临床诊断急性细菌性痢疾的流行病学、病原学及临床特点

Epidemiological,pathogenic and clinical characteristics of acute bacterial dysentery diagnosed clinically

目的了解北京市近年来急性细菌性痢疾(简称菌痢)的临床、流行病学特点及致病菌分布情况,提供确诊菌痢的症状特征。方法以2011年4月1日~2015年10月31日就诊于北京市某两家三级综合医院肠道门诊的247例临床诊断为"急性细菌性痢疾"的患者为研究对象,对患者一般资料、症状体征、病原检测等结果进行统计分析。结果临床诊断急性细菌性痢疾患者以青少年居多(70.85%);职业构成以干部职员(29.96%)、家务及待业(20.24%)、离退休人员(15.38%)和学生(10.12%)为主;菌痢发病率有明显季节性,发病高峰位于5~9月;大便细菌培养阳性率18.22%,细菌性痢疾确诊率5.67%,其中宋内菌群占78.57%;菌痢确诊患者症状不典型,高热、里急后重比例高,但腹痛、腹泻10~20次/d、脓血便、血白细胞升高等典型临床表现与其他致病菌感染组(B组)及便培养阴性组(C组)无区别。结论细菌性痢疾确诊患者临床表现高热更明显,病原菌宋内菌群占绝对优势。现有的临床诊断标准误诊率很高,对推动志贺菌检验新技术的广泛应用有着十分重要的意义。

Objective To investigate the clinical and epidemiological features of acute bacterial dysentery and its pathogen distribution in recent years in Beijing,and to establish criteria for its diagnosis. Methods The data of age,occupation,symptoms,signs,pathogen detection from 247 patients with acute bacillary dysentery diagnosed clinically during five years（2011- 04- 01 ～2015- 10- 31） were analyzed retrospectively. Results Most patients with acute bacillary dysentery were young adult（70. 85%）;the occupations of the 247 patients included office workers and functionaries（29. 96%）,unemployed and housewives（20. 24%）,retirees（15. 38%）,students（10. 12%）,unknowns（9. 72%）,commercial attendants（5. 26%）,and others（9. 31%）; the incidence of bacillary dysentery had the feature of seasonality,and the peaks were in May to September; the positive rate of fecal bacterial culture was 18. 22%,5. 67% of the patients were diagnosed as with bacterial dysentery by fecal bacterial culture and the percentage of shigella sonnei were 78. 57%; symptoms of the patients were diagnosed by fecal bacterial culture are atypical,highest temperature and tenesmus are more obvious,but compared with the other two groups the typical symptoms including abdominal pain,diarrhea episodes per day 10 ～ 20,bloody purulent stool and high leukocyte were no difference. Conclusion Highest temperature of patients who were diagnosed as with bacterial dysentery by fecal bacterial culture are more significant,and S sonnei is the dominant pathogen. The proportion of misdiagnosis and missed diagnosis are both very high,relying on existing clinical diagnostic criteria. It＇s very important,to promote extensive using of new shigella test technology in clinic.