杭州市职业人群附红细胞体感染情况调查

发布时间：2018-04-30 06:47

本文选题：附红细胞体 + 感染率　；参考：《浙江大学》2009年硕士论文

【摘要】： 背景和目的不明原因的血液炎症、反复的上呼吸道感染,这些常见的亚健康症状,可能是一种人畜共患病—附红细胞体感染引起的。根据现有资料,附红细胞体是条件致病性病原体,感染后多为潜伏状态,在机体抵抗力下降或处于某些应激状态(生理性或病理性)时发病。在临床表现上与感冒、疟疾、贫血等疾病易相混淆,医疗单位又缺乏特异的实验诊断手段,致使病例不易被发现。近些年国内刚刚开始报道这一疾病,而根据上海近千例白领的体检报告,其中有三成人已被感染主要原因是生吃肉食以及外出就餐不洁所致。一般认为人类对附红细胞体普遍易感,其感染率与性别、年龄无明显关系,具有家庭聚集性及一定职业分布特点,兽医、奶牛饲养员、屠宰工人、禽兽肉类加工人员等人群感染率高于其他职业人群。目前,人附红细胞体病诊断主要依据有可疑流行病学接触史,出现可疑的临床症状、体征,又难以用其他疾病予以解释者,加上实验室检查有阳性结果可作为确诊的主要依据。附红细胞体病作为一种新发现的人兽共患病,许多医务工作者对其还较陌生,对其研究还刚起步,从80年代以后国内外学者才对附红细胞体感染人畜及其发病情况研究的越来越多,1986年Puntaric首次报道了1例人附红细胞体病。在我国,1992年首次报道,随后在江苏、河北、广西、广东、新疆、甘肃等地均有发现。全国有部分地区针对附红细胞体感染的流行情况开展过调查,结果表明,各地的感染率差别非常悬殊,在3.27%～97.29%之间。而在浙江省尚未见有关附红体感染情况的研究报道。本研究通过调查杭州市肉联厂的职工和其内外对照人群有关附红细胞体感染情况,掌握杭州市特殊人群附红体感染的比例;初步探讨附红体感染的危险因素;同时摸索附红体感染检测技术。该研究结果有助于了解附红细胞体的感染途径,为相关部门制订预防附红细胞体感染的决策提供科学依据。材料与方法根据文献复习结果,结合杭州市的实际,根据估计附红细胞体感染率约30%,容许误差0.2P,以及显著性水平为P=0.05,计算外对照人群样本量约为233人。该人群要求为杭州在杭州持续居住半年以上,接受调查时未患急性疾病或未处于疾病急性期,采集血样并做问卷调查。职业人群根据调查时在岗人员符合条件者纳入。特定人群1:杭州市肉类联合加工厂直接进行屠宰、去毛、开膛、分割、包装等接触生肉类的工作。特定人群1内对照:杭州市肉类联合加工厂未直接进行屠宰、去毛、开膛、分割、包装等接触生肉类的工作的人员,包括管理科室、销售、后勤等人员。特定人群2:杭州市奶业有限公司接触活畜人群,包括挤奶工、畜类饲养员及兽医。使用调查问卷调查研究对象在被调查前一年内所居住地区域(城区、城乡结合部、郊区、农村)、家中饲养宠物情况、接触家畜(猪、牛、羊等)产品情况、接触后及时洗手情况、使用洗涤剂或肥皂洗手情况、接触时手、臂皮肤破损情况、接触时手部防护情况、食用肉类情况、食用频率、肉类的烹饪方式、食用未熟透的肉类情况、在外就餐情况、常外出就餐的场所、以及患有慢性病、发热、贫血情况。采集研究对象静脉血标本2ml,将采集到的血液压制成血涂片,姬-瑞氏快速液染色、镜检。阳性判定标准:以同一个视野中发现符合附红细胞体特征的为阳性。统计分析方法:数据采用Epidata平行双录入,并设置核查及逻辑检错。使用Spss13.0软件进行统计分析。使用描述性统计方法对资料的基本情况进行描述,使用卡方检验对分类资料进行统计分析,使用非条件Logistic回归筛选危险因素。结果本次研究共调查了580人,其中外对照人群351人,肉联厂从事屠宰等操作的工人64人,肉联厂内对照118人,畜牧场工人35名,兽医12名。经染色镜检,共检出附红体感染者共54名,总体阳性率为9.31%。其中外对照人群感染率为7.12%(25/351),肉联厂从事屠宰等操作工感染率20.31%(13/64);畜牧场工人、兽医染率21.28%(10/47),三者感染率之间有统计学差异(x2=14.45,P＜0.05)。外对照人群各年龄组感染率无显著差异(Fisher精确检验,P＞0.05);未发现男性和女性附红体感染率有差异(x2=1.179,P＞0.05);未发现不同季节附红体感染率存在不同(Fisher精确检验,P＞0.05);城区、城乡结合部、郊区及农村人群感染率也没有明显差异(Fisher精确检验P＞0.05);感染率从小学级别到大学级别逐渐降低,但经过趋势卡方检验,无统计学意义(x2=2.98,P＞0.05);人群中未养宠物者(主要指犬、猫等常见宠物)及豢养宠物者的感染率差异无显著性(x2=0.82,P＞0.05);接触动物皮毛、生肉、动物排泄物等的人群附红体感染率与不接触的人群并无统计学差异(x2=0.178,P=0.67),但是接触后及时洗手的人群感染率则低于不及时洗手的人群无统计学意义(x2=11.36,P＜0.05);而以肥皂等清洁用品洗手的人群感染率低于只用水洗手的人群(x2=6.76,P＜0.05);在日常生活中与动物皮毛、排泄物、生肉等的接触时是否受伤对附红体感染没有明显的影响(x2=0.033,P＞0.05);另外,分析发现,经常食用牛肉、羊肉、猪肉或者鸡肉的人群附红体感染率与不食用者无统计学差异。食用肉类频率不同的人群感染率也无统计学差异。食用生或者半生的肉类人群的感染率与未食用者感染率无统计学差异。在外就餐情况与附红体感染无显著性差异。选取该人群中附红体阳性感染者作为病例,未感染者作为对照,进行Logistic回归分析。暂未发现居住区域、豢养宠物、接触动物皮毛、生肉、动物排泄物等、以及外伤、就餐情况等为附红体感染的危险因素。而发现文化程度越高者比文化程度低者感染附红体的危险性要小,但结果有待进一步验证。本次使用的改良瑞氏-姬氏快速染色法,与其他染色法比较,阳性检出率较高,染色背景清晰,杂质较少,具有对胞浆和核的染色效果好,层次对比非常明显,结构更为清晰,容易辨认,染色速度快等优点。结论此次调查初步掌握了杭州地区附红体感染情况,了解了杭州市人群附红体感染的危险因素,确定附红体感染的高危人群;通过比较确定了改良的瑞氏-姬氏快速染色法为较优的实验室检验方法,并根据调查结果提出采取针对性预防措施。
[Abstract]:In recent years , it has been reported in 1992 that there is no obvious relationship between the infection rate and the sex and age , and it is not easy to be explained . In the past few years , it has been reported in 1992 that the infection rate and sex and age are not obvious . In our country , the first report in 1992 has been reported in 1992 , and then in Jiangsu , Hebei , Guangxi , Guangdong , Xinjiang , Gansu and so on .

The prevalence of red blood cell infection was investigated in some parts of China . The results showed that the infection rate was very different from 3.27 % to 97.29 % .

Materials and Methods According to the literature review results , according to the actual situation of Hangzhou , according to the estimated rate of infection rate of the attached red cell body is about 30 % , the allowable error is 0 . 2P , and the significance level is P = 0.05 , and the sample size of the external control population is about 233 . The specific group 1 : Hangzhou meat joint processing plant is not directly slaughtered , dehaired , opened , divided , packaged and so on to contact raw meat . The specific group 2 : Hangzhou Milk Industry Co . , Ltd . is in contact with the live animal population , including milking workers , livestock keepers and veterinary .

Use survey questionnaires to study the situation of the objects in the areas of residence ( urban , rural , suburban , rural ) , home - fed pets , contact domestic animals ( pigs , cattle , sheep , etc . ) within one year prior to the investigation , wash hands in time after exposure , use detergent or soap to wash hands , contact with hands , arm skin damage , contact with hand protection , eating meat , eating frequency , cooking mode of meat , eating uncooked meat , eating outside meals , frequent absence of meals , and people suffering from chronic diseases , fever , and anemia .

2 ml of venous blood from the study object were collected , and the collected blood was pressed into a blood smear , and the Agaricus Blaise rapid liquid staining and microscopic examination were performed .

Positive criteria : positive in the same field of view were found to be consistent with the characteristics of the red blood cells .

Statistical analysis method : Epidata parallel double entry is adopted , and verification and logical error detection are set up . Spss13.0 software is used for statistical analysis . Descriptive statistics method is used to describe the basic condition of the data , and the classification data is statistically analyzed by using the Chi - square test , and the risk factors are screened using non - conditional logistic regression .

Results The total positive rate was 9.31 % . The infection rate was 7.12 % ( 25 / 351 ) and 21.28 % ( 10 / 47 ) in meat factory . There was a significant difference between the infection rates among the three ( x2 = 14.45 , P < 0.05 ) .

There was no significant difference in the rate of infection between male and female ( x2 = 1.179 , P > 0.05 ) . There was no significant difference in the rate of infection among people with different seasons ( x2 = 6.76 , P > 0.05 ) . The higher the cultural degree , the higher the risk of infection with the red body , but the results need to be further verified .

Compared with other dyeing methods , the modified Rayleigh - Ji ' s fast staining method has the advantages of high positive detection rate , clear dyeing background , less impurities , good dyeing effect on cytoplasm and core , obvious hierarchy comparison , clearer structure , easy identification , quick dyeing speed and the like .

Conclusion The investigation has preliminarily mastered the situation of red body infection in Hangzhou area , the risk factors of red body infection in Hangzhou population , the determination of the high - risk population with red - body infection , and the comparison of the improved method for laboratory test with the improved reeldrin - Ji ' s fast staining method , and put forward the targeted preventive measures according to the results of the investigation .

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R181.3

【参考文献】