婴幼儿感染性腹泻病原学特征分析

Etiology of infectious diarrhea in infants and young children

目的了解近3年浙江中北部地区5岁以下婴幼儿腹泻病的病原构成及流行病学特点,为制定预防控制措施提供依据。方法对2012年1月至2014年12月浙江大学医学院附属儿童医院就诊的5岁以下腹泻患儿进行个案调查及粪便标本采集,采用细菌培养法检测14种肠道致病菌;采用荧光定量PCR方法检测5种病毒核酸及5种致泻大肠埃希菌毒力基因。结果 426份粪便标本共检出各类腹泻病原248株,总检出率为58.22%。其中病毒检出率为43.90%,以A组轮状病毒(19.25%)和GⅡ型诺如病毒(18.30%)为主,其余依次为腺病毒(3.29%)、札如病毒(2.82%)、星状病毒(0.23%)。肠道致病菌检出率为14.32%,共检出5种病原菌,以致泻性大肠埃希菌为主(8.92%),其余依次为沙门菌(3.99%)、小肠结肠炎耶尔森菌(0.71%)、嗜水气单胞菌(0.47%)、空肠弯曲菌(0.23%)。结论浙江中北部地区婴幼儿感染性腹泻的主要病原体依次是A组轮状病毒、GⅡ型诺如病毒和致泻性大肠埃希菌。病毒性腹泻的防控应以秋冬季为重点,细菌性腹泻的防控应以夏秋季为重点。

Objective To understand the etiologic and epidemiologic characteristics of infectious diarrhea in infants and young children aged〈 5 years in central and northern Zhejiang in recent three years and provide evidence for the development of prevention and control measures. Methods Case investigation and stool sample collection were conducted among children aged 〈5 years who sought medical care in Children＇s Hospital of School of Medicine,Zhejiang University from January 2012 to December 2014. Bacteria culture was done to detect 14 kinds of intestinal bacteria and real-time PCR was conducted to detect nucleic acid of 5 kinds of viruses and the virulence genes of 5 kinds of Escherichia coli. Results A total of 248 strains of diarrhea pathogens were detected in 426 stool samples（ 58. 22%）.The virus detection rate was 43. 90%,the viruses detected mainly included rotavirus group A（ 19. 25%） and norovirus GⅡ（ 18. 30%）,adenovirus（ 3. 29%）,sapovirus（ 2. 82%） and astrovirus（ 0. 23%）. The bacterium detection rate was 14. 32%,and 5 kinds of bacteria were detected,i. e. diarrhoeagenic Escherichia coli（ 8. 92%）,Salmonella（ 3. 99%）,Yersinia enterocolitica（ 0. 71%）,Aeromonas hydrophila（ 0. 47%） and Campylobacter jejuni（ 0. 23%）.Conclusion Rotavirus group A,norovirus G Ⅱ and diarrhoeagenic Escherichia coli were the major pathogens causing infectious diarrhea in infants and young children in central and northern Zhejiang The prevention and control of viral diarrhea should be strengthened in autumn and winter,and the prevention and control of bacterial diarrhea should be strengthened in summer and autumn.