医疗机构发热呼吸道症候群监测病例定义筛选与评估研究  

Case definition selection and evaluation research of the hospital-based febrile respiratory syndromic surveillance

作　　者：郭玉清 林帆 连怡遥 李柏松 吴彦霖[1] 李开明 李刚 王丽萍[1] Guo Yuqing;Lin Fan;Lian Yiyao;Li Bosong;Wu Yanlin;Li Kaiming;Li Gang;Wang Liping(Division of Infectious Disease,National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases,Chinese Center for Disease Control and Prevention,Beijing 102206,China;National Institute for Nutrition and Health,Chinese Center for Disease Control and Prevention,Beijing 100050,China;Chongqing Center for Disease Control and Prevention,Chongqing 400042,China;Information Statistics Center,Beijing Center for Disease Control and Prevention,Beijing 100013,China)

机构地区：[1]中国疾病预防控制中心传染病管理处,传染病溯源预警与智能决策全国重点实验室,北京102206 [2]中国疾病预防控制中心营养与健康所营养流行病学室,北京100050 [3]重庆市疾病预防控制中心,重庆400042 [4]北京市疾病预防控制中心信息统计中心,北京100013

出　　处：《疾病监测》2024年第5期616-621,共6页Disease Surveillance

基　　金：国家科技重大专项(No.2018ZX10713001);公共卫生应急反应机制(No.102393220020010000017)。

摘　　要：目的分析急性发热呼吸道症候群常见病原感染患者早期临床症状特征,科学筛选常见症状组合,为医疗机构开展智慧化发热呼吸道症候群监测,以期为及早发现急性呼吸道传染病暴发与预警提供参考。方法利用2011—2015年全国发热呼吸道症候群病例的临床症状和病原学等数据,采用描述性分析方法对不同特征人群感染早期临床症状特征进行分析;通过灵敏度、特异度、阳性预测值和阴性预测值评估不同症状组合的监测效果。结果不同年龄组和病原感染患者早期发热程度和咳嗽、咽痛、流涕等呼吸道常见症状构成存在差异,但发热、咳嗽为各年龄组以及病原类型最为常见的临床症状。“发热≥37.2℃,伴有咳嗽、咽痛、流涕症状之一”的病例定义灵敏度较高,为71.63%,特异度为33.52%,在此定义基础上增加“咳痰”症状对灵敏度的改善,差异无统计学意义(P>0.05);与其他症状组合相比,其阳性预测值和阴性预测值差异较小,分别为33.41%和71.73%。结论为及时发现呼吸道传染病聚集性或病例异常升高疫情,以“发热≥37.2℃,伴有咳嗽、咽痛、流涕症状之一”的病例定义在医疗机构开展症候群监测灵敏度较高,具有一定的早期预警应用价值。Objective To explore the early clinical symptom characteristics of patients confirmed common acute respiratory infectious and to select combinations of common clinical symptoms in order to provide references for intelligent febrile respiratory syndromic surveillance in the hospital-based to aid in early warning of acute respiratory infectious disease outbreaks.Methods Data on clinical manifestations and laboratory testing results was collected from nationwide surveillance of all-age patients with acute respiratory infections between 2011−2015.Descriptive analysis was used to describe the early clinical characteristics in different population groups.Sensitivity,specificity,positive and negative predictive values were calculated for various symptom complexes.Results Fever and cough were the most common symptoms of the cases,although proportions of early common respiratory symptoms including degree of fever,cough,sore throat,runny nose and others varied by age-group and pathogen type.Fever(≥37.2℃)plus cough or sore throat or runny nose case definition had maximum sensitivity(71.63%)but low specificity(33.52%).No difference was found in the improvement of sensitivity by adding sputum to the criteria(P>0.05).Compared with other symptom combinations,the difference of positive predictive value and negative predictive value was slight,which was 33.41%and 71.73%,respectively.Conclusions Case definition of fever(≥37.2℃)plus cough or sore throat or runny nose was more sensitive in the hospital-based febrile respiratory syndromic surveillance which would be useful for early detecting clusters and abnormal rises of acute respiratory infectious diseases cases.

关 键 词：发热呼吸道症候群 早期症状 病例定义 评估 

分 类 号：R211[医药卫生—中医学] R373.1