某军校不明病因急性肝炎爆发流行的调查与随访

An outbreak of etiologically unknown hepatitis:Epidemiological investigation and follow up

目的 对某军校不明病因的急性肝炎爆发进行流行病学调查 ,并结合临床与病理特点作初步探讨 .方法 对流行区两个不同人群 ,普查 AL T及 SB,异常者检测 HBs Ag、抗 -HAV Ig M,抗 - HEV,HGV RNA及血、尿重金属和有机磷 .逐项调查环境、食堂、水源等 .选取典型病例做肝活检 .结果 学员罹患率 80 .9% (5 0 7/ 6 2 7) ,教职员工 18.9% (6 0 / 318) .经血和经水传播途径被排除 .环境与个人卫生差、分餐制不严、发病有宿舍聚集性等提示通过日常生活接触感染 .实验室检查结果均阴性 ,可排除已知的病毒性肝炎及中毒性肝损害 .临床征象与肝组织病理检查符合急性病毒性肝炎 .

AIM An epidemiological survey was pursued into an epidemic outbreak of etiologically unknown hepatitis occurring in a military academy in Wuhan to make clear the cause of it by referring to clinical and liver histopathological features. METHODS Besides epidemiologicalroutines,some cases at random were assayed about hepatitis A E and G serologically or by RT PCR, and 9 of 38 inpatients were examined through liver biopsy. RESULTS The attack rate of students was as high as 80.86% (507/627) while the faculty only 18.87% (60/318), a marked significance. Neither history of transfusion nor contaminated injection was recorded of all victims. Water borne transmission was also ruled out. However the dormitory distribution of cases, poor environmental condition and personal hygiene, as well as sharing dish habit, were closely related to this outbreak. The negative laboratory results excluded the recognized hepatitis A^E, G and toxipathic factors. But the clinical diagnoses and liver histopathological reports were acute viral hepatitis consistently. CONCLUSION The epidemic hepatitis is thought to belong to viral hepatitis enterically transmitted by a non A and non E hepatitis agent.