2018-2022年湖北省荆州市855例肾综合征出血热病例流行特征及临床特征分析  

Epidemiological and clinical characteristics of 855 cases of hemorrhagic fever with renal syndrome in Jingzhou,Hubei,2018-2022

作　　者：刘天[1] 揭宝池 林志强[3] 向泉 秦周 阮德欣 赵婧[4] 吴杨[5] 陈琦[5] 官旭华[5] Liu Tian;Jie Baochi;Lin Zhiqiang;Xiang Quan;Qin Zhou;Ruan Dexin;Zhao Jing;Wu Yang;Chen Qi;Guan Xuhua(Department for Infectious Disease Control and Prevention,Jingzhou Prefectural Center for Disease Control and Prevention,Jingzhou 434000,Hubei,China;Shashi District Center for Disease Control and Prevention,Jingzhou 434000,Hubei,China;Public Health Department,Jingzhou Central Hospital,Jingzhou 434000,Hubei,China;National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases,Health Emergency Center,Chinese Center for Disease Control and Prevention,Beijing 102206,China;Department for Infectious Disease Control and Prevention,Hubei Provincial Center for Disease Control and Prevention,Wuhan 430079,Hubei,China)

机构地区：[1]荆州市疾病预防控制中心传染病防治所,湖北荆州434000 [2]沙市区疾病预防控制中心,湖北荆州434000 [3]荆州市中心医院公共卫生科,湖北荆州434000 [4]中国疾病预防控制中心卫生应急中心,传染病溯源预警与智能决策全国重点实验室,北京102206 [5]湖北省疾病预防控制中心传染病防治所,湖北武汉430079

出　　处：《疾病监测》2025年第3期352-357,共6页Disease Surveillance

基　　金：中国疾病预防控制中心公共卫生应急反应机制的运行(No.102393220020010000017);荆州市2023年医疗卫生科技计划项目(No.2023HC38)。

摘　　要：目的了解湖北省荆州市肾综合征出血热(HFRS)病例的流行病学特征和临床特征,识别重症病例影响因素,为该病的科学防控提供依据。方法收集2018—2022年荆州市报告的855例HFRS病例个案调查资料,采用描述性流行病学方法描述流行病学特征和临床特征。logistic回归用于重症HFRS影响因素分析。结果855例病例中,轻型36例(27.60%),中型333例(38.95%),重型169例(19.77%),危重型49例(5.73%),不详68例(7.95%)。死亡13例,痊愈737例,不详105例,病死率为1.73%。HFRS病例发病呈双峰型特点,最高峰出现在4—7月(586例,68.54%);次高峰出现在11月至次年1月(143例,16.73%)。年均发病率居前3位的地区分别为江陵县(7.12/10万)、公安县(5.68/10万)、监利市(3.89/10万)。855例HFRS患者职业中,农民占比最高(532例,62.22%);90.60%从事水稻、虾稻等农作物种植。暴露因素调查显示工作场所有鼠或鼠排泄物(74.09%)、房内有鼠(65.28%)、食物/粮食无防鼠设备(61.34%)占比较高。临床症状及体征中占比居前3位的依次为乏力(783例,94.00%)、发热(777例,93.93%)、头痛(530例,63.93%)。实验室检查占比居前3位的依次为血小板减少(670例,87.13%)、尿蛋白阳性(497例,76.46%)、白细胞增多(470例,62.42%)。重症HFRS影响因素分析显示,控制不同地区影响后,出现尿膜状物/管型尿/血尿(比值比=2.60,95%置信区间:1.47~4.61)是危险因素。结论荆州市HFRS病例流行有明显时空聚集性,中老年男性农民高发,特别是从事水稻种植和虾稻养殖的农民。HFRS临床症状不典型,需针对重点人群和地区加大健康教育宣传力度,并加强医务人员培训,提高HFRS诊治能力和防治能力。Objective To understand the epidemiological and clinical characteristics of hemorrhagic fever with renal syndrome(HFRS) in Jingzhou,Hubei province,from 2018 to 2022,identify factors associated with severe cases,and provide evidence for the effective prevention and control of HFRS.Methods The information was collected from 855 HFRS cases reported in Jingzhou from 2018 to 2022 for a descriptive epidemiological analysis.Logistic regression model was used for the analysis on the factors associated with severe HFRS cases.Results In the 855 cases,36(27.60%) were mild cases,333(38.95%) were moderate cases,169(19.77%) were severe cases,49(5.73%) were cases with critical illness,and 68(7.95%)were cases with unknown severity.Thirteen cases were fatal,737 cases recovered,and the outcomes of 105 cases were unknown.The case fatality rate was 1.73%.The incidence of HFRS showed a bimodal pattern,with the peak occurring during April-July (586 cases,68.54%) and the sub-peak occurring during November-January (143 cases,16.73%).The top three areas with high average annual incidence rates were Jiangling (7.12/100 000),Gong'an (5.68/100 000),and Jianli (3.89/100 000).In the 855 HFRS cases,farmers accounted for the highest proportion (532 cases,62.22%),and 90.60%of the cases had been involved in the productions of rice,shrimp,and other crops.The exposure factor investigation showed a higher proportion of workplaces with rats or rat excrement (74.09%),households with rats (65.28%),and food/grain stores without protection against rodent (61.34%).The top three clinical symptoms and signs were fatigue (783 cases,94.00%),fever (777 cases,93.93%),and headache (530 cases,63.93%).The top three laboratory examination results were decreased platelets (670 cases,87.13%),positive urine protein (497 cases,76.46%),and increased white blood cells (470 cases,62.42%).The analysis on risk factors for severe HFRS,after controlling for area difference,showed that the presence of membranous substances,casts in urine,or hematuria (odds ratio=2.60,95%confid

关 键 词：肾综合征出血热 流行特征 临床特征 荆州市 危险因素 

分 类 号：R211[医药卫生—中医学] R512.8