中国北方麻疹患者的临床特征和流行病学分析

发布时间：2018-05-18 19:53

本文选题：麻疹 + 肺炎　；参考：《中国人民解放军医学院》2016年博士论文

【摘要】：背景2013年底至2014年上半年,北京、沈阳等地出现大量麻疹患者。此次流行的麻疹在临床表现上有何特点?麻疹患者免疫学特点如何?麻疹发病率突然升高是否因为出现病毒基因变异?为了回答上述问题我们进行了相关研究。材料和方法收集2014年1月-5月在解放军302医院住院的112例麻疹患者的临床资料；采集30例麻疹患者急性期、恢复期及30例对照者外周血,采用流式细胞术进行免疫学检测,并对结果进行统计分析.同期采集解放军第302医院112例(同上)和沈阳市第六人民医院150例麻疹患者的血清及咽拭子,检测麻疹病毒IgM抗体,分离病毒进行基因测序,分析麻疹病毒N基因和H基因的分子特征.结果1.麻疹患者的流行病学及临床特点：在112例麻疹患者中,发病前有麻疹患者接触者46例(41.07%)；78例(69.64%)患者未曾接种过麻疹疫苗；成人患者85例(75.89%)发热后出疹时间3天(2～4),热程天数7天(6～9)；临床表现以发热(100%)、皮疹(100%)、咳嗽(90.18%)、流涕(85.71%).结膜炎(100%)和口腔柯氏斑(78.57%)为主.麻疹并发肺炎37例(33.04%),其中8个月10例(76.92%)、18岁19例(22.35%),差异有统计学意义(P0.01)；肝损害56例(50%),其中8个月2例(3.57%)、18岁51例(91.07%),差异有统计学意义(P0.01). COX回归模型提示,麻疹患者是否并发肺炎是影响总病程的独立危险因素(P0.01)。2.麻疹患者免疫学和病毒学特点：成人麻疹患者急性期和恢复期CD4+IL17+、CD4+IFNγ+及CD8+IFN γ+ T淋巴细胞比例均较对照组降低(P0.05)；急性期麻疹患者CD8+IL22+细胞比例明显升高,与恢复期和对照组比较差异均有统计学意义(P0.05)。麻疹患者调节性T淋巴细胞比例明显升高。两家医院共262例麻疹患者中,病毒IgM抗体阳性234例(89.32%),咽拭子分离麻疹病毒阳性82株(31.30%),均为H1a基因型；H蛋白基因测序显示有S240N、Y481N和P397L替代变异。结论1.在112例患者中,18岁麻疹患者肺炎发生率较高(48.65%),成人麻疹患者肝损害发生率较高(60.00%)。肺炎是影响麻疹患者总病程的独立危险因素。2. 成人麻疹患者体内淋巴细胞总数降低,急性期麻疹患者CD4+T淋巴细胞呈下降趋势,CD8+T淋巴细胞呈上升趋势。麻疹患者CD3+IFNγ、CD4+IL17+T淋巴细胞明显减少；急性期CD8+IL22+ T淋巴细胞明显升高,恢复期逐渐下降。麻疹患者Treg细胞在急性期和恢复期比例均明显升高。3. 北京和沈阳地区麻疹疫情的病毒以H1a基因型为主,为中国目前主要流行的麻疹基因型。此外,H蛋白基因测序结果提示,目前施行的麻疹减毒活疫苗仍能有效保护易感人群。
[Abstract]:Background : In the first half of 2013 to the first half of 2014 , there were a large number of measles patients in Beijing , Shenyang and the like . What are the characteristics of measles in the clinical manifestation ? How does the measles incidence increase suddenly ? Did the measles incidence increase suddenly ? In order to answer the above - mentioned problems , we carried out related research . Materials and methods collect the clinical data of 112 measles patients who were hospitalized in 302 hospitals of PLA from January to May 2014 .
In the same period , 112 cases ( ibid . ) and 150 measles patients in the Sixth People ' s Hospital of Shenyang City were collected , and the molecular characteristics of measles virus N gene and H gene were analyzed . Results 1 . Epidemiological and clinical characteristics of measles virus N gene and H gene were analyzed .
Seventy - eight ( 69.64 % ) patients were not vaccinated against measles ;
In 85 cases ( 75.89 % ) of adult patients , the rash time was 3 days ( 2 ~ 4 ) and the heat course was 7 days ( 6 ~ 9 ) .
The clinical manifestations were fever ( 100 % ) , rash ( 100 % ) , cough ( 90.18 % ) , nasal discharge ( 85.71 % ) , conjunctivitis ( 100 % ) and oral cavity ( 78.57 % ) .
Liver damage was 56 cases ( 50 % ) , 8 months 2 cases ( 3.57 % ) , 18 years old 51 cases ( 91.07 % ) , the difference was statistically significant ( P0.01 ) . The COX regression model suggested that whether the patients with measles accompanied pneumonia were independent risk factors ( P0.01 ) . 2 . Immunologic and virological characteristics of measles patients : CD4 + IL17 + , CD4 + IFN纬 + and CD8 + IFN纬 + T lymphocytes in adult measles patients were lower than those in the control group ( P0.05 ) .
The percentage of CD8 + IL22 + cells in patients with acute measles was significantly higher than that in control group ( P0.05 ) .
Conclusion 1 . Among 112 patients , the incidence of pneumonia in 18 years of age is high ( 48.65 % ) , and the incidence of liver damage in adult patients with measles is high ( 60.00 % ) . Pneumonia is an independent risk factor affecting the overall course of measles . The total number of lymphocytes in the patients with measles decreased and the number of CD4 + T lymphocytes decreased and CD8 + T lymphocytes increased .
In acute phase , CD8 + IL22 + T lymphocytes increased significantly and the recovery period decreased gradually . The proportion of Treg cells in measles patients increased significantly in acute phase and recovery period . In addition , the results suggested that the measles attenuated live vaccine currently in effect can effectively protect the susceptible population .
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R511.1

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