=表5, caption=

1247例中枢神经系统感染性疾病发病年龄段 [例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 14~30岁 31~40岁 41~50岁 51~60岁 61~70岁 >70岁 H P
病毒 370(71.2) 149(63.4) 94(48.0) 78(45.9) 40(41.2) 12(41.4) 72.633 <0.001
结核分枝杆菌 82(15.8) 42(17.9) 50(25.5) 35(20.6) 34(35.1) 6(20.7)
其他细菌 45(8.7) 23(9.8) 28(14.3) 32(18.8) 16(16.5) 6(20.7)
真菌 20(3.8) 9(3.8) 13(6.6) 18(10.6) 4(4.1) 4(13.8)
寄生虫 1(0.2) 6(2.6) 6(3.1) 3(1.8) 2(2.1) 0
梅毒螺旋体 2(0.4) 5(2.1) 5(2.6) 4(2.4) 1(1.0) 1(3.4)
立克次体 0(0.4) 1(0.4) 0 0 0 0
合计 520(100.0) 235(100.0) 196(100.0) 170(100.0) 97(100.0) 29(100.0)
), ArticleFig(id=1199379097995539353, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=EN, label=Tab.6, caption=

Education level of 977 cases of infectious diseases of the central nervous system [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 小学及以下 初中 高中(中专) 大学(大专)及以上 H P
病毒 40(41.2) 166(58.7) 150(59.7) 217(62.7) 24.625 <0.001
结核分枝杆菌 23(23.7) 50(17.6) 50(19.9) 66(19.1)
其他细菌 24(24.7) 44(15.5) 28(11.2) 32(9.2)
真菌 8(8.3) 11(3.9) 15(6.0) 24(6.9)
寄生虫 2(2.1) 2(0.7) 5(2.0) 3(0.9)
梅毒螺旋体 0 9(3.2) 3(1.2) 4(1.2)
立克次体 0 1(0.4) 0 0
合计 97(100.0) 283(100.0) 251(100.0) 346(100.0)
), ArticleFig(id=1199379098062648218, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=CN, label=表6, caption=

977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 小学及以下 初中 高中(中专) 大学(大专)及以上 H P
病毒 40(41.2) 166(58.7) 150(59.7) 217(62.7) 24.625 <0.001
结核分枝杆菌 23(23.7) 50(17.6) 50(19.9) 66(19.1)
其他细菌 24(24.7) 44(15.5) 28(11.2) 32(9.2)
真菌 8(8.3) 11(3.9) 15(6.0) 24(6.9)
寄生虫 2(2.1) 2(0.7) 5(2.0) 3(0.9)
梅毒螺旋体 0 9(3.2) 3(1.2) 4(1.2)
立克次体 0 1(0.4) 0 0
合计 97(100.0) 283(100.0) 251(100.0) 346(100.0)
), ArticleFig(id=1199379098129757083, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=EN, label=Tab.7, caption=

Occupation distribution of 913 cases of infectious diseases of the central nervous system [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 农民 工人 公务员 科技人员 商业人员 教师 学生 H P
病毒 113(49.1) 84(59.2) 99(55.9) 13(72.2) 71(72.5) 26(49.1) 141(72.3) 23.358 <0.001
结核分枝杆菌 57(24.8) 31(21.8) 45(25.4) 2(11.1) 13(13.3) 15(28.3) 27(13.9)
其他细菌 44(19.1) 11(7.8) 19(10.7) 0 6(6.1) 8(15.1) 19(9.7)
真菌 11(4.8) 8(5.6) 9(5.1) 2(11.1) 5(5.1) 3(5.7) 6(3.1)
寄生虫 4(1.7) 1(0.7) 3(1.7) 0 2(2.0) 0 1(0.5)
梅毒螺旋体 1(0.4) 7(4.9) 2(1.1) 1(5.6) 1(1.0) 1(1.9) 1(0.5)
立克次体 0 0 0 0 0 0 0
合计 230(100.0) 142(100.0) 177(100.0) 18(100.0) 98(100.0) 53(100.0) 195(100.0)
), ArticleFig(id=1199379098192671644, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=CN, label=表7, caption=

913例中枢神经系统感染性疾病患者的职业分布 [例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 农民 工人 公务员 科技人员 商业人员 教师 学生 H P
病毒 113(49.1) 84(59.2) 99(55.9) 13(72.2) 71(72.5) 26(49.1) 141(72.3) 23.358 <0.001
结核分枝杆菌 57(24.8) 31(21.8) 45(25.4) 2(11.1) 13(13.3) 15(28.3) 27(13.9)
其他细菌 44(19.1) 11(7.8) 19(10.7) 0 6(6.1) 8(15.1) 19(9.7)
真菌 11(4.8) 8(5.6) 9(5.1) 2(11.1) 5(5.1) 3(5.7) 6(3.1)
寄生虫 4(1.7) 1(0.7) 3(1.7) 0 2(2.0) 0 1(0.5)
梅毒螺旋体 1(0.4) 7(4.9) 2(1.1) 1(5.6) 1(1.0) 1(1.9) 1(0.5)
立克次体 0 0 0 0 0 0 0
合计 230(100.0) 142(100.0) 177(100.0) 18(100.0) 98(100.0) 53(100.0) 195(100.0)
), ArticleFig(id=1199379098263974813, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=EN, label=Tab.8, caption=

Clinical manifestations of 1247 cases of infectious diseases of the central nervous system [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
临床表现 病毒 结核分枝杆菌 其他细菌 真菌 寄生虫 梅毒螺旋体 立克次体 合计
发热 601(61.5) 213(21.8) 107(11.0) 46(4.7) 7(0.7) 2(0.2) 1(0.1) 977(100.0)
头痛 523(57.7) 212(23.4) 102(11.2) 55(6.1) 10(1.1) 4(0.4) 1(0.1) 907(100.0)
恶心、呕吐 253(55.1) 111(24.2) 53(11.5) 35(7.6) 5(1.1) 1(0.2) 1(0.2) 459(100.0)
视乳头水肿 18(31.0) 28(48.3) 4(6.9) 7(12.1) 0 1(1.7) 0 58(100.0)
意识障碍 229(62.2) 67(18.2) 49(13.3) 17(4.6) 5(1.4) 1(0.3) 0 368(100.0)
精神行为异常 225(75.3) 46(15.4) 14(4.7) 8(2.7) 1(0.3) 5(1.7) 0 299(100.0)
认知功能下降 193(65.9) 60(20.5) 17(5.8) 12(4.1) 4(1.4) 7(2.4) 0 293(100.0)
癫痫 242(77.1) 24(7.6) 33(10.5) 8(2.5) 4(1.3) 3(1.0) 0 314(100.0)
癫痫持续状态 5(100.0) 0 0 0 0 0 0 5(100.0)
脑神经受损 38(28.4) 47(35.1) 23(17.2) 20(14.9) 0 6(4.5) 0 134(100.0)
视神经 2(16.7) 3(25.0) 1(8.3) 5(41.7) 0 1(8.3) 0 12(100.0)
动眼神经 1(7.1) 2(14.3) 4(28.6) 6(42.9) 0 1(7.1) 0 14(100.0)
三叉神经 1(14.3) 2(28.6) 1(14.3) 2(28.6) 0 1(14.3) 0 7(100.0)
展神经 9(24.3) 11(29.7) 10(27.0) 5(13.5) 0 2(5.4) 0 37(100.0)
面神经 8(22.9) 15(42.9) 6(17.0) 5(14.3) 0 1(2.9) 0 35(100.0)
听神经 2(10.5) 7(36.8) 3(15.8) 6(31.6) 0 1(5.3) 0 19(100.0)
肢体无力 78(37.9) 68(33.0) 37(18.0) 11(5.3) 5(2.4) 7(3.4) 0 206(100.0)
感觉障碍 15(21.4) 29(41.4) 17(24.3) 2(2.9) 2(2.9) 5(7.1) 0 70(100.0)
共计失调 51(47.7) 29(27.1) 18(16.8) 4(3.7) 1(0.9) 4(3.7) 0 107(100.0)
病理征阳性 117(47.4) 75(30.4) 34(13.8) 12(4.9) 3(1.2) 6(2.4) 0 247(100.0)
脑膜刺激征 372(57.1) 159(24.4) 78(12.0) 37(5.7) 5(0.8) 1(0.2) 0 652(100.0)
自主神经功能 80(53.7) 43(28.9) 15(10.0) 5(3.4) 2(1.3) 4(2.7) 0 149(100.0)
), ArticleFig(id=1199379098343666590, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=CN, label=表8, caption=

1247例中枢神经系统感染性疾病的临床表现 [例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
临床表现 病毒 结核分枝杆菌 其他细菌 真菌 寄生虫 梅毒螺旋体 立克次体 合计
发热 601(61.5) 213(21.8) 107(11.0) 46(4.7) 7(0.7) 2(0.2) 1(0.1) 977(100.0)
头痛 523(57.7) 212(23.4) 102(11.2) 55(6.1) 10(1.1) 4(0.4) 1(0.1) 907(100.0)
恶心、呕吐 253(55.1) 111(24.2) 53(11.5) 35(7.6) 5(1.1) 1(0.2) 1(0.2) 459(100.0)
视乳头水肿 18(31.0) 28(48.3) 4(6.9) 7(12.1) 0 1(1.7) 0 58(100.0)
意识障碍 229(62.2) 67(18.2) 49(13.3) 17(4.6) 5(1.4) 1(0.3) 0 368(100.0)
精神行为异常 225(75.3) 46(15.4) 14(4.7) 8(2.7) 1(0.3) 5(1.7) 0 299(100.0)
认知功能下降 193(65.9) 60(20.5) 17(5.8) 12(4.1) 4(1.4) 7(2.4) 0 293(100.0)
癫痫 242(77.1) 24(7.6) 33(10.5) 8(2.5) 4(1.3) 3(1.0) 0 314(100.0)
癫痫持续状态 5(100.0) 0 0 0 0 0 0 5(100.0)
脑神经受损 38(28.4) 47(35.1) 23(17.2) 20(14.9) 0 6(4.5) 0 134(100.0)
视神经 2(16.7) 3(25.0) 1(8.3) 5(41.7) 0 1(8.3) 0 12(100.0)
动眼神经 1(7.1) 2(14.3) 4(28.6) 6(42.9) 0 1(7.1) 0 14(100.0)
三叉神经 1(14.3) 2(28.6) 1(14.3) 2(28.6) 0 1(14.3) 0 7(100.0)
展神经 9(24.3) 11(29.7) 10(27.0) 5(13.5) 0 2(5.4) 0 37(100.0)
面神经 8(22.9) 15(42.9) 6(17.0) 5(14.3) 0 1(2.9) 0 35(100.0)
听神经 2(10.5) 7(36.8) 3(15.8) 6(31.6) 0 1(5.3) 0 19(100.0)
肢体无力 78(37.9) 68(33.0) 37(18.0) 11(5.3) 5(2.4) 7(3.4) 0 206(100.0)
感觉障碍 15(21.4) 29(41.4) 17(24.3) 2(2.9) 2(2.9) 5(7.1) 0 70(100.0)
共计失调 51(47.7) 29(27.1) 18(16.8) 4(3.7) 1(0.9) 4(3.7) 0 107(100.0)
病理征阳性 117(47.4) 75(30.4) 34(13.8) 12(4.9) 3(1.2) 6(2.4) 0 247(100.0)
脑膜刺激征 372(57.1) 159(24.4) 78(12.0) 37(5.7) 5(0.8) 1(0.2) 0 652(100.0)
自主神经功能 80(53.7) 43(28.9) 15(10.0) 5(3.4) 2(1.3) 4(2.7) 0 149(100.0)
), ArticleFig(id=1199379098419164063, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=EN, label=Tab.9, caption=

Number of days of 1247 cases of initial hospitalization of infectious diseases of the central nervous system [M(Q1, Q3)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 首次住院天数 H P
病毒 17.00(11.00, 24.00) 32.281 <0.001
结核分枝杆菌 19.00(10.00, 33.00)
其他细菌 19.00(12.75, 29.00)
真菌 27.50(16.25, 52.00)
寄生虫 14.50(11.00, 22.25)
梅毒螺旋体 16.50(9.75, 23.25)
立克次体 7.00
合计 18.00(11.00, 27.00)
), ArticleFig(id=1199379098519827360, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=CN, label=表9, caption=

1247例中枢神经系统感染性疾病患者的首次住院天数 [M(Q1，Q3)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 首次住院天数 H P
病毒 17.00(11.00, 24.00) 32.281 <0.001
结核分枝杆菌 19.00(10.00, 33.00)
其他细菌 19.00(12.75, 29.00)
真菌 27.50(16.25, 52.00)
寄生虫 14.50(11.00, 22.25)
梅毒螺旋体 16.50(9.75, 23.25)
立克次体 7.00
合计 18.00(11.00, 27.00)
), ArticleFig(id=1199379098654045089, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=EN, label=Tab.10, caption=

Cost of 1247 cases of initial hospitalization of infectious diseases of the central nervous system [M(Q1, Q3)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 首次住院费用(万元) H P
病毒 2.52(1.48, 4.19) 84.967 <0.001
结核分枝杆菌 3.30(1.53, 6.37)
其他细菌 4.20(2.47, 9.07)
真菌 9.87(6.13, 14.08)
寄生虫 1.53(1.43, 2.31)
梅毒螺旋体 2.04(1.34, 3.66)
立克次体 1.21
合计 2.95(1.60, 5.92)
), ArticleFig(id=1199379098716959650, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=CN, label=表10, caption=

1247例中枢神经系统感染性疾病患者的首次住院费用 [M(Q1，Q3)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 首次住院费用(万元) H P
病毒 2.52(1.48, 4.19) 84.967 <0.001
结核分枝杆菌 3.30(1.53, 6.37)
其他细菌 4.20(2.47, 9.07)
真菌 9.87(6.13, 14.08)
寄生虫 1.53(1.43, 2.31)
梅毒螺旋体 2.04(1.34, 3.66)
立克次体 1.21
合计 2.95(1.60, 5.92)
), ArticleFig(id=1199379098779874211, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=EN, label=Tab.11, caption=

Positive rate of mNGS in 127 cases of infectious diseases of the central nervous system

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 送检数(例) 阳性[例(%)] χ2 P
病毒 51 22(43.1) 9.885 0.070
结核分枝杆菌 33 12(36.4)
其他细菌 25 18(72.0)
真菌 14 7(50.0)
寄生虫 1 0
梅毒螺旋体 2 1(50.0)
立克次体 1 1(100.0)
合计 127 61(48.0)
), ArticleFig(id=1199379098851177380, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=CN, label=表11, caption=

127例中枢神经系统感染性疾病mNGS检测阳性结果

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 送检数(例) 阳性[例(%)] χ2 P
病毒 51 22(43.1) 9.885 0.070
结核分枝杆菌 33 12(36.4)
其他细菌 25 18(72.0)
真菌 14 7(50.0)
寄生虫 1 0
梅毒螺旋体 2 1(50.0)
立克次体 1 1(100.0)
合计 127 61(48.0)
), ArticleFig(id=1199379098922480549, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=EN, label=Tab.12, caption=

Prognosis of 1247 cases of infectious diseases of the central nervous system [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 治愈或好转 死亡
合计 1183(94.9) 20(1.6)
病毒 726(97.7) 3(0.4)
结核分枝杆菌 233(93.6) 5(2.0)
其他细菌 133(88.7) 6(4.0)
真菌 56(82.4) 6(8.8)
寄生虫 17(94.4) 0
梅毒螺旋体 17(94.4) 0
立克次体 1(100.0) 0
), ArticleFig(id=1199379098977006502, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1199340583031501633, language=CN, label=表12, caption=

1247例中枢神经系统感染性疾病预后 [例(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
病原体 治愈或好转 死亡
合计 1183(94.9) 20(1.6)
病毒 726(97.7) 3(0.4)
结核分枝杆菌 233(93.6) 5(2.0)
其他细菌 133(88.7) 6(4.0)
真菌 56(82.4) 6(8.8)
寄生虫 17(94.4) 0
梅毒螺旋体 17(94.4) 0
立克次体 1(100.0) 0
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1247例中枢神经系统感染性疾病的流行病学及临床特征分析
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赵家华 1 , 岑雨樱 1 , 许晓娇 1 , 杨飞 2 , 张兴文 2 , 董钊 2 , 刘若卓 2 , 黄德晖 2 , 崔荣太 2 , 王湘庆 2 , 田成林 2 , 黄旭升 2 , 于生元 2 , 张家堂 2, *
解放军医学杂志 | 临床研究 2024,49(1): 43-49
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解放军医学杂志 | 临床研究 2024, 49(1): 43-49
1247例中枢神经系统感染性疾病的流行病学及临床特征分析
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赵家华1, 岑雨樱1, 许晓娇1, 杨飞2, 张兴文2, 董钊2, 刘若卓2, 黄德晖2, 崔荣太2, 王湘庆2, 田成林2, 黄旭升2, 于生元2, 张家堂2, *
作者信息
  • 1 解放军医学院研究生院， 北京 100853
  • 2 解放军总医院第一医学中心神经内科医学部， 北京 100853

    • 赵家华，硕士研究生，主要从事中枢神经系统感染的相关研究

通讯作者:

张家堂，E-mail：
Analysis of epidemiological and clinical characteristics of 1247 cases of infectious diseases of the central nervous system
Jia-Hua Zhao1, Yu-Ying Cen1, Xiao-Jiao Xu1, Fei Yang2, Xing-Wen Zhang2, Zhao Dong2, Ruo-Zhuo Liu2, De-Hui Huang2, Rong-Tai Cui2, Xiang-Qing Wang2, Cheng-Lin Tian2, Xu-Sheng Huang2, Sheng-Yuan Yu2, Jia-Tang Zhang2, *
Affiliations
  • 1 Graduate School, Medical School of Chinese PLA, Beijing 100853, China
  • 2 Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
出版时间: 2024-01-28 doi: 10.11855/j.issn.0577-7402.2453.2023.0417
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摘要
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目的 总结单中心中枢神经系统(CNS)感染性疾病的流行病学及临床特征。方法 回顾性分析2001-2020年解放军总医院第一医学中心诊治的1247例CNS感染性疾病患者的病原体、性别、发病年龄与时间、受教育程度、职业分布等流行病学特点，以及临床表现、住院天数、住院费用、宏基因组学测序的阳性率和预后等临床特征。结果 1247例CNS感染性疾病患者的病原体依次为病毒743(59.6%)、结核分枝杆菌249(20.0%)、其他细菌150(12.0%)、真菌68(5.5%)、寄生虫18(1.4%)、梅毒螺旋体18(1.4%)和立克次体1(0.1%)；2011-2020年的病例数较2001-2010年增加177例(33.1%，P<0.05)；病原体的季节分布差异无统计学意义(P>0.05)；男女比例为1.87︰1，多在60岁以下发病；病毒以学生人群易感，尤以大学(大专)及以上学历者较多；结核分枝杆菌和其他细菌感染以农民偏多，梅毒螺旋体感染多见于工人；临床表现以发热、头痛及脑膜刺激征多见，脑神经受累以展神经居多；宏基因组学第二代测序明显提高了临床诊断的精准性；患者中位住院天数为18.00(11.00，27.00) d，中位住院费用2.95(1.60，5.92)万元；疾病病死率1.6%。结论 CNS感染性疾病发病率近年有升高趋势，临床表现复杂、症状重、预后差。早期精准诊断及临床规范治疗有利于降低病死率，减轻疾病负担。

中枢神经系统  /  感染性疾病  /  流行病学  /  临床特征

Objective To summarize the epidemiological and clinical features of infectious diseases of the central nervous system (CNS) by a single-center analysis. Methods A retrospective analysis was conducted on the data of 1247 cases of CNS infectious diseases diagnosed and treated in the First Medical Center of PLA General Hospital from 2001 to 2020. Results The data for this group of CNS infectious diseases by disease type in descending order of number of cases were viruses 743(59.6%), Mycobacterium tuberculosis 249(20.0%), other bacteria 150(12.0%), fungi 68(5.5%), parasites 18(1.4%), Treponema pallidum 18(1.4%) and rickettsia 1(0.1%). The number of cases increased by 177 cases (33.1%) in the latter 10 years compared to the previous 10 years (P<0.05). No significant difference in seasonal distribution pattern of data between disease types (P>0.05). Male to female ratio is 1.87︰1, mostly under 60 years of age.Viruses are more likely to infect students, most often at university/college level and above, farmers are overrepresented among bacteria and Mycobacterium tuberculosis, and more infections of Treponema pallidum in workers. CNS infectious diseases are characterized by fever, headache and signs of meningeal irritation, with the adductor nerve being the more commonly involved cranial nerve. Matagenomic next-generation sequencing improves clinical diagnostic capabilities. The median hospital days for CNS infectious diseases are 18.00(11.00, 27.00) and median hospital costs are ¥29,500(¥16,000, ¥59,200). The mortality rate from CNS infectious diseases is 1.6%. Conclusions The incidence of CNS infectious diseases is increasing last ten years, with complex clinical presentation, severe symptoms and poor prognosis. Early and accurate diagnosis and standardized clinical treatment can significantly reduce the morbidity and mortality rate and ease the burden of disease.

central nervous system  /  infectious disease  /  epidemiology  /  clinical characteristics
赵家华, 岑雨樱, 许晓娇, 杨飞, 张兴文, 董钊, 刘若卓, 黄德晖, 崔荣太, 王湘庆, 田成林, 黄旭升, 于生元, 张家堂. 1247例中枢神经系统感染性疾病的流行病学及临床特征分析. 解放军医学杂志, 2024 , 49 (1) : 43 -49 . DOI: 10.11855/j.issn.0577-7402.2453.2023.0417
Jia-Hua Zhao, Yu-Ying Cen, Xiao-Jiao Xu, Fei Yang, Xing-Wen Zhang, Zhao Dong, Ruo-Zhuo Liu, De-Hui Huang, Rong-Tai Cui, Xiang-Qing Wang, Cheng-Lin Tian, Xu-Sheng Huang, Sheng-Yuan Yu, Jia-Tang Zhang. Analysis of epidemiological and clinical characteristics of 1247 cases of infectious diseases of the central nervous system[J]. Medical Journal of Chinese People’s Liberation Army, 2024 , 49 (1) : 43 -49 . DOI: 10.11855/j.issn.0577-7402.2453.2023.0417
正文
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中枢神经系统(central nervous system，CNS)感染性疾病是神经系统的常见病。2017年全球新发500万例脑(膜)炎，死亡达29万例[1-2]。其病原体多样，同一类型病原体又包括不同种属，导致其临床表现差异性较大。国内外开展了诸多探讨CNS感染性疾病流行规律和临床表现的研究[3]，然而受种族差异、广谱抗生素不规范应用、疫苗接种、人口流动和职业暴露等因素的影响，结论差别较大[4-5]。此外，既往研究多集中在特定人群如儿童[6-8]或单一病原体[9-10]，且数据年代久远。本研究对解放军总医院第一医学中心神经内科近20年来诊治的1247例CNS感染性疾病患者进行回顾性分析，将其流行病学及临床特点报告如下。
1 资料与方法
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1.1 研究对象
选取2001年1月1日-2020年12月31日解放军总医院第一医学中心诊治的1247例CNS感染性疾病患者进行回顾性分析。纳入标准：(1)年龄≥14岁；(2)临床确诊或很可能诊断为CNS感染性疾病。排除标准：病史资料严重不全。本研究经解放军总医院第一医学中心医学伦理委员会审核批准(批准号：2021-272)。
1.2 研究方法
按《国际疾病分类第十次修订本(ICD-10)》[11]进行病例分类，将符合条件的病例按病原体的不同分为病毒、结核分枝杆菌、其他细菌(不含结核分枝杆菌)、真菌、寄生虫、梅毒螺旋体和立克次体感染者。采集患者信息，包括姓名、性别、年龄、发病日期、入(出)院日期、临床表现、主要诊断和预后转归等。结核性脑膜炎的诊断参照Thwaites标准[12]，其余诊断标准参考《实用神经病学(第4版)》[13]，所有隐球菌性脑膜炎均经病原学确诊。采用Epidata 3.1软件对临床资料进行双录入。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、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、首次住院天数、首次住院费用、宏基因组学第二代测序的阳性率和预后等临床特点。
1.3 统计学处理
采用SPSS 26.0软件进行统计分析。计量资料符合正态分布时以$\bar{x}±s$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；若不符合正态分布，以M(Q1，Q3)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Scheffe法。等级资料多组和两组间比较均采用秩和检验。P<0.05为差异有统计学意义。
2 结果
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2.1 病原体构成
共纳入1247例患者，病原体以病毒居多，为743例(59.6%)，其他依次为结核分枝杆菌249例(20.0%)、其他细菌150例(12.0%)、真菌68例(5.5%)、寄生虫18例(1.4%)、梅毒螺旋体18例(1.4%)和立克次体1例(0.1%，表1)。
2.2 年度分布
2011-2020年病例数较2001-2010年增加177例[177/535(33.1%)，P<0.05]；其中2011-2020年共收治真菌感染50例[50/68(73.5%)]，较2001-2010年明显增加(P<0.05)。年度分布上，各病原体间差异明显(P<0.05)；其中2015年、2020年各病原体病例数均比上一年明显下降(P<0.05，表2、图1)。
2.3 季节分布
本组病例的季节分布，各病原体间差异均无统计学意义(P>0.05，表3)。
2.4 性别构成
本组病例中，男女比例为1.87︰1，男性占65.1%(812/1247)。各病原体感染者均以男性居多，不同病原体感染者的性别构成分布差异无统计学意义(P>0.05，表4)。
2.5 发病年龄
本组病例发病年龄段以≤60岁[1121/1247(90.0%)]为主，不同病原体感染者发病年龄段分布上有明显差异(H=72.633，P<0.001)。病毒、结核分枝杆菌、其他细菌和真菌感染者以14~30岁年龄段居多，70岁以上较少(P<0.05)；梅毒螺旋体和寄生虫感染30~50岁发病者多于其他年龄段(P<0.05，表5)。
2.6 受教育程度
本组病例不同病原体者的受教育程度存在明显差异(H=24.625，P<0.001)。其中，病毒感染者以大学(大专)及以上学历较多[217/573(37.9%)，P<0.05]，其他细菌感染者以初中学历居多[44/128(34.4%)，P<0.05，表6]。
2.7 职业分布
本组病例不同病原体者的职业分布存在明显差异(H=23.358，P<0.001)。其中，病毒感染者以学生较多[141/547(25.8%)，P<0.05]，结核分枝杆菌[57/190(30.0%)]和其他细菌[44/107(41.1%)]感染者均以农民居多(P<0.05)，而梅毒螺旋体感染多见于工人[7/14(50.0%)，P<0.05，表7]。
2.8 临床表现
本组1247例患者的临床表现以发热(977例，78.3%)、头痛(907例，72.7%)及脑膜刺激征(652例，52.3%)多见；其次为恶心、呕吐(459例，36.8%)，意识障碍(368例，29.5%)和癫痫(314例，25.2%)等。此外，癫痫、精神行为异常和认知功能下降多见于病毒感染者，其次是结核分枝杆菌和其他细菌感染者。脑神经受累(134例，10.7%)，其中展神经(37例，27.6%)、面神经(35例，26.1%)及听神经(19例，14.2%)受累较常见，嗅神经、迷走神经、副神经和舌下神经受累较少。脑神经受累较多的病原体依次为结核分枝杆菌、病毒、其他细菌和真菌(表8)。
2.9 首次住院天数
本组患者中位首次住院天数为18.00(11.00，27.00) d，不同病原体感染者住院天数存在明显差异(H=32.281，P<0.001)。真菌感染者中位住院天数较长，为27.50(16.25，52.00) d (P<0.05)，寄生虫感染者为14.50(11.00，22.25) d，立克次体感染者为7.00 d，均较短(表9)。
2.10 首次住院费用
本组患者的中位首次住院费用为2.95(1.60，5.92)万元，不同病原体感染者间存在明显差异(H=84.967，P<0.001)。其中，真菌感染者中位首次住院费用较高，为9.87(6.13，14.08)万元(P<0.05)，而寄生虫感染者[1.53(1.43，2.31)万元]和立克次体感染者(1.21万元)住院费用较少(P<0.05，表10)。
2.11 宏基因组学第二代测序(metagenomic next-generation sequencing，mNGS)结果
自mNGS应用于临床，共127例患者脑脊液送检mNGS，其中61例检出致病病原体，总体阳性率为48.0%。其中其他细菌的阳性率较高(18/25，72.0%)，其次为真菌(7/14，50.0%)、病毒(22/51，43.1%)和结核分枝杆菌(12/33，36.4%，表11)。
2.12 预后
本组1247例患者中痊愈178例，好转1005例，无效40例，加重4例，死亡20例。总体治愈好转率为94.9%(1183/1247)，而不同病原体感染患者的治愈好转率存在明显差异(P<0.001)，其中病毒较高(726/743，97.7%)，真菌较低(56/68，82.4%)。总体病死率为1.6%(20/1247)，不同病原体感染患者的病死率存在明显差异(P<0.001)，其中真菌较高(6/68，8.8%)，其次为其他细菌(6/150，4.0%)、结核分枝杆菌(5/249，2.0%)和病毒(3/743，0.4%，表12)。
3 讨论
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CNS感染性疾病病原体种类多、起病急，病死率高[14]，但若救治及时，一般可治愈[15]。因此，早期诊断并及时给予敏感性抗生素治疗至关重要。本组病例数据特点与既往研究有诸多相同和不同之处，虽然单中心数据可能存在偏倚，不能完全代表CNS感染性疾病的整体规律，但通过详尽的比较分析，仍能在一定程度上揭示其特点，为临床医师提供诊治思路。
本研究对2001-2020年1247例CNS感染性疾病的分析结果显示，2011-2020年病例数较2001-2010年增加33.1%，且多种病原体感染例数均明显增加，其中真菌感染增加较多。非洲[2]和美国[16]的相关研究显示，因相关疫苗的开发应用，近年来疑似脑膜炎尤其是细菌性脑膜炎病例数下降，与本组结果不同。邹月丽等[17]对石家庄及周边地区2006-2011年CNS感染性疾病的分析结果显示，多种病原体感染的例数均呈增长趋势；杨进孙等[5]报告了弋矶山医院1993-2012年CNS感染性疾病病例数，发现2003-2012年较此前10年增加，19.08%。上述国内研究提示，CNS感染性疾病近年来呈增长趋势，考虑与以下原因有关：(1)广谱抗生素及免疫抑制剂的应用导致免疫功能低下者更易发生机会性感染。本研究61例隐球菌性脑膜炎患者中，14例长期服用皮质激素或免疫抑制剂，1例为HIV感染。(2)传统诊断方法的普及和新型诊断方法的涌现提高了各级医院的临床诊断水平。2015年以来，mNGS在国内逐渐应用于CNS感染性疾病的诊断，其阳性率为15.7%~57.0%[18]。本组数据脑脊液mNGS阳性率为48.0%，其中细菌最高，为72.0%，病毒为43.1%，均较传统检测手段明显提高。(3)近年来我国经济快速发展，跨区域和跨环境的学习、工作及旅居等社会活动增多，也增加了感染机会。(4)随机动车的日益增多和神经外科专科建设的普及，开放性颅脑损伤、脑脊液漏、人工材料植入及开颅手术等引起的CNS感染同样呈上升趋势[19]。后两者也许是国内数据与欧美发达国家及不发达国家不同的主要原因。此外，本组数据2015年病例数下降，考虑与神经感染主诊组负责人出国做访问学者，导致亚专科患者的收容量减少有关；2020年各病原体病例数均较此前明显下降，可能与新型冠状病毒感染流行以来，严格佩戴口罩、人员流动减少和外地来院就诊数减少有关。
CNS感染性疾病某些病原体表现出明显的季节性，但不同研究结果不一。非洲的一项研究显示，脑膜炎表现出强烈的季节性，高峰发生在1~4月的干燥季节，随雨季开始，每年5月开始下降[20]。英格兰的一项回顾性研究发现，脑膜炎在冬季达到发病高峰，而夏季发病最少[21]。我国西北地区一项长达5年的监测结果显示，脑(膜)炎的季节分布差异不明显[22]，本组结果亦然。考虑与以下原因有关：(1)本中心床位数量有限，各季节均满负荷收治，虽发病例数不同，但收治病例数变化不大；(2)病毒作为本组病例的主要病原体，其本身季节性并不明显，掩盖了整体特点。
本组病例男性居多(812/1247，65.1%)，多为60岁以下(1121/1247，90.0%)发病，且随年龄增长呈减少趋势，与既往研究一致[23-25]。CNS感染性疾病在男性和年轻人中多见，考虑与以下原因有关：(1)该人群外出学习、工作、户外运动等活动频繁；(2)男性肥胖、吸烟、酗酒、不良卫生习惯和HIV感染等因素也不容忽视；(3)外出聚餐、喜生冷食物、冰箱储存食物未充分加热等也可能是其原因。
本组病例的其他人口学特点：(1)病毒更易感染学生群体，大学(大专)及以上学历较多(217/573，37.9%)。学生是年轻群体的主要组成部分，高学历人群往往是经济和社会活动中的活跃人群，因此该结果并不意外。(2)结核分枝杆菌和其他细菌感染以农民偏多，可能与农民基数大，以及部分地区生活贫困有关。(3)梅毒螺旋体感染多见于工人(7/14，50.0%)，因此，加强性传播疾病的防范，加大对农民工群体的人文和社会关爱尤为重要。
CNS感染性疾病的临床表现以发热、头痛和脑膜刺激征等多见。除脑膜受累外，还可出现精神与行为异常、认知功能下降、癫痫和肢体无力等局灶性症状体征。脑神经损害多见于CNS结核，外展神经更易受累，可能与该神经在颅底的行程较长、易受炎性渗出物和高颅压的影响有关[26]。本组病例的临床表现基本符合上述特点。
全球每年约有145万脑(膜)炎病例，次均住院22.63 d，次均费用2.33万元[27]。本组病例的中位住院天数为18.00(11.00，27.00) d，中位住院费用为2.95(1.60，5.92)万元。可见，CNS感染性疾病给家庭和社会造成了沉重的经济负担。本研究CNS病毒感染性疾病的中位住院天数为17.00(11.00，24.00) d，明显高于既往报道的9 d[28]，可能与本组病例病情复杂和危重比例较高有关。本研究CNS真菌感染性疾病的中位住院天数较长[27.50(16.25，52.00) d]，中位住院费用亦较高[9.87(6.13，14.08)万元]，与患者住院周期长、并发症多和病死率高有直接相关性。
文献报道CNS感染性疾病的病死率较高，可达5.8%[2]。本组虽多为晚期和重症患者，但病死率仅为1.6%，明显低于全球平均值。就单一病原体而言，新型隐球菌性脑膜炎全球病死率高达81.2%[29]，而本组仅为9.8%，这得益于本中心规范的诊疗方案及完善的救治体系，同时可能与合并HIV感染的例数较少有关。
总之，CNS感染性疾病发病率高、临床症状复杂、预后差、社会负担重，加强对疾病的认识，应用mNGS技术等现代手段提高早期诊断水平，根据相关指南和共识规范临床治疗，可提高治愈率，降低病死率，减轻疾病负担。鉴于本组病例存在单中心、数据区域分布局限、时间跨度大可能造成数据偏倚等不足，多中心、多地区、不同时间跨度的分层研究显得十分迫切和必要。
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2024年第49卷第1期
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doi: 10.11855/j.issn.0577-7402.2453.2023.0417
  • 接收时间：2022-11-23
  • 首发时间：2025-11-23
  • 出版时间：2024-01-28
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  • 收稿日期：2022-11-23
  • 录用日期：2023-03-20
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National Key Research and Development Program of China(2020YFC2005403)
国家重点研发计划(2020YFC2005403)
作者信息
    1 解放军医学院研究生院， 北京 100853
    2 解放军总医院第一医学中心神经内科医学部， 北京 100853

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
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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