回顾性队列研究结合logistic回归分析在食源性疾病暴发事件中的应用

Application of retrospective cohort study combined with logistic regression analysis in food-borne disease outbreak events

目的探讨回顾性队列研究结合logistic回归分析在食源性疾病可疑食物推断中的应用。方法在现场流行病学调查的基础上,应用回顾性队列研究圈定导致食源性疾病多个可疑危险食物,利用logistic回归多因素分析推断最可疑食物。结果本次食源性疾病反应以恶心、腹部绞痛、腹泻等急性胃肠道症状为主,共搜索病例63例,罹患率为81.82%(63/77),其中男性发病29例,罹患率为78.38%(29/37),女性发病34例,罹患率为85.00%(34/40),男女性别罹患率差异无统计学意义(χ~2=0.567,P>0.05)。病例多为15~45岁之间,各年龄组间罹患率差异无统计学意义(χ~2=0.136,P>0.05)。首发病例发病时间为2013年8月18日,末例病例发病时间为2013年8月20日,流行曲线符合点源暴发模式。回顾性队列研究单因素分析结果显示,升学宴中的刀拍黄瓜(RR=2.58,95%CI:1.49~4.45)、云丝(RR=1.80,95%CI:1.10~2.96)和凉拌鸡蛋干(RR=3.80,95%CI:1.79~8.06)等为引起食源性疾病的可疑危险食物。Logistic回归多因素分析结果显示,刀拍黄瓜(OR=52.00,95%CI:2.62~1 033.83)是本次食源性疾病的最可疑食物。从2份凉菜间砧板和抹布中检出福氏4型志贺氏菌。结论回顾性队列研究结合logistic回归分析可以在食源性疾病可疑食物推断中消除信息偏倚,为分析性流行病学推断可疑食物提供参考依据。

[ Objective ] To explore the application of retrospective cohort study combined with logistic regression analysis in the suspicious food inference of food-borne diseases. [Methods ] On the basis of field epidemiological investigation, the retrospective cohort study was applied to search for suspicious foods and logistic regression analysis was used to determine causes of the food- borne disease.[Results] The main clinical symptoms of this food-borne disease were acute gastrointestinal symptoms such as nau- sea,abdominal pain,diarrhea and so on. A total of 63 cases were collected and age was between 15 to 45 years old,of which attack rate was 81.82% （63/77）. There were 29 male patients and 34 female patients,with the attack rate of 78.38% （29/37） and 85% （34/40） respectively. There were no significant differences in attack rate between gender groups （X2=0.567 ,P〉0.05 ） and among age groups （X2=0.136,P〉0.05）. The onset time of the first case and the last case was on August 18,2013 and August 20,2013 respectively. The epidemic curve was consistent with the outbreak of the point source. The results of retrospective cohort study showed that cucumber salad （RR=2.58,95%CI： 1.49-4.45）,sliced bean curd （RR=1.80,95%CI： 1.10-2.96） and cold dry egg （RR=3.80,95%CI： 1.79-8.06） in celebration party were suspected risk foods. And further multivariate logistic regression analysis showed the cucumber salad （OR=52.00,95%CI：2.62-1 033.83） was the most suspicious factor of this food-borne dis-ease. Shigella flexneri 4 was detected from 2 samples of cutting boards and cloth in cold dishes room. [ Conclusion ] Retrospective cohort study combined with logistic regression analysis can eliminate information bias and provide clues of suspected factors in food borne diseases.