产肠毒素大肠杆菌腹泻病的系列研究（Ⅱ）临床特点

Studies on Enterotoxigenic Escherichia Coli Diarrhea(Ⅱ) :Clinical Features

用产肠毒素大肠杆菌（ＥＴＥＣ）的４种主要毒力基因（ＬＴ、ＳＴｐ、ＳＴｈ、ＣＦＡ／Ｉ）制成同位素标记的探针作为诊断手段，在广州市远郊农村对ＥＴＥＣ腹泻病做了系列研究。该病年发病率１２．１７％，年龄１个月～７５岁。不足５岁的发病率为８０．２８％，其中不足２岁的高达１８．９７％；５岁以上的为２．１８％，差异非常显著（Ｐ＜０．０１）．男孩显著高于女孩（Ｐ＜０．０１）．发病高峰在７月（１．４７％）和１１月（１．７６％）。临床症状以腹泻（１００％）、呕吐（３２．５％）、食欲差（２８．９％）为主，９５％的不足２岁患者伴有上感症状，３１．３％有３８℃以下低热，个别达３９℃以上者常伴有合并感染，但成人少见，７５％患者为水样便或稀便，１４．５％为粘液便，３．６％为脓血便；有脓血便者常合并志贺氏菌、空肠弯曲菌或侵袭性大肠杆菌（ＥＩＥＣ）感染。８２％的患者每天大便３～５次，＞１０次者常有合并感染。菌型以ＥＴＥＣ－ＳＴｐ为主，依次为ＬＴ、ＳＴ／ＬＴ和ＣＦＡ／Ｉ。病程一般为３～４天。对常用抗菌药物敏感，但对红霉素、四环素、青霉素Ｇ有高度抗性，且多重抗性十分普遍。

tudies on enterotoxigenic escherichia coli(ETEC)diarrhea were carried out in the suburb ofGuangzhou for one year. Four probes for the genes encoding ETEC extoxigens(LT,STh, STp and CFA/I) were used for detecting ETEC strains. A total of 5116 villagers were surveyed and the annual incidencerate was 12. 17%. The oldest patient was 75 years old and the youngest was 1 month of age. The incidencerate under 5 years of age was significantly higher than that above 5 years of age(80. 28%versus 2. 18%,p<0.05). The incidence rate in boys was significantly higher than girls(P<0.05).The incidence rate un-der 2 years of age was 187%(1. 9 episodes/person/year).Two peaks of ETEC diarrhea were found in ayear, one in July and another in November. The analyses on the clinical features of ETEC diarrhea showedthat: diarrhea(100%) , poor appetite 28.9%(23/83) , nausea and /or vomiting 32. 5%(27/83) , tenesmus3.6%(3/83 ). 95%of children under 2 years of age had upper respiratory tract infection. Adult patientshas no fever. Some of the children with diarrhea had a low fever. The children temperature above 39℃of-ten had mixed infections, The properties of the stool of ETEC diarrheal patients were: watery stools 75%(62/83), mucous stools 14.5%(12/83), pus and bloody stools 3.6%(3/83). The latter was usually com-paried with Shigella, Campylobacter or EIEC infections. On the average , the patients with ETEC diarrheapassed 3-5 stools per day. The patients who passed more than 10 stools per day usually had mixed infec-tions. ETEC-STa strains were the most frequently detected in ETEC diarrheal patients. 75%- 100%of di-arrheal patients caused by LT , LT/ST and CFA/I had watery or loose stools. The patients with ETEC-STp diarrheo might have loose or watery stools with bloody. Mixed infection rate was 51. 8%(43/83). The average course of illness was 3-4days. ETEC strains were sensitive to gentamycin, furazolidone andfurantoin; however , they were resistant to erythromycin, penicillin G and tetracyclin, moreover , multire-sistant strains were quite common.