2016年—2021年丽水市社区获得性腹泻患者病毒检测及流行病学特征分析

Viral detection and epidemiological characteristics analysis of community-acquired diarrhea in Lishui City from 2016 to 2021

目的分析丽水市社区获得性腹泻患者常见病毒的流行病学特征,为临床抗感染治疗和疫情防控提供依据。方法随机收集浙江大学丽水医院门诊腹泻患者的大便标本,采用ELISA法检测A组轮状病毒(RV),以多重PCR法检测B/C组轮状病毒、诺如病毒GⅠ/GⅡ型(NoV-GⅠ和NoV-GⅡ)、札如病毒(SAPO)、星状病毒(AstV)和肠道腺病毒(EAdV),分析本地区肠道病毒分布特征。分析RV和EAdV 2种病毒在不同性别、年龄、时间和气温的发病率。结果共收集腹泻患者大便标本601份,病毒总体检出率为10.48%;其中NoV、RVA、EAdV、AstV和SAPO的构成比依次为42.29%、25.40%、20.63%、19.05%和4.76%,未见B/C组轮状病毒。共收集腹泻患者RV和EAdV抗原筛查结果8542例,二者总体阳性率分别为14.60%和3.69%。婴幼儿中,RV发病率在1岁~3岁最高,是其他年龄段的3.4倍(P<0.001);而EAdV感染阳性率却随年龄增长逐年升高。RV感染主要集中在12月—来年3月,占总数的86.61%,且人数与月平均气温高度成负相关(P<0.01);尤其日平均气温为4℃~16℃时,RV感染的相对危险度达4.81(4.26~5.42)。结论丽水地区社区获得性腹泻患者病毒感染以RV和NoV为主,日平均气温4℃~16℃是1岁~3岁婴幼儿感染RV的高危因素。

Objective To analyze the viral epidemiological characteristics in outpatients with community-acquired diarrhea in Lishui City,so as to provide laboratory data for clinical treatment and prevention.Methods Stool specimens from outpatients with diarrhea in Lishui Hospital of Zhejiang University were randomly collected.The rotavirus group A(RA)was screened by ELISA,and rotavirus group B/C,norovirus type GⅠ/GⅡ(NoV-GⅠand NoV-GⅡ),sapovirus(SAPO),astrovirus(AstV)and adenovirus(EAdV)were detected by multiple PCRs.Then the epidemiological characteristics of RV and EAdV in different gender,age,time and temperature were analyzed.Results Totally,601 stool specimens were collected with the overall positive rates of 10.48%.The composition ratios of NoV,RVA,EAdV,AstV and SAPO were 42.29%,25.40%,20.63%,19.05%and 4.76%respectively;no group B/C rotavirus was found.A total of 8542 diarrhea cases screening for RV and EAdV antigen were collected,and the overall positive rates of the two were 14.60%and 3.69%,respectively.The incidence of RV is highest at the age of 1-3,which is 3.4 folds to that of other age groups(P<0.001);while the EAdV infection rate increased year by year.RV infection is mainly occurred from December to March of the following year,accounting for 86.61%of the total,and the number of patients is highly negatively correlated with the monthly average temperature(P<0.01);especially when the average daily temperature is 4℃-16℃,and the relative risk of RV infection reaches 4.81(4.26-5.42).Conclusion Community-acquired viral infections in Lishui City are dominated by RV and NoV.The daily average temperature of 4℃-16℃is a high risk factor for RV infection in children aged 1-3.