上海市徐汇区2017—2023年成人腹泻病监测结果  

Pathogen surveillance of adults diarrhea disease in Xuhui District,Shanghai,2017-2023

作　　者：何丽 崔晓娴 沈小婷[1] 王凯悦 王雅新[1] 钱雨澜 王慧珍 陆一涵 丰俊 陶艳琳[1] HE Li;CUI Xiaoxian;SHEN Xiaoting;WANG Kaiyue;WANG Yaxin;QIAN Yulan;WANG Huizhen;LU Yihan;FENG Jun;TAO Yanlin(Xuhui District Center for Disease Control&Prevention,Shanghai 200237,China;Shanghai Municipal Center for Disease Control&Prevention,Shanghai 200336,China;Shanghai Medical College Fudan University,Shanghai 200032,China)

机构地区：[1]上海市徐汇区疾病预防控制中心,上海200237 [2]上海市疾病预防控制中心,上海200336 [3]复旦大学上海医学院,上海200032

出　　处：《中国热带医学》2024年第12期1452-1457,共6页China Tropical Medicine

基　　金：上海市加强公共卫生体系建设三年行动计划(2023—2025)学科带头人项目(No.GWVI-11.2-XD28);上海市徐汇区科委公共卫生项目(No.SHXH202146)

摘　　要：目的 分析2017—2023年上海市徐汇区成人腹泻病的流行特征、变化趋势、影响因素及病原谱构成,为腹泻病病原监测和疾病防控提供科学依据。方法 收集2017—2023年徐汇区哨点医院成人腹泻病患者标本,用实时荧光定量PCR法(real time quantitative polymerase chain reaction, qPCR)对肠道致病菌进行核酸检测。对其中30份标本进行鸟枪法宏基因组二代测序(metagenomic next-generation sequencing, mNGS),以METAMIC种或属水平上每百万次总读数至少超过1个reads的物种作为宏基因组阳性病原体的判定标准。构建并比较qPCR和mNGS检出的病原谱差异。结果 共收集1 265份成人腹泻病标本,年度病原阳性率呈显著性上升趋势(χ^(2)=23.493,P<0.05),2023年最高,达64.9%(100/154)。男性发病较高(52.9%,669/1 265),26~45岁为主要发病人群(51.8%,655/1 265),夏秋季是感染高发季节(67.7%,857/1 265)。大部分患者(72.3%,914/1 265)能在发病后1 d内及时就诊。67.8%(858/1 265)的患者发病前食用过可疑肉蛋乳和水产品。qPCR结果显示诺如病毒GⅡ型(22.6%,132/584)、空肠弯曲菌(20.0%,117/584)和产肠毒素大肠埃希菌(13.0%,76/584)检出率排在前3位。不同年份病原谱构成差异有统计学意义(χ^(2)=79.578,P<0.05),肠集聚性大肠埃希菌、空肠弯曲菌和诺如病毒GⅡ型是占比变化较大的病原。mNGS结果提示的病原谱与监测结果差异有统计学意义(P<0.05),排在前3位的优势病原分别为轮状病毒(93.3%,28/30)、水泡病毒(83.3%,25/30)和疱疹病毒(80.0%,24/30)。影响因素分析表明,年龄、可疑食品、是否发热是病原检出率影响因素(P<0.05)。结论 2017—2023年上海市徐汇区成人腹泻病总体阳性率呈现上升趋势。夏秋季为感染高发季,其中病毒检出以夏季为主,细菌检出以夏秋季为主。建议mNGS可以与常规的检测技术手段互为补充,为有效防控腹泻病提供科学依据。Objective To analyze the epidemiological characteristics,trends,risk factors,and pathogenic spectrum of adult diarrheal diseases in Xuhui District,Shanghai from 2017 to 2023,so as to provide scientific reference for pathogen monitoring and disease prevention and control of diarrheal diseases.Methods Samples of adult patients with diarrhea in sentinel hospitals of Xuhui District from 2017 to 2023 were collected,and nucleic acid detection of intestinal pathogens was conducted using real-time quantitative PCR.Thirty specimens were subjected to shotgun metagenomic next-generation sequencing(mNGS),with species identified as metagenomic positive pathogens at the level of genus or species by a threshold that at least one read per million of total reads identified by METAMIC.Pathogenic spectrum detected by qPCR and mNGS was listed and compared.Results A total of 1265 adult diarrheal specimens were collected,showing a significant upward trend in pathogen positivity rates(χ^(2)=23.493,P<0.05),peaking in 2023 at 64.9%(100/154).A higher incidence was found among males(52.9%,669/1265),with the primary affected age group being 26-45 years(51.8%,655/1265),and summer and autumn being peak seasons for infection(67.7%,857/1265).Most patients(72.3%,914/1265)sought medical attention within one day of onset.Before onset,67.8%(858/1265)of patients had eaten suspicious meat,eggs,dairy,or seafood products.qPCR results revealed the top three dominant pathogens as Norovirus GII(22.6%,132/584),Campylobacter jejuni(20.0%,117/584),and enterotoxigenic Escherichia coli(13.0%,76/584).There were significant differences in pathogenic spectrum across different years(χ^(2)=79.578,P<0.05),with enteroaggregative E.coli,Campylobacter jejuni,and Norovirus GII showing the most variation in prevalence.The difference in pathogenic spectrum detected by mNGS and qPCR was also significant(P<0.05),with the top three most abundant pathogens being Rotavirus(93.3%,28/30),Vesiculovirus(83.3%,25/30),and Herpesvirus(80.0%,24/30).Factor analysis indicated that age

关 键 词：腹泻病 宏基因组二代测序 实时荧光定量PCR法 病原谱 上海市 

分 类 号：R181.3[医药卫生—流行病学]