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目的了解不同类型标本在肠道病毒所致病毒性脑炎病例诊断中的作用。方法采集临床诊断为病毒性脑炎病例标本,采用实时荧光RT-PCR法检测肠道病毒核酸,包括EV71、CA16和其他肠道病毒。结果 143例病例中,脑脊液、肛拭子和咽拭子中的肠道病毒阳性率分别为30.8%、88.1%和71.3%。脑脊液标本中检出率明显低于咽拭子或肛拭子,差异有统计学意义(P<0.01)。肛拭子中检出率高于咽拭子,差异有统计学意义(P<0.01),2种标本检出一致性一般(Kappa=0.420)。有皮疹出现且临床诊断为手足口重症合并脑炎的患者,脑脊液与其他标本组合后检出率均显著提高,差异有统计学意义(P<0.01);脑脊液、肛拭子和咽拭子组合后的检出率同单纯肛拭子和咽拭子组合的肠道病毒检出率之间差异无统计学意义(P>0.05)。结论肛拭子组合咽拭子可获得病毒性脑炎病例中肠道病毒的最大检出率。
Objective To understand the role of different types of specimens in the diagnosis of viral encephalitis caused by enteroviruses. Methods The samples of clinical diagnosis of viral encephalitis were collected and the enterovirus nucleic acids including EV71, CA16 and other enteroviruses were detected by real-time fluorescence RT-PCR. Results The positive rates of enterovirus in cerebrospinal fluid, anal swab and throat swab in 143 cases were 30.8%, 88.1% and 71.3% respectively. The detection rate of cerebrospinal fluid samples was significantly lower than that of throat swabs or anal swabs, the difference was statistically significant (P <0.01). The detection rate of anal swab was higher than that of throat swab, the difference was statistically significant (P <0.01). The consistency of two kinds of specimens was general (Kappa = 0.420). There was a rash and clinical diagnosis of hand, foot and mouth severe combined with encephalitis patients, cerebrospinal fluid and other specimens combined detection rate were significantly increased, the difference was statistically significant (P <0.01); cerebrospinal fluid, anal swab and throat swab combination There was no significant difference in the detection rate of enterovirus between the detection rate and the simple anal swab and throat swab (P> 0.05). Conclusion Anal swab combined with throat swab can get the maximum detection rate of enterovirus in the case of viral encephalitis.