Etiological analysis of surveillance cases of diarrhea syndrome in Gansu Province from 2009 to 2018
ZHU Wan-qi and YUAN Yan contributed equally to this article
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摘要:
目的 了解甘肃省腹泻症候群病原谱分布与流行特征。 方法 采集甘肃省2009-2018年哨点医院腹泻症候群监测病例的粪便标本, 以实时荧光链式反应检测病毒核酸, 以分离培养法检测细菌。 结果 4 406例标本中检出1 547例阳性病例, 病原阳性率35.11%。其中1 281例检出病毒, 病毒阳性率47.20%;287例检出细菌, 细菌阳性率8.57%。病原谱前五位是轮状病毒(46.04%)、星状病毒(13.37%)、诺如病毒(13.15%)、志贺菌(9.90%)和腺病毒(7.81%)。轮状病毒、诺如病毒、星状病毒、志贺菌与非伤寒沙门菌在各年龄段感染情况的差异具有统计学意义(均有P < 0.05)。11月到次年3月病毒阳性率较高, 6-8月细菌阳性率较高。各病原流行季节不同, 四季都以轮状病毒感染为主。 结论 甘肃省腹泻症候群病例病原谱较广泛, 病毒性腹泻更常见, 发病具有明显的季节高峰。加强持续性监测可掌握病原特征与流行趋势, 有助于对重点人群采取针对性与季节性防控措施。 Abstract:Objective To understand pathogenic distribution and epidemiological characteristics of diarrhea syndrome in Gansu Province. Methods Fecal specimens from diarrhea syndrome surveillance cases at sentinel hospitals in Gansu Province from 2009 to 2018 were collected, and virus nucleic acids were detected by real-time fluorescent chain reaction, and bacteria were detected by isolation culture. Results 1 547 positive cases were detected from 4 406 stool specimens with the positive rate of 35.11%. Among the positive samples, 1 281 cases were positive for virus with the positive rate of 47.20%; 287 cases were positive for bacteria with the positive rate of 8.57%. Top five of pathogenic spectrum were rotavirus(46.04%), astrovirus(13.37%), norovirus(13.15%), Shigella(9.90%) and adenovirus(7.81%). In different age groups, statistically significant differences were found in the positive rates of rotavirus, norovirus, astrovirus, Shigella and non-typhoid Salmonella(all P < 0.05). The positive rate of virus was higher from November to March of next year, and the positive rate of bacteria was higher from June to August. The epidemic seasons of pathogens were different, of which rotavirus was dominating in four seasons. Conclusions The pathogenic spectrum of diarrhea is wide relatively in Gansu Province, and viral diarrhea is more common, with obvious seasonal peak. Continuous monitoring should be strengthened to grasp characteristics and epidemic trends of pathogens, and it is helpful to take targeted and seasonal preventive measures in population at high risk. -
Key words:
- Diarrhea syndrome /
- Pathogen surveillance /
- Epidemic characteristic
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图 1 2009-2018年病原检出时间分布
Figure 1. Time distribution of pathogens detection from 2009 to 2018
图 3 不同年龄段病例感染病原流行特征
注:图A为病毒流行特征; 图B为细菌流行特征。
Figure 3. Epidemic characteristics of pathogens in different age groups
表 1 腹泻症候群病例病原检出情况
Table 1. Pathogenic detection results of diarrhea syndrome cases
病原 阳性数(个) 检测数(个) 阳性率(%)(95% CI值) 构成比(%) 病毒 轮状病毒 837 2 617 31.98(30.19~33.77) 46.04 A组 798 2 617 30.49(28.73~32.25) 43.89 B组 15 1 623 0.92(0.46~1.38) 0.83 C组 24 1 620 1.48(0.89~2.07) 1.32 星状病毒 243 2 527 9.62(8.47~10.77) 13.37 诺如病毒 239 2 514 9.51(8.36~10.66) 13.15 GI型 49 2 514 1.95(1.41~2.49) 2.70 GII型 190 2 514 7.58(6.42~8.53) 10.45 腺病毒 142 2 580 5.50(4.62~6.38) 7.81 札如病毒 66 2 494 2.65(2.02~3.28) 3.63 细菌 志贺菌 180 3 267 5.51(4.73~6.29) 9.90 致泻性大肠埃希菌 50 2 427 2.06(1.49~2.63) 2.75 非伤寒沙门菌 53 3 127 1.69(1.24~2.14) 2.92 嗜水气单胞菌 4 2 048 0.20(0.01~0.39) 0.22 空肠弯曲菌 1 1 709 0.06(0.00~0.18) 0.06 小肠结肠炎耶尔森菌 1 1 972 0.05(0.00~0.15) 0.06 霍乱弧菌 1 3 089 0.03(0.00~0.08) 0.06 副溶血弧菌 1 2 989 0.03(0.00~0.08) 0.06 
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表 2 主要病原在各年龄组的检出情况[n (%)]a
Table 2. Detection results of major pathogens in different age groups [n (%)]a
病原 年龄段 χ2值 P值 0月~ 7月~ 3岁~ 18岁~ ≥65岁 轮状病毒 194(31.75)b 580(46.29)b 25(8.96) 26(6.58) 12(15.19) 257.370 < 0.001 A组 184(31.42) 557(41.34) 24(19.71) 23(5.82) 10(12.66) 210.396 < 0.001 B组 3(0.87) 9(1.26) 0(0.00) 3(0.96) 0(0.00) 3.272 0.513 C组 7(2.03) 14(1.97) 1(0.53) 0(0.00) 2(3.08) 8.893 0.064 星状病毒 70(11.68) 128(10.50) 16(6.69) 26(6.81) 3(3.85) 13.158 0.011 诺如病毒 57(9.42)c 137(11.70)c 19(7.12) 19(4.95) 6(7.59) 15.305 0.004 GI型 10(1.65) 27(2.21) 5(2.25) 6(1.56) 1(1.27) 1.305 0.861 GII型 47(8.10) 110(8.99) 14(6.37) 13(3.13) 5(6.33) 15.329 0.004 志贺菌 10(1.78) 62(4.27) 57(14.29)d 44(6.83) 7(4.83) 83.442 < 0.001 非伤寒沙门菌 7(1.05) 19(1.37) 6(1.69) 19(3.26) 2(1.45) 11.196 0.024 致泻性大肠埃希菌 8(1.76) 26(2.44) 9(3.21) 6(1.15) 1(0.88) 5.916 0.206 注:a括号外为病例数, 括号内为阳性率(%); b Bonferroni法校正后, “0月~”、“7月~”组阳性率与“3岁~”、“18岁~”、“≥65岁”组两两比较均有P < 0.01;c Bonferroni法校正后, “0月~”、“7月~”组阳性率与“3岁~”、“18岁~”、“≥65岁”组两两比较均有P < 0.05;d Bonferroni法校正后, “3岁~”组阳性率与其他年龄组两两比较均有P < 0.01。
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表 3 主要病原季节性检出情况[n (%)]a
Table 3. Seasonal detection results of major pathogens[n (%)]a
病原 春季b 夏季c 秋季d 冬季e χ2值 P值 轮状病毒 222(43.53)f 157(20.44) 276(35.66) 182(39.74)f 91.606 < 0.001 诺如病毒 69(11.29)f 40(5.38) 66(9.23) 64(14.38)f 29.306 < 0.001 星状病毒 55(8.93) 46(6.11) 84(11.97)g 58(12.72)g 20.503 < 0.001 志贺菌 8(1.47) 34(3.19)h 7(0.62) 4(1.05) 23.314 < 0.001 非伤寒沙门菌 34(5.61) 77(6.95) 68(5.86) 1(0.25) 25.691 < 0.001 致泻性大肠埃希菌 3(0.69) 32(3.79)h 14(1.65) 1(0.33) 21.740 < 0.001 注:a括号外为病例数, 括号内为阳性率(%); b春季指3-5月; c夏季指6-8月; d秋季指9-11月; e冬季指12月到次年2月; f Bonferroni法校正后, 该季节阳性率与夏季、秋季两两比较均有P < 0.01;g Bonferroni法校正后, 该季节阳性率与春季、夏季两两比较均有P < 0.01;h Bonferroni法校正后, 夏季阳性率与春秋冬三季两两比较时均有P < 0.01。
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