珠海市恙虫病流行病学特征及基因分型研究

发布时间：2018-07-13 15:39

【摘要】：目的：了解珠海市恙虫病流行病学特征，同时进行恙虫病东方体病原体的分离以及基因分型，，为临床诊断、治疗、指导有效预防及对本地疫苗、快速检测试剂的制备提供理论依据。方法：通过对珠海市100例临床诊断恙虫病患者的流行病学、临床资料进行描述性分析；其中60例行外斐氏试验与恙虫病抗体检测，将结果进行阳性率对比；以恙虫病抗体阳性病例5例，采患者静脉血床旁小白鼠腹腔接种法分离恙虫病东方体；以恙虫病抗体阳性病例10例的静脉血清标本采用nPCR进行OtDNA检测、扩增、测序及同源性分析与系统进化树分析。结果：1、流行病学特征：珠海市以散发为主；病例数主要分布于4～12月，属夏秋型；病例分布无明显性别差异；各个年龄组均有病例分布，在41至70岁年龄段分布最多，占75%；患者职业以农民分布病例数最多，占73㳠。 2、临床资料分析结果显示：（1）临床特点：有野外或动物接触史67例，占67%。发热93例，占93%；其中有焦痂、溃疡者各83例、9例，各占83%、9%；有皮疹者18例，占18%；有淋巴结肿大63例，占63%；脾脏肿大3例，占3%。（2）实验室辅助检查：①血常规：白细胞计数处于正常66例，占66%；白细胞计数升高者18例，占18%；白细胞计数降低者16例，占16%。②丙氨酸转移酶69例增高，占69%；天门冬氨酸转移酶74例增高，占74%。③83例患者CRP存在不同程度的增高，占83%。（3）治疗及转归：采用多西环素、四环素治疗后，均为治愈病例，治愈率达100%。 3、外斐氏试验与恙虫病抗体检测阳性率对比：外斐氏试验阳性6例，阳性率为10.0%；恙虫病抗体检测阳性49例，阳性率为81.6%，p0.01，具有统计学意义。（100例临床诊断病例仅收集到60例患者血清作外斐氏反应及恙虫病抗体检测，另40例病例未收集到标本） 4、恙虫病东方体分离：待腹腔接种的小鼠发病后，解剖取其腹壁刮液涂片、吉姆萨染色、镜检，镜下见：紫红色圆形、椭圆形、短杆状恙虫病东方体颗粒。 5、恙虫病东方体分型结果显示：与Yonchon型同源性最高达到95%以上。结论：1、珠海市为恙虫病疫源地，属夏秋型。 2、珠海市存在Yonchon型恙虫病东方体。 3、恙虫病抗体检测阳性率高，可建议推广应用于各医院实验室作为辅助检查手段。
[Abstract]:Objective: to understand the epidemiological characteristics of tsutsugamushi disease in Zhuhai City, and to isolate the oriental pathogen of tsutsugamushi disease and genotyping it to provide clinical diagnosis, treatment, effective prevention and local vaccine. The preparation of rapid detection reagent provides theoretical basis. Methods: the epidemiology and clinical data of 100 patients with tsutsugamushi disease in Zhuhai were analyzed, and the positive rate was compared in 60 patients with tsutsugamushi disease. Origamushi tsutsugamushi was isolated by intraperitoneal inoculation in 5 cases with positive antibody to tsutsugamushi, and OtDNA was detected and amplified by nPCR in 10 venous blood samples of 10 cases with positive antibody to tsutsugamushi disease. Sequencing, homology analysis and phylogenetic tree analysis. Results: the epidemiological characteristics were as follows: in Zhuhai, the distribution was mainly sporadic, the number of cases was mainly distributed from April to December and belonged to the summer and autumn type. There was no significant gender difference in the distribution of cases, and there was a case distribution in all age groups, the most in the age group from 41 to 70 years old. The clinical data analysis showed: (1) Clinical characteristics: 67 cases (67 cases) had a history of field or animal contact. There were 93 cases of fever, accounting for 933%; among them, 83 cases had scab, 9 cases had ulcers, 9 cases had ulcer, 18 cases had rash, 18 cases had rash, 63 cases had lymphadenopathy, 63 cases had lymphadenopathy and 63 cases had splenomegaly, 3 cases had splenomegaly. (2) the blood routine of the laboratory assistant examination: the white blood cell count was in normal 66 cases, the white blood cell count was in 66 cases, the white blood cell count increased in 18 cases, the white blood cell count decreased in 16 cases, accounted for 16.2 alanine transferase in 69 cases, accounted for 69%. There were 74 cases of aspartate transferase increase, accounting for 74.383 cases of CRP increased, accounting for 833%. (3) treatment and outcome: doxycycline and tetracycline were all cured cases. The cure rate was 100. 3. The positive rates of Wafer's test and tsutsugamushi antibody test were compared: the positive rate was 10.0 in 6 cases by WFT test, and 49 cases by scrub typhus antibody test. The positive rate was 81.6% (P 0.01), which was statistically significant. (only 60 cases were collected from 100 cases of clinical diagnosis for the detection of Wafer's reaction and antibody against tsutsugamushi disease. The other 40 cases were not collected) 4. Orientalis tsutsugamushi: after the mice were inoculated intraperitoneally, the scrape smears of the abdominal wall were dissected, and the smears of the abdominal wall were stained by Gimsa. Under the microscope, they were seen as fuchsia round and oval, round, and oval. The results of oriental typhus showed that the highest homology with Yonchon was more than 95%. Conclusion: 1, Zhuhai is the foci of tsutsugamushi disease, which belongs to summer and autumn type. 2. There is Yonchon type tsutsugamushi virus in Zhuhai. 3. The positive rate of antibodies against tsutsugamushi disease is high. It is suggested that it should be applied to hospital laboratories as a means of auxiliary examination.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R513.2

【参考文献】