门诊急性腹泻儿童的肠道病原监测

Surveillance of enteric pathogens in outpatient children with acute diarrhea

目的监测门诊急性腹泻儿童的临床流行特征及肠道病原分布特点。方法2013年8月至2014年7月对复旦大学附属儿科医院门诊临床诊断为急性腹泻的儿童进行主动监测，对患儿的粪便标本进行包括诺如病毒、致泻大肠埃希菌、非伤寒沙门菌、弯曲菌、志贺菌、致病性弧菌和小肠结肠炎耶尔森菌在内的病原进行检测。统计分析采用卡方检验。结果881例急性腹泻患儿粪便中有246例（27．92％）检出病原体，其中诺如病毒、致泻大肠埃希菌、非伤寒沙门菌、弯曲菌和志贺菌分别检出98株（11．12％）、74株（8．40％）、61株（6．92％）、34株（3．86％）和2株（0．23％），未检出致病性弧菌及小肠结肠炎耶尔森菌。〈36月龄（3．27％，26／794）儿童较〉36月龄（9．20％，8／87）儿童感染弯曲菌的风险低（χ^2=7．41，P=0．006）。感染诺如病毒的患儿呕吐比较常见（37．76％），且水样便比例高（21．34％）；感染非伤寒沙门菌和弯曲菌的患儿发热（40．98％和29．41％）及粪便含黏液（21．31％和26．47％）多见。结论肠道病原感染在本次研究的急性腹泻患儿中占有重要地位，对肠道病原的持续性监测有助于儿童急性腹泻的防治。

Objective To monitor the clinical epidemiology and etiology of acute diarrhea in children in the outpatient setting in Shanghai. Methods An active surveillance study in Children＇s Hospital of Fudan University between August 2013 and July 2014 was conducted. Outpatient children with acute diarrhea were enrolled in this study and stool samples were collected. Pathogens including norovirus, diarrheagenic Escherichia coli （DEC）, nontyphoidal Salmonella spp. （NTS）, Campylobacter , Shigella , pathogenic vibrio and Yersinia enterocolitica were identified and typed. The g2 test was used for statistical analysis. Results Of the 881 stool samples from enrolled children, the pathogens included into the target detection were identified in 246 （27. 92%） cases. Norovirus, DEC, NTS, Carnpylobacter and Shigella were detected in 98 （11. 12%） cases, 74 （8. 40%） cases, 61 （6. 92%） cases, 34 （3. 86%） cases and 2 （0. 23%） cases, respectively. Neither pathogenic vibrio nor Yersinia enterocolitica was identified. Children younger than 36 months old （3.27 %, 26/794） had a lower risk （χ^2 =7.41, P =0. 006） of Campylobacter infection compared with older children （9. 20%, 8/87）. Vomiting （37. 76%） and watery diarrhea （21.34 %） were more commonly seen in children with norovirus infection; fever and mucous stool were commonly seen in diarrheal children with NTS infection （40. 98% and 21.31%, respectively） and Campylobacter infection （29.41% and 26.47%, respectively）. Conclusion Enteric pathogens play a major role in childhood acute diarrhea in Shanghai. Continuous monitoring of enteric pathogens will be helpful for reasonable treatment and prevention of acute diarrhea in children.