广西桂林市1999～2008年甲型副伤寒病后带菌队列研究  

Cohort Study of Paratyphoid Fever A Carriers in Guilin City of Guangxi,1998 - 2008

作　　者：麦浩[1] 杨进[2] 潘定权[1] 李革莉 李秀苾 马小垒[4] 龙虎[1] 秦金勇 

机构地区：[1]广西桂林市疾病预防控制中心,桂林市541001 [2]广西壮族自治区疾病预防控制中心,南宁市530021 [3]广西阳朔县疾病预防控制中心,阳朔县541900 [4]广西全州县疾病预防控制中心,全州县541500

出　　处：《广西医学》2013年第8期989-992,共4页Guangxi Medical Journal

基　　金：广西自然科学基金(2011GXNFFA018199);广西卫生厅科研立项课题(Z2010202)

摘　　要：目的了解甲型副伤寒病后带菌情况及带菌状态与脂多糖(LPS)IgG抗体滴度的关系。方法采用历史性队列研究方法,随访桂林市1999～2008年发病的甲型副伤寒患者328例,采集其3次粪便标本培养甲型副伤寒菌,同时采集血样进行LPS IgG测定。结果 328例分布于9个县区43个乡镇(街道)。328例中处于恢复期病例20例,检出带菌6例,恢复期带菌率30.00%,95%CI(12%,54%);恢复期带菌者主要原因为发病时用药不规范。处于慢性期患者308例,检出慢性带菌1例,慢性带菌率为0.32%,95%CI(0.1%,5.6%);该慢性带菌者为伴胆囊结石和肾囊肿的中年肥胖女性,病后18个月仍携带甲型副伤寒菌。7例带菌者予氨苄青霉素加左氧氟沙星联合用药连续2周,消除带菌状态。带菌者血清LPS IgG平均滴度1∶97.14,高于无带菌状态的既往病例平均滴度1∶8.59(P<0.05)。结论防控甲型副伤寒中应做好病例管理,规范、合理、全程使用抗生素;在治疗甲型副伤寒病人时,应注意伴胆道疾患或慢性泌尿系统疾患者,如治疗不彻底易发展成慢性带菌。Objective To investigatus the status of paratyphoid fever A carriers, and to explore its relation- ship with LPS IgG antibody titers. Methods Three hundred and twenty-eight patients with paratyphoid fever A who were confirmed in 1999-2008 in Guilin City were followed up in the historical cohort study. Their stool specimens were collected three times to culture Salmonella paratyphi A, and their serum specimens were collected to test LPS IgG anti- body titer. Results Three hundred and twenty-eight cases were from 9 counties and 43 towns/streets. Of 328 cases, 6 carriers was found in 20 convalescents, the positive rate was 30.00% ,95% confidence interval（CI） 12%- 54%. The treatment for the convalescents were not standard in the onset phase. A chronic carrier was found in other 308 previous paratyphoid fever A patients, the positive rate of chronic carrier was 0.32%, 95% CI 0. 1%-5.6%. This chronic carrier was a middle-aged obese women with gallbladder stones accompanied by renal cysts, and was still iden- tiffed to be a chronic carrier 18 months after onset of paratyphoid fever A. Seven carriers were treated with ampicillin and levofloxacin for two weeks and then became negative. The mean serum LPS IgG titer in carriers was significantly higher than that in non-carriers （ 1 ： 97.14 vs 1 ： 8.59, P 〈 0.05 ）. Conclusion Case management should be strengthened, and the standard, reasonable, full-course use of antibiotics should be adapted in the prevention and con- trol of paratyphoid fever A. We should pay attention to the patients with biliary tract disease or chronic urinary diseasein the treatment of paratyphoid fever A. If the patient is not treated completely, he or she may easily become a chronic carrier.

关 键 词：甲型副伤寒 慢性带菌 脂多糖IgG 队列研究 桂林市 

分 类 号：R183.4[医药卫生—流行病学] R516.3[医药卫生—公共卫生与预防医学]