797例急性腹泻患者病原菌检测结果的临床分析

Clinical analysis of pathogens surveillance in 797 patients with acute infectious diarrhea

目的探讨门诊急性感染性腹泻患者的病原菌检出情况及临床特点。方法回顾性分析2010年4月至2011年12月首都医科大学宣武医院肠道门诊收治的797例急性腹泻患者的病原学资料及临床特点。结果 797例患者中病原菌检测阳性者186例(23.3%),检测出1种病原菌者180例(22.6%),检测出2种病原菌者6例(0.8%)。其中志贺菌81例(43.5%),包括宋内志贺菌66例,福氏志贺菌15例;沙门菌48例(25.8%);副溶血弧菌30例(16.1%);大肠埃希菌7例(3.8%);单胞菌7例(3.8%);其他肠杆菌19例(10.2%)。青壮年组病原菌检出率较中年组、老年组显著增高(26.4%vs.17.8%vs.18.7%,P<0.05)。病原菌检出阳性率较高的月份为7、8、9月,阳性检出率分别为32.0%、54.0%、29.0%。病原菌检测阳性与阴性组比较,伴发热、血白细胞计数>10×109/L和(或)中性粒细胞比例>0.75、就诊时初步诊断为感染性腹泻及细菌性痢疾的例数4个方面,差异有统计学意义(P<0.05)。结论感染性腹泻的主要致病菌是志贺菌;7～9月份是感染性腹泻的高发季节;青壮年发病率较高;病原菌检测阳性组较阴性组病情重,临床特点与病原菌检测结果相符率较高。

Objective To analyze the clinical characteristics and results of pathogen detection in outpatients with acute infectious diarrhea.Methods A retrospective study was performed in 797 patients with acute infectious diarrhea in enteric disease clinic of Xuanwu Hospital from April 2010 to December 2011.Results Of the 797 cases,186 cases（23.3%） were positive for pathogens including 180 cases（22.6%） with 1 pathogens and 6 cases（0.8%） with 2 pathogens.There were 81 cases（43.5%） of Shigella including 66 S.sonnei and 15 S.flexneri,48 cases（25.8%） of Salmonella,30 cases（16.1%） of Vibrio parahaemolyticus,7 cases（3.8%） of Escherichia coli,7 cases（3.8%） of Aeromonas and 19 cases（10.2%） of other enterobacteria.Pathogen detection rates in young patients were significantly higher than those in middle-aged patients and elderly patients（26.4% vs.17.8% vs.18.7,P 〈0.05）.High prevalence of infectious diarrhea occurred in July,August and September,with positive detection rate of 32.0%,54.0% and 29.0%,respectively.There were significant differences in fever,white cell counts 10×10^9/L and（or） neutrophil percentage 0.75,diagnosis of infectious diarrhea and bacillary dysentery between the groups positive and negative for pathogens detection（P 〈0.05）.Conclusions The main pathogen of acute infectious diarrhea is Shigella.The prevalent months of infectious diarrhea are July,August and September.High incidence occurs in young adults.According to the clinical characteristics,illness of patients with positive pathogens are more serious than those with negative pathogens.And clinical characteristics are in accordance with the results of pathogen detection very well.