新疆5983例麻疹确诊病例临床症状谱分析

Analysis of symptom spectrum of 5983 confirmed cases of measles in Xinjiang

目的探讨新疆麻疹确诊病例的临床特征,为临床医师早诊断、减少漏诊或误诊提供参考依据。方法通过全国麻疹监测信息系统,收集2015-2019年新疆麻疹实验室确诊的病例,采用描述性方法回顾分析年龄分布、免疫史及发热、皮疹、咳嗽、结膜炎和柯氏斑等临床症状。结果2015-2019年新疆麻疹实验室共确诊病例5983例,各临床症状发生率发热98.36%、皮疹97.58%、咳嗽89.84%、结膜炎68.79%、卡他症状66.34%、柯氏斑46.68%、淋巴结肿大10.65%和关节疼痛8.54%;肺炎、腹泻等并发症的发生率为34.08%;有155种临床症状组合表现类型,划分为4个症候群;87.85%的病例同时伴有发热、皮疹和咳嗽症状;11.62%的病例有免疫接种史,88.38%的病例无免疫接种史或接种史不详。结论新疆麻疹确诊病例临床表现形式多样,造成早期诊断困难,并受年龄和疫苗接种影响;在广泛使用麻疹疫苗的时代,应结合当地临床症状的特点,提高临床医师早期识别和诊断病人的能力,及时有效地发现病例是消除麻疹工作的重要环节。

Objective To explore the clinical features of confirmed cases of measles in Xinjiang,so as to provide references for early diagnosis and decrease of missed diagnosis or misdiagnosis.Methods The cases of laboratory-confirmed measles were collected from the national measles surveillance information system in Xinjiang during 2015 to 2019.The distributions of age,immunological history,fever,rash,cough,conjunctivitis and koplise macule were retrospectively analyzed with descriptive method.Results There were 5983 measles cases confirmed by laboratory examination in Xinjiang from 2015 to 2019.The incidence of each clinical symptoms was 98.36%of fever,97.58%of rash,89.84%of cough,68.79%of conjunctivitis,66.34%of catarrh,46.68%of koplise macule,10.65%of lymphadenectasis,8.54%of arthralgia,and 34.08%of complications of pneumonia,diarrhea and others.There were 155 combinations of the clinical symptoms,including 4 syndrome groups;87.85%of the cases with the symptoms of fever,rash and cough simultaneously,11.62%of the cases with vaccination history,88.38%of the cases without vaccination history or vaccination not clear.Conclusions It is difficult to make the early diagnosis of measles due to the diverse symptoms at clinic,and the diagnosis is influenced by the age and vaccination history in Xinjiang.In the age of wide application of measles vaccine,improvement of the ability of early identification and diagnosis of measles of the clinician,prompt and effective discovery of the cases are the important links in the elimination of measles.