临床诊断急性细菌性痢疾的流行病学、病原学及临床特点

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目的了解北京市近年来急性细菌性痢疾(简称菌痢)的临床、流行病学特点及致病菌分布情况,提供确诊菌痢的症状特征。方法以2011年4月1日~2015年10月31日就诊于北京市某两家三级综合医院肠道门诊的247例临床诊断为“急性细菌性痢疾”的患者为研究对象,对患者一般资料、症状体征、病原检测等结果进行统计分析。结果临床诊断急性细菌性痢疾患者以青少年居多(70.85%);职业构成以干部职员(29.96%)、家务及待业(20.24%)、离退休人员(15.38%)和学生(10.12%)为主;菌痢发病率有明显季节性,发病高峰位于5~9月;大便细菌培养阳性率18.22%,细菌性痢疾确诊率5.67%,其中宋内菌群占78.57%;菌痢确诊患者症状不典型,高热、里急后重比例高,但腹痛、腹泻10~20次/d、脓血便、血白细胞升高等典型临床表现与其他致病菌感染组(B组)及便培养阴性组(C组)无区别。结论细菌性痢疾确诊患者临床表现高热更明显,病原菌宋内菌群占绝对优势。现有的临床诊断标准误诊率很高,对推动志贺菌检验新技术的广泛应用有着十分重要的意义。 Objective To understand the clinical and epidemiological characteristics of acute bacillary dysentery (hereinafter referred to as bacillary dysentery) in Beijing and the distribution of pathogens, and to provide the symptom characteristics of confirmed bacillary dysentery. Methods From April 1, 2011 to October 31, 2015, 247 clinically diagnosed patients with acute bacterial dysentery were enrolled in the gut clinic of two level three general hospitals in Beijing. General information of patients, symptoms and signs, pathogen detection and other results for statistical analysis. Results The majority of patients with acute bacillary dysentery were clinically diagnosed (70.85%). The occupational composition was mainly composed of cadres (29.96%), housework and unemployed (20.24%), retirees (15.38%) and students (10.12% The incidence of bacillary dysentery was significantly seasonal, the peak of incidence was from May to September; the positive rate of stool bacterial culture was 18.22%, the diagnosis rate of bacterial diarrhea was 5.67%, accounting for 78.57% of the total bacteria in Song Dynasty; the symptoms of bacillary dysentery were not typical, High fever, tenesmus and high proportion of weight, but abdominal pain, diarrhea 10 ~ 20 times / d, pus and blood stools, leukocytosis and other typical clinical manifestations and other pathogenic bacteria infection group (B group) and stool culture negative group (C group) no difference. Conclusion The clinical manifestation of bacillary dysentery is more obvious in clinical manifestations, and the bacteria in the pathogen Song occupy the absolute superiority. The existing clinical diagnostic criteria have a high misdiagnosis rate, which is of great significance to promote the widespread application of new technologies for Shigella testing.
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