2013—2018年广州市麻疹实验室确诊病例特征及影响因素分析  

Characteristics and influencing factors of laboratory-confirmed measles cases in Guangzhou city,2013-2018

作　　者：朱娉婷 张颖[1] 云雪霞[1] 曹毅敏[1] 狄飚[1] 许建雄[1] 李美霞[1] 贺晴[1] ZHU Ping-ting;ZHANG Ying;YUN Xue-xia;CAO Yi-min;DI Biao;XU Jian-xiong;LI Mei-xia;HE Qing(Guangzhou Municipal Center for Disease Control and Prevention,Guangzhou,Guangdong 510440,China)

机构地区：[1]广州市疾病预防控制中心,广东广州510440

出　　处：《实用预防医学》2020年第10期1182-1185,共4页Practical Preventive Medicine

基　　金：国家科技重大专项(2017ZX10103011005);广州市科技计划项目(201804020084);广州市医学重点学科建设项目(2017-2019-07)。

摘　　要：目的探讨广州市麻疹实验室确诊病例的特征及影响因素,提高麻疹疑似病例的早期识别和诊断,为消除麻疹提供科学依据。方法选择2013—2018年经实验室诊断的麻疹病例,采用logistic回归分析实验室病例的影响因素。结果2013—2018年广州市共报告6310例疑似病例,病例采血送检率为93.22%。实验室检测阳性和阴性病例分别有2992例和2370例。经多因素分析结果显示,性别、年龄、报告单位、咳嗽、结膜炎、含麻疹疫苗免疫史、出疹至采血间隔天数等因素均有统计学意义。男性、0~7 m和8 m^14 y人群、出现咳嗽、结膜炎、三级医院报告、未接种含麻疹成分疫苗、出疹后4~28 d采血检测等是实验室阳性病例的危险因素,OR值和95%CI值分别为1.725(1.139~2.613)、8.774(1.313~58.614)、12.271(1.907~78.957)、3.654(2.201~6.067)、1.944(1.238~3.052)、5.738(1.471~22.384)、9.647(2.354~39.530)、2.505(1.651~3.800)。结论收集疑似病例基本信息、临床症状、免疫史等有助于提高麻疹病例早期识别和诊断。同时,在消除麻疹的关键时期,应对无含麻疫苗接种史的高风险人群接种疫苗,提高临床医生诊断水平。Objective To explore the characteristics and influencing factors of laboratory-confirmed measles cases in Guangzhou city,to improve the early identification and diagnosis of suspected measles cases,and to provide a scientific basis for measles elimination.Methods Laboratory-confirmed measles cases in 2013-2018 were selected,and then logistic regression analysis was performed to identify the factors influencing these cases.Results A total of 6,310 suspected measles cases were reported in Guangzhou city in 2013-2018,and the blood detection rate of the cases was 93.22%.2,992 measles IgM-positive patients and 2,370 measles IgM-negative patients were detected in this study.Multivariate logistic regression analysis showed that factors such as gender,age,reporting unit,cough,conjunctivitis,vaccination history of measles-containing vaccine(MCV),and the number of days between rash onset and blood sampling were significantly associated with measles IgM-positive status.Males(OR=1.725,95%CI:1.139-2.613),populations aged 0-7 months(OR=8.774,95%CI:1.313-58.614)and 8 months-14 years(OR=12.271,95%CI:1.907-78.957),cough(OR=3.654,95%CI:2.201-6.067),conjunctivitis(OR=1.944,95%CI:1.238-3.052),reporting from tertiary hospitals(OR=5.738,95%CI:1.471-22.384),having no vaccination with MCV(OR=9.647,95%CI:2.354-39.530),and conducting blood sampling and detection within 4-28 days after eruption(OR=2.505,95%CI:1.651-3.800)were risk factors for laboratory-confirmed measles IgM-positive cases.Conclusions Collecting suspected measles cases’general information,clinical symptoms and history of immunization is conducive to early identification and diagnosis of measles cases.At the same time,routine vaccination among high-risk population without MCV vaccination history should be strengthened in the critical period of measles elimination,and diagnosis level of clinicians should be improved.

关 键 词：麻疹 实验室确诊病例 影响因素 含麻疹成分疫苗 

分 类 号：R511.2[医药卫生—内科学]