北京市临床诊断细菌性痢疾流行特征和病原谱
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摘要
目的分析临床诊断细菌性痢疾患者的病原谱变化及流行病学、临床特征,为提高细菌性痢疾实验室确诊率提供依据。方法 2015年1月-2017年12月,选择北京市肠道门诊临床诊断细菌性痢疾并采集粪便标本的病例,进行肠道细菌检测。同时,未被正确诊断但实验室检测为志贺菌的病例也纳入研究。分析病例的病原谱变化,比较志贺菌阳性、肠道细菌阳性与其他病例三组病例的流行病学和临床特征有无差异。结果 903例临床诊断细菌性痢疾病例,以及31例培养出志贺菌的其他病例被纳入此次研究。2015-2017年,优势菌分别为志贺菌(8.04%),副溶血性弧菌(11.07%)和肠致泻性大肠杆菌(7.81%)。2015-2017年,志贺菌检出率逐年下降,副溶血性弧菌检出率波动较大。志贺菌阳性、肠道细菌阳性与其他病例三组腹泻病例在月份、地区、腹泻次数、粪便性状、是否呕吐、是否发热和白细胞计数是否符合诊断标准方面差异有统计学意义。结论临床诊断细菌性痢疾病例中志贺菌检出率逐年下降,肠致泻性大肠杆菌、副溶血性弧菌等肠道细菌检出率较高。建议结合病例流行病学及临床特征综合诊断,提高实验室诊断符合率。
Objective To analyze the changes of pathogen spectrum, the epidemiological and clinical characteristics of clinical bacillary dysentery patients, and to provide the basis for the increment of laboratory coincidence rate of bacterial dysentery. Methods Clinical bacillary dysentery patients were selected in Beijing during January 2015 and December 2017. Stool specimens from were collected and tested for intestinal bacteria. And patients who were only laboratory confirmed of Shigella infection were also included in this study. The changes of pathogen spectrum in clinical bacillary dysentery patients were analyzed. We compared the differences of epidemiological and clinical characteristics between Shigella infected cases, the intestinal bacteria infected cases, and other diarrhea cases. Results 903 clinical bacillary dysentery patients and 31 laboratory confirmed shigella cases were included in this study. 2015-2017, The major intestinal infection was caused by shigella(8.04%), Vibrio parahaemolyticus(11.07%) and Escherichia coli(7.81%). The detection rates of shigella declined yearly, while V. parahaemolyticus was in fluctuation. There were statistical differences among the three groups in months, the districts, number of diarrhea, stool properties, presentations of vomiting and fever, and the count of white blood cells of over 15/HP. Conclusion The detection rate of clinical bacillary dysentery cases declined year by year, but the detection rates of E. coli and V. parahaemolyticus were high. The epidemiological and clinical characteristics of the cases should be taken into consideration in diagnosis in order to improve the laboratory coincidence rate.
Objective To analyze the changes of pathogen spectrum, the epidemiological and clinical characteristics of clinical bacillary dysentery patients, and to provide the basis for the increment of laboratory coincidence rate of bacterial dysentery. Methods Clinical bacillary dysentery patients were selected in Beijing during January 2015 and December 2017. Stool specimens from were collected and tested for intestinal bacteria. And patients who were only laboratory confirmed of Shigella infection were also included in this study. The changes of pathogen spectrum in clinical bacillary dysentery patients were analyzed. We compared the differences of epidemiological and clinical characteristics between Shigella infected cases, the intestinal bacteria infected cases, and other diarrhea cases. Results 903 clinical bacillary dysentery patients and 31 laboratory confirmed shigella cases were included in this study. 2015-2017, The major intestinal infection was caused by shigella(8.04%), Vibrio parahaemolyticus(11.07%) and Escherichia coli(7.81%). The detection rates of shigella declined yearly, while V. parahaemolyticus was in fluctuation. There were statistical differences among the three groups in months, the districts, number of diarrhea, stool properties, presentations of vomiting and fever, and the count of white blood cells of over 15/HP. Conclusion The detection rate of clinical bacillary dysentery cases declined year by year, but the detection rates of E. coli and V. parahaemolyticus were high. The epidemiological and clinical characteristics of the cases should be taken into consideration in diagnosis in order to improve the laboratory coincidence rate.
引文
[1] 闫革彬,彭华,舒高林,等.两起GII.2型诺如病毒急性胃肠炎暴发疫情的病原学分析[J].国际病毒学杂志,2017,24(6):384-388.
[2] 任燕,靳淼,许少坚,等.2016-2017年深圳市龙华区诺如病毒疫情流行特征及病原学特点[J].国际病毒学杂志,2018,25(2):109-112.
[3] ZHANG H,SI Y L,WANG X F,et al.Patterns of bacillary dysentery in China,2005-2010[J].Int J Environ Res Public Health,2016,13(2):164.
[4] 贺拴友,高丽莉,石胜刚,等.某部一起细菌性痢疾暴发的调查[J].解放军预防医学杂志,2007,25(2):139.
[5] 孟琨,岳英明,王蕾.感染性腹泻的临床特征及流行病学研究[J].中国临床保健杂志,2017,20(6):751-754.
[6] 修丽华.2008-2012年龙城区细菌性痢疾和其他感染性腹泻病流行特征对比分析[J].中国实用医药,2016,11(5):288-289.
[7] 卫生部.细菌性和阿米巴性痢疾诊断标准:WS 287-2008[S].北京:人民卫生出版社,2009.
[8] 田祎,钱海坤,贾蕾,等.圆形分布法分析北京市细菌性痢疾发病季节变化[J].现代预防医学,2017,44(21):3853-3855.
[9] 贾丽丽,陈永亮,杨育松.2008-2013年北京市密云县细菌性痢疾流行病学特征[J].首都公共卫生,2015,9(1):20-23.
[10] 高璐,张维.2008-2014年天津市细菌性痢疾流行病学特征及志贺菌检测结果分析[J].天津医药,2017,45(6):651-656.
[11] 涂银萍,苏文晶,白书媛,等.大便培养确诊细菌性痢疾者的临床特点分析[J].中国医刊,2016,51(12):90-92.
[12] LIVIO S,STROCKBINE N A,PANCHALINGAM S,et al.Shigella isolates from the global enteric multicenter study inform vaccine development[J].Clin Infect Dis,2014,59(7):933-41.
[13] UD-DIN A,WAHID S.Relationship among Shigella spp.and enteroinvasive escherichia coli (EIEC) and their differentiation[J].Braz J Microbiol,2015,45(4):1131-1138.
[14] 曹亿会,周晓芳,姜黎黎,等.2012-2015年云南省病毒性腹泻病原监测分析[J].国际病毒学杂志,2018,25(1):35-38.
[15] 龙琴,刘靳波.细菌分子生物学分型技术研究进展[J].国际检验医学杂志,2015,36(10):1423-1425.
[16] MANI S,WIERZBA T,WALKER R I.Status of vaccine research and development for Shigella[J].Vaccine,2016,34(26):2887-2894.
[2] 任燕,靳淼,许少坚,等.2016-2017年深圳市龙华区诺如病毒疫情流行特征及病原学特点[J].国际病毒学杂志,2018,25(2):109-112.
[3] ZHANG H,SI Y L,WANG X F,et al.Patterns of bacillary dysentery in China,2005-2010[J].Int J Environ Res Public Health,2016,13(2):164.
[4] 贺拴友,高丽莉,石胜刚,等.某部一起细菌性痢疾暴发的调查[J].解放军预防医学杂志,2007,25(2):139.
[5] 孟琨,岳英明,王蕾.感染性腹泻的临床特征及流行病学研究[J].中国临床保健杂志,2017,20(6):751-754.
[6] 修丽华.2008-2012年龙城区细菌性痢疾和其他感染性腹泻病流行特征对比分析[J].中国实用医药,2016,11(5):288-289.
[7] 卫生部.细菌性和阿米巴性痢疾诊断标准:WS 287-2008[S].北京:人民卫生出版社,2009.
[8] 田祎,钱海坤,贾蕾,等.圆形分布法分析北京市细菌性痢疾发病季节变化[J].现代预防医学,2017,44(21):3853-3855.
[9] 贾丽丽,陈永亮,杨育松.2008-2013年北京市密云县细菌性痢疾流行病学特征[J].首都公共卫生,2015,9(1):20-23.
[10] 高璐,张维.2008-2014年天津市细菌性痢疾流行病学特征及志贺菌检测结果分析[J].天津医药,2017,45(6):651-656.
[11] 涂银萍,苏文晶,白书媛,等.大便培养确诊细菌性痢疾者的临床特点分析[J].中国医刊,2016,51(12):90-92.
[12] LIVIO S,STROCKBINE N A,PANCHALINGAM S,et al.Shigella isolates from the global enteric multicenter study inform vaccine development[J].Clin Infect Dis,2014,59(7):933-41.
[13] UD-DIN A,WAHID S.Relationship among Shigella spp.and enteroinvasive escherichia coli (EIEC) and their differentiation[J].Braz J Microbiol,2015,45(4):1131-1138.
[14] 曹亿会,周晓芳,姜黎黎,等.2012-2015年云南省病毒性腹泻病原监测分析[J].国际病毒学杂志,2018,25(1):35-38.
[15] 龙琴,刘靳波.细菌分子生物学分型技术研究进展[J].国际检验医学杂志,2015,36(10):1423-1425.
[16] MANI S,WIERZBA T,WALKER R I.Status of vaccine research and development for Shigella[J].Vaccine,2016,34(26):2887-2894.