合肥市流行性脑脊髓膜炎流行病学特征研究
发布时间：2018-07-18 09:46
【摘要】： 目的分析合肥市流行性脑脊髓膜炎流行特征、临床表现与实验室检测结果,为临床诊治提供依据;并建立流脑疫情预测模型GM(1,1),探讨其应用于预测流脑发病率的可行性。同时探讨气象因素与流行性脑脊髓膜炎发病的关系,为实施流脑的预防和控制策略提供科学依据。 方法描述流行病学方法分析和回顾性分析合肥市2003-2007年流脑疫情资料;根据合肥市2002-2006年流脑发病率数据建立流脑发病率预测灰色模型GM(1,1),并做拟合效果检验,外推预测2007年合肥市流脑发病率,从而评价合肥市2007年流脑防制效果。运用描述性流行病学方法和回归分析研究合肥地区2003-2007年流行性脑脊髓膜炎发病率与相关气象影响因素(气温、降水量、日照时数和相对湿度)。将合肥市2003-2007年流行性脑脊髓膜炎月平均发病数据进行分析,对可能影响流行性脑脊髓膜炎发病的气温、降水量、日照时数和相对湿度4项研究变量进行单因素相关分析和多元逐步分析。 结果 1.合肥市2003-2007年累积发病394例,其中2007年度发病率最高(2.84/10万);经实验室确诊共130例(33.0%),结果均为C群;病例年龄中位数为14.32岁(最小为2个月,最大为78岁),发病率最高年龄组为15-19岁组(6.04/10万),该年龄组病例占总病例的比例也最高(29.11%);在校学生占所有病例的50.80%,并且在校学生发病构成比逐年上升,2007年占57.58%;冬春季发病高峰明显,80.9%的病例发生在1-4月份;共发生21起(56例)聚集性流脑疫情,8起发生在学校,其中职业学校4起,实验室结果显示均是C群。 2.首发症状以发热+头晕+呕吐,发热+头晕,仅发热为主,分别占23.6%、12.4%、10.9%,发病后在首次在私人门诊就诊的占11.2%,乡镇卫生院占3.8%,县级医疗机占17.5%,市级医疗机构占29.9%,省级医疗机构占36.3%,不详者占1.3%,暴发病例与散发病例在首次就诊不同单位的构成比有统计学差异(P0.05);普通型占79.66%,暴发型占19.31%,轻型占1.03%,对其中C群病例分型结果显示普通型占81.73%,暴发型占17.31%,轻型占0.97%,C群和所有病例的临床分型差异无统计学意义(P0.05);临床症状主要有发热、呕吐、恶心、颈项强直、剧烈头痛、皮肤瘀点瘀斑、皮肤出血点和神志不清,构成比均超过50%,布氏征在所有病例和C群病例的分布有统计学差异(P0.05); 3. 8例出现血白细胞数下降,其中C群流脑占2例,15例出现血中性粒细胞数下降,其中C群流脑占3例;死亡病例有2例出现了血中性粒细胞数下降。 4.流脑发病率预测模型为Yt = 0. 49927e0 .556t?0.40827,经拟合检验,模型拟合精度好(C=0.2931,P=1.00)。利用本模型对合肥市2007年流脑发病率进行外推,估计2007年合肥市流脑发病率为5.985/100 000,实际发病率为2.84/100 000,降幅达210.8%。 5.流脑的发病与气温和相对湿度呈显著负相关,回归方程为:Y=9.015-0.747 x1+0.067x4,x1和x4分别代表气温和相对湿度。 结论C群代替了A群成为合肥市近几年的流行优势菌株,并引起流脑疫情的反弹上升,病例年龄分布出现上移趋势,需要进一步的监测研究。C群流脑在首发症状、临床分型、临床表现等方面并没有发现比所有病例严重;流脑病例中出现了血白细胞和中性粒细胞数下降的现象,值得我们关注。该模型较好地拟合了合肥市流脑发病趋势,预测结果具有一定的参考价值。2007年合肥市流脑实际发病率远远低于预测值,提示我市流脑防治工作取得了明显的效果。气温和相对湿度成为影响流脑发病的主要气象因素。气象因素可以对流脑的发病起到一定的预测作用。
[Abstract]:Objective to analyze the epidemic characteristics of epidemic cerebrospinal meningitis in Hefei, to provide the basis for clinical diagnosis and treatment, and to establish a prediction model of epidemic cerebrospinal meningitis (GM (1,1)), and to explore the feasibility of its application in predicting the incidence of epidemic cerebrospinal meningitis. A scientific basis for the prevention and control strategy is provided.
Methods descriptive epidemiological methods were used to analyze and retrospective analysis the data of 2003-2007 year epidemic cerebrospinal epidemics in Hefei. According to the data of the 2002-2006 year cerebrovascular incidence in Hefei, the grey model GM (1,1) was set up, and the fitting effect was tested. The incidence of flow brain in Hefei in 2007 was extrapolated to evaluate the prevention and control of the flow of brain in Hefei in 2007. The incidence of 2003-2007 year epidemic cerebrospinal meningitis in Hefei area and related meteorological factors (temperature, precipitation, sunshine hours and relative humidity) were studied by descriptive epidemiological method and regression analysis. The data of monthly average incidence of meningitis in 2003-2007 years in Hefei city were analyzed, which could affect the prevalence of epidemic cerebrospinal meningitis. Single factor correlation analysis and multivariate stepwise analysis were conducted on 4 variables, including temperature, precipitation, sunshine duration and relative humidity, in cerebrospinal meningitis.
Result
1. there were 394 cases of cumulative incidence in Hefei for 2003-2007 years, of which the incidence of 2007 was the highest (2.84/10 million); 130 cases (33%) were confirmed by laboratory diagnosis. The results were all C group; the median age of case age was 14.32 years (the smallest was 2 months, the largest was 78 years old), the highest incidence was in the 15-19 years group of 15-19 years (6.04/10 million), and the proportion of the age group was also the proportion of the total cases. The highest (29.11%); the students accounted for 50.80% of all cases, and the incidence of school students increased year by year, accounting for 57.58% in 2007; in winter and spring, the peak of incidence was obvious and 80.9% of the cases occurred in 1-4 months; 21 (56 cases) had aggregated epidemic cerebrospinal epidemics, 8 of them occurred in school, of which the vocational schools were 4, the laboratory results showed C groups.
2. first symptoms were fever + dizziness + vomiting, fever + dizziness, fever + dizziness, fever and dizziness, only fever, accounting for 23.6%, 12.4%, 10.9% respectively, 11.2% in the private clinic, 3.8% in township hospitals, 17.5% in township hospitals, 29.9% in the municipal medical institutions, 36.3% in the provincial medical institutions, 1.3% at the provincial level, 1.3% of the unknown, and the outbreaks of cases and sporadic cases were the first in the first The composition ratio of the different units was statistically different (P0.05), the common type accounted for 79.66%, the violent style accounted for 19.31%, and the light accounted for 1.03%. The classification results of C group cases showed that the common type was 81.73%, the violent style accounted for 17.31%, and the light accounted for 0.97%. The clinical classification difference between the C group and all cases was not statistically significant (P0.05); clinical symptoms mainly had fever, vomiting. Vomiting, nausea, neck ankylosis, severe headache, skin ecchymosis, skin bleeding point and unconsciousness were more than 50%, and the distribution of brucellus sign in all cases and C group cases was statistically different (P0.05).
The number of blood leucocyte decreased in 3.8 cases, of which 2 cases were C group and 15 cases of blood neutrophils decreased, of which 3 cases were C group and 2 cases of death cases had the decrease of blood neutrophil number.
4. Yt = 0. 49927e0.556t? 0.40827, after fitting test, the model fitting accuracy is good (C=0.2931, P=1.00). Using this model to extrapolate the incidence of Hefei in 2007, the incidence of Hefei is estimated to be 5.985/100 000, the actual incidence of 2.84/100 000, a decrease of 210.8%.
5. there was a significant negative correlation between the incidence of cerebrospinal meningitis and temperature and relative humidity. The regression equation was Y=9.015-0.747 x1+0.067x4, X1 and X4 respectively representing temperature and relative humidity.
Conclusion C group instead of A group became the dominant strain of Hefei in recent years, and caused the bounce of epidemic cerebrospinal epidemics, the age distribution of cases increased, and further monitoring and study of the first symptoms, clinical typing and clinical manifestations of.C group were not more serious than all cases. The decline of white blood cells and neutrophils is worthy of our attention. This model is better fitting the trend of the epidemic in Hefei. The prediction results have a certain reference value in.2007 years in Hefei, the actual incidence of the flow of brain in the city is far below the predicted value, suggesting that the prevention and control of the flow of brain in our city has achieved obvious effect. Meteorological factors may play a certain role in predicting the incidence of epidemic cerebrospinal meningitis.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R515.2;R181.3
本文编号：2131520
[Abstract]:Objective to analyze the epidemic characteristics of epidemic cerebrospinal meningitis in Hefei, to provide the basis for clinical diagnosis and treatment, and to establish a prediction model of epidemic cerebrospinal meningitis (GM (1,1)), and to explore the feasibility of its application in predicting the incidence of epidemic cerebrospinal meningitis. A scientific basis for the prevention and control strategy is provided.
Methods descriptive epidemiological methods were used to analyze and retrospective analysis the data of 2003-2007 year epidemic cerebrospinal epidemics in Hefei. According to the data of the 2002-2006 year cerebrovascular incidence in Hefei, the grey model GM (1,1) was set up, and the fitting effect was tested. The incidence of flow brain in Hefei in 2007 was extrapolated to evaluate the prevention and control of the flow of brain in Hefei in 2007. The incidence of 2003-2007 year epidemic cerebrospinal meningitis in Hefei area and related meteorological factors (temperature, precipitation, sunshine hours and relative humidity) were studied by descriptive epidemiological method and regression analysis. The data of monthly average incidence of meningitis in 2003-2007 years in Hefei city were analyzed, which could affect the prevalence of epidemic cerebrospinal meningitis. Single factor correlation analysis and multivariate stepwise analysis were conducted on 4 variables, including temperature, precipitation, sunshine duration and relative humidity, in cerebrospinal meningitis.
Result
1. there were 394 cases of cumulative incidence in Hefei for 2003-2007 years, of which the incidence of 2007 was the highest (2.84/10 million); 130 cases (33%) were confirmed by laboratory diagnosis. The results were all C group; the median age of case age was 14.32 years (the smallest was 2 months, the largest was 78 years old), the highest incidence was in the 15-19 years group of 15-19 years (6.04/10 million), and the proportion of the age group was also the proportion of the total cases. The highest (29.11%); the students accounted for 50.80% of all cases, and the incidence of school students increased year by year, accounting for 57.58% in 2007; in winter and spring, the peak of incidence was obvious and 80.9% of the cases occurred in 1-4 months; 21 (56 cases) had aggregated epidemic cerebrospinal epidemics, 8 of them occurred in school, of which the vocational schools were 4, the laboratory results showed C groups.
2. first symptoms were fever + dizziness + vomiting, fever + dizziness, fever + dizziness, fever and dizziness, only fever, accounting for 23.6%, 12.4%, 10.9% respectively, 11.2% in the private clinic, 3.8% in township hospitals, 17.5% in township hospitals, 29.9% in the municipal medical institutions, 36.3% in the provincial medical institutions, 1.3% at the provincial level, 1.3% of the unknown, and the outbreaks of cases and sporadic cases were the first in the first The composition ratio of the different units was statistically different (P0.05), the common type accounted for 79.66%, the violent style accounted for 19.31%, and the light accounted for 1.03%. The classification results of C group cases showed that the common type was 81.73%, the violent style accounted for 17.31%, and the light accounted for 0.97%. The clinical classification difference between the C group and all cases was not statistically significant (P0.05); clinical symptoms mainly had fever, vomiting. Vomiting, nausea, neck ankylosis, severe headache, skin ecchymosis, skin bleeding point and unconsciousness were more than 50%, and the distribution of brucellus sign in all cases and C group cases was statistically different (P0.05).
The number of blood leucocyte decreased in 3.8 cases, of which 2 cases were C group and 15 cases of blood neutrophils decreased, of which 3 cases were C group and 2 cases of death cases had the decrease of blood neutrophil number.
4. Yt = 0. 49927e0.556t? 0.40827, after fitting test, the model fitting accuracy is good (C=0.2931, P=1.00). Using this model to extrapolate the incidence of Hefei in 2007, the incidence of Hefei is estimated to be 5.985/100 000, the actual incidence of 2.84/100 000, a decrease of 210.8%.
5. there was a significant negative correlation between the incidence of cerebrospinal meningitis and temperature and relative humidity. The regression equation was Y=9.015-0.747 x1+0.067x4, X1 and X4 respectively representing temperature and relative humidity.
Conclusion C group instead of A group became the dominant strain of Hefei in recent years, and caused the bounce of epidemic cerebrospinal epidemics, the age distribution of cases increased, and further monitoring and study of the first symptoms, clinical typing and clinical manifestations of.C group were not more serious than all cases. The decline of white blood cells and neutrophils is worthy of our attention. This model is better fitting the trend of the epidemic in Hefei. The prediction results have a certain reference value in.2007 years in Hefei, the actual incidence of the flow of brain in the city is far below the predicted value, suggesting that the prevention and control of the flow of brain in our city has achieved obvious effect. Meteorological factors may play a certain role in predicting the incidence of epidemic cerebrospinal meningitis.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R515.2;R181.3
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