江苏省部分地区儿童流感嗜血杆菌感染及抗体水平调查

发布时间：2019-06-03 03:56

【摘要】： 流感嗜血杆菌(Haemophilus influenzae，Hi)，是目前儿童细菌性感染的主要病原体之一，有近30％的急性下呼吸道感染由Hi感染所致，b型占绝大多数。过去60年中，很多国家已从多方面开展了对Hib的研究。上世纪80年代起，Hib结合疫苗开始广泛应用，30年间取得了很好的预防效果。到2004年底已有94个国家将Hib结合疫苗纳入了国家计划免疫，而和许多发展中国家一样，我国未将其列入其中，原因之一就是对Hi感染缺乏有效监测，对其引起的感染性疾病的认识还不够充分和深入。本课题以江苏省部分地区(滨海、丹阳、楚州)为现场，在健康儿童中开展流感嗜血杆菌的流行病学研究。第一部分江苏省部分地区儿童抗b型流感嗜血杆菌多糖抗体水平调查人群中抗体水平的高低直接影响疾病的发病，不同国家、地区、种族和年龄层的人群有不同的抗体水平，故了解江苏部分地区健康儿童抗b型流感嗜血杆菌多糖抗体水平对该地区疫苗的合理使用可提供基础资料和科学依据。本研究采用酶联免疫吸附试验(ELISA)对健康儿童血清中的Hib-PRP自然抗体水平进行检测。主要结果如下： 1．总体抗Hib-PRP抗体水平血清抗Hib-PRP抗体水平≥0.15μg／mL时视为阳性，三地儿童血清Hib-PRP抗体总体阳性率为60.81％(869／1429)。Hib-PRP抗体几何平均滴定度(GMT)为0.60μg／mL。 2．不同地区儿童抗Hib-PRP抗体水平滨海，丹阳，楚州三地的保护性阳性率分别为46.64％，66.14％及72.44％；楚州和丹阳地区阳性率无显著性差异(X~2=2.50，P=0.066)，楚州和滨海，丹阳和滨海地区阳性率差异则有统计学意义(X~2=50.01，，P＜0.001；=30.70，P＜0.001)。 3．不同年龄段儿童抗Hib-PRP抗体水平抗体水平与年龄有很密切的关系，脐带血抗体含量较高，滨海、楚州、丹阳三地分别为0.72μg／mL，1.39μg／mL，1.13μg／mL，随后下降，4-6月龄时降到最低点，随着年龄的增长，抗体水平又逐渐上升。丹阳，楚州地区上升幅度较大，5岁后均大于1μg／mL，滨海地区抗体水平较前两个地区低，但也有明显增高。第二部分江苏省部分地区健康儿童流感嗜血杆菌带菌率调查流感嗜血杆菌是人体鼻咽、口咽部常见的定殖菌，健康人群的自然携带是Hi引起侵袭性疾病的重要原因。本研究结合细菌培养和PCR检测方法，在春季检测江苏部分地区(滨海、丹阳)健康儿童的带菌情况，为临床防治提供参考。结果如下： 1．1岁以内每两个月划分为一组，1岁之后则以一年为一组，各组的Hi携带率分别为55.65％、53.76％、66.02％、54.88％、62.12％、59.15％、63.24％、61.54％、63.33％、50.56％，其中5～6月龄的携带率为最高。 2．各年龄组抗体阳性率随着年龄先下降，后上升，在3～4月龄时为最低，1岁之后，抗体水平阳性率均在50％以上。 3．Hi携带率在男女儿童之间差异无统计学意义。第三部分江苏省南京市b型流感嗜血杆菌细菌性脑膜炎病例监测目前包括我国在内的大部分发展中国家尚未将Hib结合疫苗纳入国家扩大的计划免疫，很大一部分原因是缺乏该病详尽资料，尤其是准确的发病率和疾病负担评价资料。我国仅有杨永弘等1990-1992年在合肥开展过Hib发病率的研究。自2006年12月至2008年12月，中国疾病预防控制中心在江苏省南京市开展细菌型脑膜炎病例的监测。结果显示：2006年12月至2007年4月南京市共有细菌性脑膜炎患者10例，其中1例为Hib病例，占细菌性脑膜炎的10％。此项工作仍在行进中。
[Abstract]:Haemophilus influenzae (Hi) is one of the main pathogens of bacterial infection in children. In the last 60 years, the study of Hib has been carried out in many countries. Since the 1980s, Hib has been widely used in combination with the vaccine, and a good preventive effect has been achieved in the past 30 years. By the end of 2004,94 countries have included Hib-bound vaccines in national plans, as in many developing countries, one of which is the lack of effective monitoring of the Hi-infection and the insufficient and in-depth understanding of the infectious diseases that it causes. The epidemiological study of Haemophilus influenzae was carried out in healthy children by taking part of Jiangsu Province (Binhai, Danyang, and Chuzhou) as the site. Anti-b-type Haemophilus influenzae in some parts of Jiangsu Province The level of the antibody in the level of the sugar antibody directly affects the incidence of the disease, different countries, regions, races and years. The anti-b-type Haemophilus influenzae polysaccharide antibody level of the healthy children in some parts of Jiangsu Province is reasonable for the vaccine in the region, according to the different antibody levels of the population of the aging layer. The basic data and scientific basis can be provided. The present study uses an enzyme-linked immunosorbent assay (ELISA) to treat Hib in healthy children's serum. PRP natural antibody The level is tested. The main results are as follows: 1. The overall anti-Hib-PRP antibody level was considered positive when the level of the anti-Hib-PRP antibody was 0.15. m u.g/ mL, and the serum Hib-PRP antibody in the three children was considered positive. The overall positive rate of PRP was 60.81% (869/1429). Hib- The geometric mean titer (GMT) of the PRP antibody is 0. The protective positive rates of the anti-Hib-PRP antibody in different areas were 46.64%, 66.14% and 72.44%, respectively. There was no significant difference in the positive rate of positive rate in the region of Chuzhou and Danyang (X ~ 2 = 2.50, P = 0.066), and the positive rate of positive rate in Chuzhou and Binhai, Danyang and Binhai region. Statistical significance (X ~ 2 = 50.01, P <0 (.001; = 30.70, P <0.001).3. The level of anti-Hib-PRP antibody in children of different age groups has a close relationship with the age, and the content of the cord blood antibody is high, the coastal and the Chu 0.72 & mu; g/ mL in the state and Danyang, respectively 1.39. m u.g/ mL, 1.13. mu.g/ mL, followed by a decrease, to the lowest point at 4-6 months of age, with the increase in age, the level of antibody As a result, the rise in the area of Danyang and Chuzhou is large, and after the age of 5, it is more than 1. The level of antibody in the coastal area was lower than that in the first two areas, but it also increased significantly. The second part of Jiangsu Province Haemophilus influenzae (H. influenzae) with H. influenzae (H. H.) and H. influenzae (Haemophilus influenzae) are the common pathogenic bacteria in the nasopharynx and oropharynx of the human body, and the natural carrying of the healthy population is H. i. Invasiveness The results of this study, combined with the methods of bacterial culture and PCR, were used to detect the condition of the band of the healthy children in some parts of Jiangsu province (Binhai and Danyang) in spring. The results are as follows:1.1 year old is divided into one group, one year after one year, and the Hi-carrying rate of each group is 55.65%,5. 3.76%, 66.02%, 54.88%, 62.12%, 59.15%, 63.24%, 61.54%, 63.33% And the carrying rate of 5 to 6 months is the highest. 2. The positive rate of antibody in all age groups decreased with age, then The positive rate of the antibody was more than 50% at the age of 3 to 4 months and the positive rate of the antibody was more than 50% after the age of 1. No statistical significance. The third part of the river Surveillance of the bacterial meningitis in the b-type Haemophilus influenzae in Nanjing, Jiangsu Province Most of the developing countries, including my country, have not included Hib-bound vaccines in the country's expanded plan for immunization, a large part of which is due to the lack of detailed information on the disease Materials, especially the accurate incidence and disease burden evaluation data, are only the study of the incidence of Hib in Hefei from 1990 to 1992, such as Yang Yonghong and the like. Since December 2006
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R181.3

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