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目的了解急性播散性脑脊髓炎(Acute Disseminated Encephalomyelitis,ADEM)流行病学特点、临床特征,病因的特点,为预防接种后ADEM的调查诊断和处置提供参考。方法从中国医院知识数据库(2000～2012年)收集ADEM病例个案资料,采用描述性分析方法分析所有个案的性别、年龄、病因、潜伏期和转归等特征。结果1155例个案中男性占57.92%。61.56%为感染后脑脊髓炎(postinfectious encephalomyelitis,PIE),14.29%为疫苗接种后脑脊髓炎(postvaccinal encephalomyelitis,PVE)、其中狂犬病疫苗排第一位。PIE和PVE在性别和病例转归上差异无统计学意义,在潜伏期和年龄上差异有统计学显著性意义。结论 ADEM主要是由感染和疫苗接种引起。PIE和PVE在潜伏期和发病年龄上差异有统计学显著性意义。应加强进一步研究ADEM与预防接种的因果关系,研究制订ADEM与预防接种因果关系的调查诊断和鉴定技术标准,减低误判的几率,减少相关纠纷的产生。
Objective To understand the epidemiological characteristics, clinical features and etiological characteristics of acute disseminated encephalomyelitis (ADEM) and provide reference for the investigation and diagnosis of ADEM after vaccination. Methods The data of ADEM cases were collected from Chinese hospital knowledge database (from 2000 to 2012), and the sex, age, etiology, latency and outcome of all cases were analyzed by descriptive analysis. Results In 1155 cases, men accounted for 57.92%. 61.56% were postinfectious encephalomyelitis (PIE), and 14.29% were postvaccinal encephalomyelitis (PVE). Among them, rabies vaccine ranked first. PIE and PVE had no statistical significance in the gender and case prognosis, and there was significant difference in latency and age. Conclusion ADEM is mainly caused by infection and vaccination. PIE and PVE in the incubation period and the age of onset differences were statistically significant. The causal relationship between ADEM and vaccination should be further studied, the technical standards for investigation diagnosis and identification of the causal relationship between ADEM and vaccination should be studied, so as to reduce the chance of miscarriage of justice and reduce the incidence of related disputes.