Objective: To investigate human enterovirus (HEV) infection and clinical characteristics of viral encephalitis patients in Pingdingshan, Henan Province. Methods: Cerebrospinal fluid specimens and epidemiological information were collected from 274 viral encephalitis patients in the departments of pediatrics and neurology in hospitals in Pingdingshan, Henan Province, from April 2011 to August 2012. Patients with bacterial infections were excluded from the study. Demographic information was collected by questionnaires and clinical information was mainly obtained from hospital examinations. Viral RNA was extracted using magnetic bead extraction. Real-time RT-PCR was then performed for HEV, CV-A16, and EV-A71 testing. SPSS statistical software was statistical analyses. Significant differences were determined using the chi-squared test (P<0.05). Results: Among 274 cases of viral encephalitis, 180 cases (65.7%) were male and 94 cases were female (34.3%). The median age was 2.17 years. Approximately 61.3% (168) of patients were younger than 3 years of age. A total of 107 (39.1%), 2 (0.7%), and 42 (15.3%) cases were positive for HEV, CV-A16, and EV-A71, respectively. Eleven patients were younger than 6 months of age and one patient was co-infected with HEV and EV-A71. In the<3, 3-5, 6-15, and>15 years old age groups, HEV infections comprised 31.5% (53/168), 52.9% (18/34), 53.0% (35/66), and 16.7% (1/6) (χ(2)=13.10, P=0.003), respectively. The EV-A71 infection rates were 17.9% (30/168), 23.5% (8/34), 6.1% (4/66), and 0 (χ(2)=8.04, P=0.045), respectively. The other enterovirus (OEV) infection rates were 12.5% (21/168), 29.4% (10/34), 48.5% (32/66), and 16.7% (1/6) (χ(2)=35.19, P<0.001), respectively. The rate of vomiting in OEV and EV-A71 infected patients was 73% (44/60) and 26% (11/42), respectively, while the frequency of skin rash in OEV and EV-A71 infected patients was 32% (19/60) and 79% (33/42), respectively. Approximately 95% (99/104) of patients infected with HEV had a fever, and the breathing rhythm change rate was 19% (20/104), which was lower than that of patients without HEV infection (36.8% (60/163)) (χ(2)=9.35, P=0.002). Conclusion: In Pingdingshan, HEV was a major causative agent of viral encephalitis and the rate of OEV infection was high, especially in children aged 3-15 years old. Fever was a common clinical symptom of patients infected with HEV. Patients infected with OEV primarily exhibited vomiting symptoms and EV-A71 infected patients showed skin rash.
目的： 分析河南省部分病毒性脑炎患者人类肠道病毒（HEV）的感染情况及其临床特征。 方法： 选取2011年4月至2012年8月在河南省平顶山市3所医院内儿科和神经内科被诊断为病毒性脑炎的患者为研究对象，同时排除细菌感染者，共274例。采用自行设计的调查问卷收集患者的基本信息，医疗机构检查结果主要来源于医院患者资料。采集研究对象的脑脊液标本，使用磁珠法自动核酸提取仪进行病毒RNA提取，采用实时荧光RT-PCR试剂进行HEV核酸检测，采用分型试剂进行肠道病毒A71型（EV-A71）、柯萨奇病毒A16型（CV-A16）的核酸检测。采用χ(2)检验比较不同年龄研究对象感染HEV差异。 结果： 274例病毒性脑炎患者中，男性为180例（65.7%），女性为94例（34.3%）；年龄中位数为2.17岁，主要集中在3岁以下（61.3%，168例）。HEV总感染率为39.1%（107例），CV-A16感染率为0.7%（2例），EV-A71感染率为15.3%（42例）。≤6月龄患者共11例，其中HEV感染者为1例，属EV-A71型别；<3、3~5、6~15、>15岁患者HEV总感染率分别为32%（53/168）、53%（18/34）、53%（35/66）、1/6（χ(2)=13.10，P=0.003）；EV-A71感染率分别为18%（30/168）、24%（8/34）、6%（4/66）、0（χ(2)=8.04，P=0.045）；其他HEV（OEV）感染率分别为13%（21/168）、29%（10/34）、49%（32/66）、1/6（χ(2)=35.19，P<0.001）。OEV和EV-A71感染者呕吐比例分别为73%（44/60）和26%（11/42），其出现皮疹比例分别为32%（19/60）和79%（33/42）。HEV感染者发热比例为95%（99/104），其出现呼吸节律改变症状的比例[19%（20/104）]低于未感染者[36.8%（60/163）]（χ(2)=9.35，P=0.002）。 结论： 河南省平顶山地区病毒性脑炎患者中HEV感染率较高，尤其是3~15岁患者。HEV感染者发热比例较高，为普遍临床表现；OEV感染者较容易出现呕吐症状，EV-A71感染者较容易出现皮疹。.
Keywords: Clinical symptoms; Encephalitis, viral; Enterovirus.