2009-2014年浙江省哨点医院急性腹泻患者病原监测研究  

Monitoring and research on pathogen spectrum in patients with acute diarrhea from sentinel hospital of Zhejiang Province during 2009 to 2014

作　　者：郑书发[1,2] 余斐[1,2] 陈晓[1,2] 崔大伟[1,2] 杨先知[1,2] 谢国良[1,2] 王忆吟 余建兴[3] 李中杰[4] 陈瑜[1,2] 

机构地区：[1]浙江大学医学院附属第一医院检验科,杭州310003 [2]浙江省临床体外诊断技术研究重点实验室 [3]中国医学科学院病原生物学研究所 [4]中国疾病预防控制中心传染病预防控制处

出　　处：《中华预防医学杂志》2016年第12期1084-1090,共7页Chinese Journal of Preventive Medicine

基　　金：国家科技重大专项“传染病监测技术平台”项目（2012ZX10004-210）

摘　　要：目的：分析浙江省门急诊急性腹泻患者的病原构成特征。方法2009年1月至2014年12月，选择杭州、湖州、宁波、衢州以及绍兴市的7家医院作为监测哨点，以其中的内科、儿科和感染科肠道门诊以及急诊的急性腹泻患者为研究对象，调查并记录患者个人基本信息、主要症状与体征等资料，采集患者的粪便样本（5g）进行8种细菌检测（包括霍乱弧菌、志贺菌、非伤寒沙门菌、致泻性大肠埃希菌、副溶血弧菌、气单胞菌、小肠结肠炎耶尔森菌、类志贺邻单胞菌）和5种病毒（包括轮状病毒、诺如病毒、扎如病毒、星状病毒和肠道腺病毒）检测。结果2009—2014年，共采集并检测9364例急性腹泻患者的粪便标本，腹泻病原阳性率为37.38%（3500例）；单一细菌、单一病毒和多重感染总阳性率分别为13.14%（1230例）、20.75%（1943例）和3.49%（327例）。单一细菌感染者中，副溶血弧菌阳性率较高，为5.96%（558例），其次为致泻性大肠埃希菌，为3.86%（361例）；单一病毒感染者中，诺如病毒和轮状病毒阳性率均较高，分别为10.73%（1005例）和8.35%（782例）。〈15岁患者以单一病毒感染者为主，阳性率为32.69%（1014例），≥15岁患者以单一细菌感染者为主，阳性率为16.86%（1056例）。单一细菌感染者中以25～34岁者为主，阳性率为18.62%（302例）；单一病毒感染者中以1～4岁者为主，阳性率为41.12%（435例）；多重感染者中以1～4岁者为主，阳性率为7.37%（78例）。7—9月感染单一细菌者比例较高，12月至次年3月感染单一病毒者比例较高。2009—2014年，门急诊急性腹泻患者病原谱变化较小，均以轮状病毒[22.34%（782/3500）]、诺如病毒[28.71%（1005/3500）]、副溶血弧菌[15.92%（558/3500）]、致泻大肠埃希菌[10.31%（361/3500）]为主。结论浙江省2009—2014年门急诊急性腹泻患者常见病原均有�Objective To explore pathogen spectrum constitution of acute diarrhea in outpatient and emergency of Zhejiang Province, and provide basis for treatment, prevention and control of the disease. Methods During January 2009 to December 2014, we selected seven sentinel hospitals in different regions of Zhejiang, monitored and researched on pathogen spectrum in patients with acute diarrhea from outpatient and emergency. We recorded patients＇ personal basic information, the main symptoms and signs, and collected stool samples （5 g）. Eight kinds of bacteria （Vibrio cholerae, Shigella spp., Salmonella spp., Diarrheagenic E. coli, Vibrio parahaemolyticus, Aeromonas hydrophila, Yersinia enterocolitica and Plesiomonas shigelloides） and five kinds of viruses （Rotavirus, Norovirus, Sappovirus, Astrovirus and Adenovirus） were detected. Chi-square test and Fisher＇s exact probability method were used to compare different characteristics of patients with single bacterial infection, single virus infection and multiple infection （bacteria-bacteria, bacteria-viruses, virus-virus）. Results During 2009 to 2014, 9 364 fecal 〈br〉 samples from acute diarrhea patients were collected and tested, among which 3 500 cases were tested positive, with total positive rate of 37.38%. Positive rates of bacteria and viruses were 13.14%（1 230 cases） and 20.75%（1 943 cases）, respectively. Mixed infection positive rate of multiple pathogens was 3.49%（327 cases）. Positive rate of Vibrio parahaemolyticus （5.96%, 558 cases） was the highest among bacterial pathogens, followed by pathogenic Escherichia coli （3.86%, 361 cases）. Viruses were mainly Norovirus （10.73%, 1 005 cases） and rotavirus （8.35%, 782 cases）. A big difference existed in diarrheogenic pathogen spectrum between patients less than 15 years old and patients equal or older than 15 years old. Pathogens for patients less than 15 years old were mainly virus, with the positive rate of 32.69%（1 014 cases）. However, the positive rate of bacteria

关 键 词：腹泻 病原 监测 流行规律 

分 类 号：R574.62[医药卫生—消化系统] R446.5[医药卫生—内科学]