上海市输入性疟疾临床流行病学特征分析

Clinical epidemiological analysis of imported malaria in Shanghai

目的评估上海地区输入性疟疾流行病学特征及重症疟疾的危险因素。方法回顾性收集2013-2015年收治于上海市公共卫生临床中心的输入性疟疾病例资料,分析人口学、流行病学、实验室检查数据。组间比较采用Mann-Whitney法和Fisher’s精确检验,logistic回归分析危险因素评估。结果共收集输入性疟疾病例87例,平均发病年龄为36.4岁,男性82例(94.3%),女性5例(5.7%)。其中中国患者79例(90.8%),南苏丹3例(3.4%),印度2例(2.3%),喀麦隆、尼日利亚、布隆迪各1例(1.1%)。在75例能够明确感染来源地国家的病例中,感染来源地为非洲国家的多达63例(84.0%),其次为亚洲(11例,14.7%)。实验室确诊病例78例(89.7%),临床诊断病例9例(10.3%)。在实验室确诊病例中,感染恶性疟原虫(Plasmodium falciparum)最多,为66例(84.6%),感染间日疟原虫(P.vivax)10例(12.8%)。20例(23.0%)患者既往有疟疾史。患者发病至住院的中位数时间为5 d,30例(34.5%)患者在发病后的48 h内服用抗疟疾药物。符合重症疟疾标准的18例,其中1例为脑型疟,17例总胆红素>43μmol/L,3例血清肌酐>265μmol/L。多因素logistic回归分析显示,发病后48 h内服用抗疟药是预测重症疟疾的独立的危险因子(OR=0.05,95%置信区间0.01~0.43,P<0.05)。结论恶性疟原虫是本市输入性疟疾病例感染的主要虫种,非洲是主要的感染来源地。发病后及时给予抗疟治疗可降低重症疟疾的发生风险。

Objective To evaluate the epidemiological characteristics of imported malaria and analyze the risk factors for severe malaria in Shanghai, China. Methods A retrospective review was made on imported malaria cases treated in Shanghai Public Health Clinical Center during 2013-2015, focusing on the demographic information, epidemiological data, and laboratory data. Comparisons between groups were made with Mann-Whitney test and Fisher？蒺s exact test, and risk factors were analyzed with multivariate logistic regression. Results Eighty-seven imported malaria cases （82 males and 5 females） were reviewed, with an average onset age of 36.4, comprising 79 Chinese （90.8%）, 3 South Sudanese （3.4%）, 2 Indians （2.3%）, and one from each of Cameroon, Nigeria, and Burundi （1.1%）. Seventy-five cases had a defined region of malaria source, with a dominance in African countries （63, 84.0%） and then in Asia （11, 14.7%）. Seventy-eight （89.7%） were confirmed by laboratory tests while 9（10.3%） were clinically diagnosed. Among the laboratory confirmed cases, 89.7% were infected with Plasmodium falciparum and 10.3% with P. vivax. Twenty cases（23.0%） had a history of malaria infection. The median of duration from symptom onset to admission was 5 days and 30 （34.5%） patients received anti-malaria drug treatment within 48 hours after onset. Eighteen patients met the diagnostic criteria of severe malaria, of whom 1 showed cerebral malaria, 17 had serum total bilirubin elevating to 〉 43 μmol/L and 3 had a high serum creatinine level above 265 μmol/L. Multivariate logistic regression showed that medication within 48 h after onset was an independent risk factor for severe malaria （OR = 0.05, 95%CI 0.01-0.43, P〈0.05）. Conclusion Plasmodium falciparum remains a major pathogen for imported malaria in Shanghai. Africa is the major region of malaria source. Timely medication after disease onset reduces the risk for sever malaria.