2017年山东省三个城市食源性腹泻中胃肠炎病毒的病原谱特征分析

Etiology and epidemiological characteristics of gastroenteritis virus in food?borne diarrhea from three cities in Shandong Province,2017

目的分析山东省三个城市食源性腹泻病例中胃肠炎病毒病原谱的分布和流行特征。方法于2017年1—12月,以山东省济南、烟台和临沂市的6家哨点医院为研究现场,收集1397例食源性腹泻病例的粪便标本,同时获取其基本信息和临床症状。采用双重荧光定量RT PCR分别检测如病毒基因Ⅰ组(NoV GⅠ)和Ⅱ组(NoV GⅡ)、札如病毒(SaV)和人星状病毒(HAstV),采用单重荧光定量RT PCR检测轮状病毒A组(RVA),采用荧光定量PCR检测肠道腺病毒(EAdV),对病毒的特异性片段进行测序、分型。比较不同特征病例胃肠炎病毒阳性率以及阳性和阴性病例间临床症状的差异。结果年龄M(P25,P75)为23(1,42)岁;以男性为主,占57.48%(803例);≤5岁儿童居多,占36.36%(508例)。胃肠炎病毒阳性率为33.93%(474例),济南、临沂和烟台市分别为32.03%(147/459)、41.54%(189/455)和28.57%(138/483)(P<0.001);NoV GⅡ组的阳性率最高,为16.54%(231例),5月(24.75%,50/202)和6月(19.59%,38/194)出现高峰,以GⅡ.P16/GⅡ.2型(48.28%,56/116)为主。阳性病例中,44.51%(211/474)出现呕吐症状,高于阴性病例(34.13%,315/923),差异有统计学意义(P<0.001)。结论山东省食源性腹泻病例中男性、5岁以下儿童居多;NoV GⅡ流行强度较高,发病高峰为春夏季,病毒性胃肠炎临床症状不典型。

Objective To analyze the etiology and epidemiological characteristics of gastroenteritis virus in foodborne diseases from three cities in Shandong.Methods From January to December 2017,six sentinel hospitals in Jinan,Yantai and Linyi city of Shandong Province were selected as the research sites.Stool samples of 1397 diarrhea patients were collected,as well as basic information and clinical symptoms.Duplex quantitative RT PCR was used to detect Norovirus genogroupⅠ(Nov GⅠ)and genogroupⅡ(Nov GⅡ),Sapovirus(SAV)and Human astrovirus(HAstV),respectively,quantitative RT PCR was used to detect group A Rotavirus(RVA),and quantitative PCR was used to detect Enteric adenovirus(EAdV).The specific gene of the virus were sequenced and typed.It was compared that the gastroenteritis virus rate in cases with different characteristics and the clinical symptoms difference between the virus positive and negative cases.Results The median age(P25,P75)was 23(1,42),mainly male,57.48%with 803 cased and children under 5 years old,36.36%with 508 cases.The positive rate of gastroenteritis virus was 33.93%(474 cases),and that of Jinan,Linyi and Yantai City were 32.03%(147/459),41.54%(189/455)and 28.57%(138/483),respectively(P<0.001).Nov GⅡhad the highest positive rate,16.54%(231 cases),which,mainly GⅡ.P16/GⅡ.2(48.28%,56/116),peaked in May(24.75%,50/202)and June(19.59%,38/194).In patients of gastroenteritis virus positive,44.51%(211/474)had vomiting symptoms,higher than that of patients of gastroenteritis virus negative(34.13%,315/923).The difference was statistically significant(P<0.001).Conclusion In Shandong Province,the majority of gastroenteritis patients were male and children under 5 years old.Nov GⅡpossessed highest epidemic intensity,and peaked in spring and summer.Viral gastroenteritis had atypical clinical symptoms.