北京市肠道门诊腹泻患者病原谱分析

Etiological analysis of diarrhea patients visiting enteric disease clinics in Beijing

目的了解北京市肠道门诊腹泻患者的病原学特征。方法2013年7月至2014年6月在2家哨点医院肠道门诊收集腹泻患者的粪便标本595份。对沙门菌、志贺菌、副溶血性弧菌、01和0139群霍乱弧菌、致泻大肠埃希菌进行分离培养，对轮状病毒、诺如病毒、星状病毒和肠道腺病毒进行核酸检测。采用描述性流行病学方法对病原的时间分布、人群分布、血清型别等特征进行分析。组间率的比较采用χ2检验。结果595份样本中，128份细菌检测阳性，检出率为21.5％，其中致泻大肠埃希菌检出率为11．4％（68／595），其次为副溶血性弧菌（6．9％，41／595）、沙门菌（2．4％，14／595）和志贺菌（2．2％，13／595），霍乱弧菌未检出。112份样本腹泻病毒核酸检测阳性，检出率为18．8％，其中诺如病毒检出率为9．1％（54／595），其次为轮状病毒（8．7％，52／138），星状病毒（1．8％，11／595）和肠道腺病毒（o．7％，4／595）。致泻大肠埃希菌以肠致病性大肠埃希菌、肠产毒素性大肠埃希菌、肠黏附性大肠埃希菌为主，副溶血性弧菌血清型别主要为04：K8。6～g月份为病原菌检出的高峰期，当年11月至次年3月为腹泻病毒检出的高峰期。结论诺如病毒、轮状病毒亦是肠道门诊腹泻患者的主要病原，应予以重视。

Objective To investigate the etiological characteristics of diarrhea patients visiting enteric disease clinics in Beijing. Methods A total of 595 stool samples were collected among outpatients with diarrhea vistiting enteric disease clinics at two sentinel hospitals from July 2013 to June 2014. Diarrheagenie Escherichia coli （ E. coli ） , Vibrio parahemol yticus , 01 or O139 Vibrio cholerae , Salmonella and Shigella were isolated according to standard methods. And rotavirus, norovirus, astrovirus and enteric adenovirus were identified by molecular techniques. The characteristics of population and temporal distribution, and serotypes of these pathogens were analyzed using descriptive epidemiological method. Chi-square test was used for comparison between groups. Results Totally 128 bacterial strains were isolated from 595 samples, and the detection rate was 21.5 %. Diarrheagenic E. coli was most common pathogenic bacteria （11.4%, 68/595）, followed by Vibrio parahemolyticus （6. 9%, 41/595）, Salmonella （2.4%, 14/595） andShigella （2.2%, 13/595）. NoVibriocholerae was detected. One hundred and twelve viral strains were detected from all samples, and the positive rate was 18.8%. Norovirus was most common viral pathogen （9.1%, 54/595）, followed by rotavirus （8.7%, 52/595）, astrovirus （1.8%, 11/595） and enteric adenovirus （0.7%, 4/595）. Enteropathogenic E. coli, enterotoxigenic E. coli and enteroadhesive E. coli were the most common types of diarrheagenic E. coli. The most common serotype of Vibrio parahaemolyticus was 04 ： K8. The detection rate of bacterial pathogens reached the peak from June to September, while the highest detection rate of viral pathogens was found from November to the next March. Conclusion Norovirus and rotavirus are also the main pathogens of the diarnhea patients visiting enteric clinics, which should be paid enough attention.