某三级综合性医院肠道门诊夏季急性腹泻患者疾病谱及病原菌检测的意义

Causes of acute diarrhea in a tertiary general hospital and significance of detection of pathogenic bacteria

目的:分析三级综合性医院肠道门诊就诊患者疾病谱、流行病学特征,探讨病原菌检测及分布规律对肠道传染病防控的意义.方法:采用回顾性分析方法,对2009-04/2009-10就诊于北京大学第三医院肠道门诊的7064例腹泻患者,做疾病谱和流行病学特征分析及病原菌检测分布分析.结果:腹泻病例的疾病谱中,以胃肠炎患者最多,3967例(56.16%),其次是其他腹泻1782例(25.23%),还包括胃肠功能紊乱429例(6.07%)、肠易激综合征3例(0.04%);其中传染病包括细菌性痢疾539例(7.63%),其他感染性腹泻306例(4.33%),就诊人数以6、7、8月份占总体比例最大(占58.03%),肠道传染病例数以7、8、9月份占总体比例最大(占64.73%).肠道病原菌方面以志贺氏菌属28株为主(占71.79%),其中优势血清型宋内志贺菌属25例(64.10%),比2007年北京大学第三医院报道宋内志贺菌属所占比例明显提高.结论:综合医院肠道门诊腹泻病例的疾病谱较为复杂,夏秋季为就诊高峰,就诊病例以非传染病为主,细菌性痢疾志贺氏菌流行菌型变迁应引起疾病预防控制部门及医务人员的重视.

AIM： To describe the causes and epidemiologic features of acute diarrhea in a tertiary general hospital and to assess the significance of detection of pathogenic bacteria. METHODS： A total of 7064 patients who presented to the Department of Infectious Diseases, the Third Hospital of Peking University between April 2009 and October 2009 were analyzed. A retrospective study was performed to analyze the causes and epidemiologic features of acute diarrhea during the summer, as well as the distribution of pathogenic bacteria. RESULTS： Gastroenteritis diseases were the first leading cause（3967/7064, 56.16%）, followed by other causes（1782, 25.23%）, gastrointestinal dysfunction（429, 7.63%）, and irritable bowel syndrome（3, 0.04%）. Infectious diseases included bacillary dysentery（539, 7.63%） and other diseases（306, 4.33%）. The percentage of patients who visited the hospital in June, July and August was 58.03%. Intestinal infectious cases were more frequently present in July, August, and September（64.73%）. Among intestinal pathogenic bacteria, 28 strains were Shigella（71.79%）, and 25 were dominant serotype Shigella sonnei（64.10%）, which was much higher than the reported proportion in 2007 at our hospital. CONCLUSION ： The causes of diarrhea are complex, with non-infectious diseases accounting for the largest proportion. The changes in serotype of Shigella that causes bacterial dysentery should attract more attention.