天津市2010-2015年百日咳病例临床症状与误诊的特征分析  

Characteristics of clinical symptoms and misdiagnosis of pertussis between 2010 and 2015 in Tianjin

作　　者：黄海涛[1] 李永成[1] 高志刚[1] 刘勇[1] 刘鹏[1] 张颖[1] 

机构地区：[1]天津市疾病预防控制中心免疫规划科,天津300011

出　　处：《疾病监测》2016年第9期791-795,共5页Disease Surveillance

基　　金：天津市卫生和计划生育委员会科技基金(No.2015KY18)~~

摘　　要：目的对天津市近年来百日咳确诊病例的临床特征及诊断情况进行分析,提高医务人员对百日咳的认知。方法采用描述流行病学方法对在2010-2015年医院被动监测和2010-2012年社区症状主动监测中确诊的百日咳病例的临床症状进行分析。结果百日咳病例咳嗽时间中位数为14 d,咳嗽时间在14 d以下的占46.45%。25.63%的病例只表现为单纯的持续咳嗽,无其他特异的临床症状。具有阵发性痉挛性咳嗽(痉咳)症状的比例最多,占74.37%,其次为咳嗽后呕吐(呕吐)占32.95%,鸡鸣音、青紫、窒息的发生率均低于30.00%。医院监测的发生率均显著高于社区诊所(P<0.05)。1岁以下病例组出现痉咳、鸡鸣音、呕吐、青紫和窒息的发生率均为最高,15岁及以上病例组上述症状的发生率均为最低。未接种疫苗人群中痉咳、鸡鸣音、呕吐及青紫的发生率均高于已接种疫苗的人群(P<0.05)。社区诊所确诊病例在初次就诊时其误诊率高达95.16%,误诊为肺炎的比例最高,占50.00%。结论百日咳临床症状不典型,误诊率高,建议修订现行百日咳监测病例定义,提高百日咳的监测水平。Objective To analyze the clinical characteristics of pertussis cases and the diagnosis performance in Tianjin during 2010- 2015,and provide evidence to improve the clinical identification of pertussis. Methods Descriptive epidemiological analysis w as conducted by using the passive surveillance data from hospitals and active surveillance data from communities in Tianjin during this period. Results The median cough duration w as 14 days. Cough lasted for less than 14 days in 46. 45% of the cases,and 25. 63% of the cases show ed a persistent cough only without other specific clinical symptoms. The main symptom w as paroxysmal spasmodic cough（ 74. 37%）,follow ed by post cough vomiting（ 32. 95%）,inspiratory ＂w hooping＂（ 〈30. 00%）,cyanosis（ 〈30. 00%） and apnea（ 〈30. 00%）. The cases＇ symptom detection rate in hospital surveillance w as significantly higher than that in community surveillance（ P〈0. 05）. The proportion of the cases w ith paroxysmal cough,post cough vomiting,inspiratory ＂whooping＂,cyanosis and apnea w as highest in age group 〈1 year group,and low est in age group ≥ 15 years. The proportion of the cases w ith the symptoms mentioned above in the unvaccinated w as significantly higher than that in the vaccinated（ P〈0. 05）. The misdiagnosis rate of community surveillance w as 95. 16% in the first medical seeking,in w hich half of the cases w ere misdiagnosed w ith pneumonia. Conclusion The clinical symptoms of pertussis are untypical,and the misdiagnosis rate is high. It is suggested to revise the current case definition of pertussis surveillance to improve the surveillance for pertussis.

关 键 词：百日咳 临床特征 病程 误诊 

分 类 号：R516.6[医药卫生—内科学]