2013年杭州市腹泻病原谱调查和致泻性大肠埃希菌特征分析

发布时间：2018-04-13 08:56

本文选题：感染性腹泻 + 致泻性大肠埃希菌　；参考：《浙江大学》2015年硕士论文

【摘要】：目的：腹泻是一种常见肠道感染病,且发病率高,长期危害儿童、成人的身体健康。中国是感染性腹泻的高发区,感染性腹泻包括细菌性腹泻、病毒性腹泻、寄生虫性腹泻等,而其中常见的细菌有致泻性大肠埃希菌、沙门菌、志贺菌、致病性弧菌(霍乱弧菌、副溶血弧菌)、类志贺邻单胞菌、嗜水气单胞菌、小肠结肠炎耶尔森菌等。常见的病毒有轮状病毒、杯状病毒、肠道腺病毒、星状病毒等。致泻性大肠埃希菌在细菌性腹泻中比较常见,而浙江省一直以来是感染性腹泻的高发地区,但是一直缺乏相关详细的数据,因此我们选择了杭州地区,来调查该区域腹泻病原谱以及研究致泻性大肠埃希菌的分布特征。方法：收集浙江省浙江大学附属第一医院2013年急性腹泻患者的粪便标本532份,分别采用常规微生物检验程序对常见肠道致病菌进行分离培养,使用RT-PCR技术对病毒进行检测,以及对DEC菌株采用多重PCR技术进行鉴定并分类,结合通过统一的调查问卷收集到的流行病学数据对导致急性腹泻的细菌与病毒进行分析。结果：1.2013年1月至2013年12月,收集532份粪便标本。检出腹泻病原285株,检出率为53.6%。其中细菌158份,占55.4%,病毒127份,占44.6%。有48份标本同时检出两种及两种以上病原,其中细菌与细菌混合阳性28例,占9.8%；细菌和病毒混合阳性20例,占7.0%。2.细菌性腹泻中,致泻性大肠埃希菌检出率高达55.7%,列细菌性病原的首位,其次为副溶血弧菌占(19.6%),气单胞菌占(10.8%),非伤寒沙门菌占(4.4%),霍乱弧菌占(4.4%),志贺菌占(2.5%),类志贺邻单胞菌占(2.5%)。3.病毒性腹泻中,诺如病毒72株,占56.7%,轮状病毒42株,占33.1%,札如病毒10株,占7.9%,星状病毒3株,占2.4%,未检出肠道腺病毒。诺如病毒中I型和II型分别占9.7%和90.3%。4.致泻性大肠埃希菌中,肠集聚性大肠埃希菌占53.4%,产肠毒素性大肠埃希菌占15.9%,肠致病性大肠埃希菌占8.0%,肠侵袭性大肠埃希菌占1.1%,未检出肠出血性大肠埃希菌,有19株(占21.6%)同时检出多种型别的毒力基因。5.从DEC总检出率来看,不同年龄组之间存在统计学差异(P=0),不同性别间或不同季节间的检出率相近。结论：1.杭州市2013年门急诊感染性腹泻患者以致泻性大肠埃希菌、副溶血弧菌、杯状病毒和轮状病毒为主,应主动加强监测和防控,减少感染性腹泻的发病率。2.杯状病毒的检出率比轮状病毒要高,杯状病毒中,诺如病毒的检出率远远高于札如病毒,诺如病毒主要以II型为主。3.致泻性大肠埃希菌中以EAEC为主,不同年龄组EAEC的检出率存在统计学差异；EAEC夏秋季和冬春季检出率存在统计学差异。
[Abstract]:Objective: diarrhea is a common intestinal infectious disease with high incidence. It is harmful to the health of children and adults for a long time.China has a high incidence of infectious diarrhea, including bacterial diarrhea, viral diarrhea, parasitic diarrhea, and so on, among which common bacteria are diarrhoeal Escherichia coli, Salmonella, Shigella, vibrio cholerae (Vibrio cholerae, Vibrio cholerae, etc.)Vibrio parahaemolyticus, Pseudomonas shigella, Aeromonas hydrophila, Yersinia enterocolitica, etc.Common viruses include rotavirus, calix virus, intestinal adenovirus, stellate virus and so on.Diarrhoeal Escherichia coli is a common cause of bacterial diarrhea. Zhejiang Province has always been a high incidence area of infectious diarrhea, but there is a lack of relevant detailed data, so we chose Hangzhou area.To investigate the pathogeny of diarrhea in the region and to study the distribution of diarrhoeal Escherichia coli.Methods: a total of 532 fecal specimens were collected from patients with acute diarrhea in the first affiliated Hospital of Zhejiang University in 2013. The common intestinal pathogenic bacteria were isolated and cultured by routine microbiological test procedure, and the virus was detected by RT-PCR technique.The strains of DEC were identified and classified by multiple PCR technique, and the bacteria and viruses that caused acute diarrhea were analyzed by using the epidemiological data collected through a unified questionnaire.Results: 1. From January 2013 to December 2013, 532 fecal specimens were collected.285 strains of diarrhea pathogens were detected and the detection rate was 53.6%.Among them, 158 bacteria (55.4%), 127 viruses (44.6%).Two or more pathogens were detected in 48 specimens at the same time, of which 28 were mixed positive with bacteria, accounting for 9.8, and 20 were mixed positive with bacteria and virus, accounting for 7.0.2.In viral diarrhea, 72 strains of Norovirus (56.7%), 42 strains of rotavirus (33.1%), 10 strains of virus (7.9%), 3 strains of stellate virus (2.4%), no adenovirus was detected.Type I and type II accounted for 9.7% and 90.33%, respectively.Among the diarrhea Escherichia coli, 53.4% were concentrated Escherichia coli, 15.9% were enterotoxin-producing Escherichia coli, 8.0% were Escherichia coli and 1.1% were invasive Escherichia coli. No enterohemorrhagic Escherichia coli was detected.A total of 19 strains (21. 6%) were identified as virulence genes.From the total detection rate of DEC, there was statistical difference among different age groups, and the detection rate was similar between different sex or different seasons.Conclusion 1.In 2013, emergency patients with infectious diarrhea in Hangzhou were mainly caused by Escherichia coli, Vibrio parahaemolyticus, calix virus and rotavirus. Surveillance, prevention and control should be actively strengthened to reduce the incidence of infectious diarrhea.The detection rate of norovirus was much higher than that of rotavirus, and the detection rate of norovirus was much higher than that of Zanru virus.EAEC was the main cause of diarrhea Escherichia coli. There were significant differences in the detection rate of EAEC between different age groups in summer and autumn and in winter and spring.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.5

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