阑尾炎爆发区续发病例的随访  

A Follow Up Survey of Secondary Cases After Outbreak of Appendicitis at A School

作　　者：郭毅[1] 燕虹[1] 彭志远[2] 孙宁东[2] 刘俊英[3] 任玉霞[3] 

机构地区：[1]武汉大学公共卫生学院流行病学教研室,武汉430071 [2]解放军457医院外科,武汉430062 [3]解放军457医院病理科,武汉430062

出　　处：《武汉大学学报（医学版）》2002年第1期76-78,共3页Medical Journal of Wuhan University

基　　金：湖北省教育厅课题 (2 0 0 0B0 3 0 18)

摘　　要：目的 :随访调查某中学阑尾炎爆发后续发病例的特征及其危险因素。方法 :调查续发病例的分布和有关暴露因素 ,复习续发病例的住院病历和病理切片。选择某大专院校 1997年发病与爆发病例住同一医院的 8例学生患者作对照。结果 :继阑尾炎爆发后 ,1997年 9月～ 2 0 0 0年 6月该中学又发生 2 6例阑尾炎 ,2 0例经手术治疗并经病检证实 ,其中 19例为学生 ,其手术病例的累积发病率为 3.1% (19 6 18) ,男女累积发病率分别为 1.3% (4 32 1) ,5 .1% (15 2 97) ,差异有高度显著性 (χ2 =7.4 9,P <0 .0 1)。 16个班中有 8个班发病 ,有班级聚集性。病例常成簇出现 ,病例间常有接触联系。大多数病例白细胞计数和中性白细胞计数正常。阑尾炎大体观不呈化脓性改变 ,镜下观为淋巴细胞浸润为主的出血性炎症 ,主要表现为粘膜淋巴小结弥散或灶性出血 ,腔内积血并可见大量淋巴细胞。而对照病例的流行病学和病理学特征同普通阑尾炎 ,即散发 ,男多女少 ,白细胞计数普遍升高 ,中性白细胞计数每例升高。阑尾大体观和镜下观呈化脓性改变。未发现可疑的暴露因素。结论 :续发病例特点同爆发病例 ,可能为一种新型的阑尾炎 ,具有传染病的特点 。Objective:To follow up the characteristics of the secondary cases and cause of their occurrence at a school after outbreak of appendicitis in Wuhan city, Hubei province, China. Method:Distribution of patients and exposure factors were investigated. Charts and Hemotoxylin & Eosin sections of appendices were reviewed. Eight cases with appendicitis occurring at a college in 1997 and admitted to same hospital were selected as control cases to find out the characteristics of these cases. Results:20 cases among 26 clinical cases were demonstrated by operation and pathological examination from 1998 to June, 2000. There were 19 student cases among them. Cumulative attack rate in students was 3.1%(19/618). Female student cases(5.1%, 15/297) was more frequent than male student cases (1.3%, 4/321). There was significant difference between both cases(χ 2=7.49, P<0.01). There was a clustering of classes. The cases often appeared sequentially. Many cases had contact history before onset. The white blood cell counts and the neutrophil counts of most patients derived from the secondary cases were normal. Gross examination did not reveal purulent change. Pathologic examination showed disseminated or obviously focal hemorrhage in hyperplastic follicles and in tunuca mucosa with infiltration of lymphocytes and plasma cells under the epithelium of mucosa. Accumulation of a lot of red blood cells and exudation of lymphocytes were often seen in lumen of appendix. These characteristics are different from control cases who showed the characteristics of common appendicitis, namely, sporadic, more male than female. The white blood cell counts and the neutrophil counts increased in majority of cases and each case respectively. Gross examination and pathologic examination revealed purulent change. Suspected exposure factors had not be found. Conclusion: Secondary patients might probably belong to a new type of appendicitis like patients occurring in the outbreak. Their occurrence probably result from person to person transmission.

关 键 词：阑尾炎 流行病学 爆发流行病学 随访 

分 类 号：R656.8[医药卫生—外科学]