本文選題：感染性腹瀉 + 致瀉性大腸埃希菌　； 參考：《浙江大學(xué)》2015年碩士論文

【摘要】：目的：腹瀉是一種常見(jiàn)腸道感染病,且發(fā)病率高,長(zhǎng)期危害兒童、成人的身體健康。中國(guó)是感染性腹瀉的高發(fā)區(qū),感染性腹瀉包括細(xì)菌性腹瀉、病毒性腹瀉、寄生蟲(chóng)性腹瀉等,而其中常見(jiàn)的細(xì)菌有致瀉性大腸埃希菌、沙門(mén)菌、志賀菌、致病性弧菌(霍亂弧菌、副溶血弧菌)、類(lèi)志賀鄰單胞菌、嗜水氣單胞菌、小腸結(jié)腸炎耶爾森菌等。常見(jiàn)的病毒有輪狀病毒、杯狀病毒、腸道腺病毒、星狀病毒等。致瀉性大腸埃希菌在細(xì)菌性腹瀉中比較常見(jiàn),而浙江省一直以來(lái)是感染性腹瀉的高發(fā)地區(qū),但是一直缺乏相關(guān)詳細(xì)的數(shù)據(jù),因此我們選擇了杭州地區(qū),來(lái)調(diào)查該區(qū)域腹瀉病原譜以及研究致瀉性大腸埃希菌的分布特征。方法：收集浙江省浙江大學(xué)附屬第一醫(yī)院2013年急性腹瀉患者的糞便標(biāo)本532份,分別采用常規(guī)微生物檢驗(yàn)程序?qū)ΤＲ?jiàn)腸道致病菌進(jìn)行分離培養(yǎng),使用RT-PCR技術(shù)對(duì)病毒進(jìn)行檢測(cè),以及對(duì)DEC菌株采用多重PCR技術(shù)進(jìn)行鑒定并分類(lèi),結(jié)合通過(guò)統(tǒng)一的調(diào)查問(wèn)卷收集到的流行病學(xué)數(shù)據(jù)對(duì)導(dǎo)致急性腹瀉的細(xì)菌與病毒進(jìn)行分析。結(jié)果：1.2013年1月至2013年12月,收集532份糞便標(biāo)本。檢出腹瀉病原285株,檢出率為53.6%。其中細(xì)菌158份,占55.4%,病毒127份,占44.6%。有48份標(biāo)本同時(shí)檢出兩種及兩種以上病原,其中細(xì)菌與細(xì)菌混合陽(yáng)性28例,占9.8%；細(xì)菌和病毒混合陽(yáng)性20例,占7.0%。2.細(xì)菌性腹瀉中,致瀉性大腸埃希菌檢出率高達(dá)55.7%,列細(xì)菌性病原的首位,其次為副溶血弧菌占(19.6%),氣單胞菌占(10.8%),非傷寒沙門(mén)菌占(4.4%),霍亂弧菌占(4.4%),志賀菌占(2.5%),類(lèi)志賀鄰單胞菌占(2.5%)。3.病毒性腹瀉中,諾如病毒72株,占56.7%,輪狀病毒42株,占33.1%,札如病毒10株,占7.9%,星狀病毒3株,占2.4%,未檢出腸道腺病毒。諾如病毒中I型和II型分別占9.7%和90.3%。4.致瀉性大腸埃希菌中,腸集聚性大腸埃希菌占53.4%,產(chǎn)腸毒素性大腸埃希菌占15.9%,腸致病性大腸埃希菌占8.0%,腸侵襲性大腸埃希菌占1.1%,未檢出腸出血性大腸埃希菌,有19株(占21.6%)同時(shí)檢出多種型別的毒力基因。5.從DEC總檢出率來(lái)看,不同年齡組之間存在統(tǒng)計(jì)學(xué)差異(P=0),不同性別間或不同季節(jié)間的檢出率相近。結(jié)論：1.杭州市2013年門(mén)急診感染性腹瀉患者以致瀉性大腸埃希菌、副溶血弧菌、杯狀病毒和輪狀病毒為主,應(yīng)主動(dòng)加強(qiáng)監(jiān)測(cè)和防控,減少感染性腹瀉的發(fā)病率。2.杯狀病毒的檢出率比輪狀病毒要高,杯狀病毒中,諾如病毒的檢出率遠(yuǎn)遠(yuǎn)高于札如病毒,諾如病毒主要以II型為主。3.致瀉性大腸埃希菌中以EAEC為主,不同年齡組EAEC的檢出率存在統(tǒng)計(jì)學(xué)差異；EAEC夏秋季和冬春季檢出率存在統(tǒng)計(jì)學(xué)差異。
[Abstract]:Objective: diarrhea is a common intestinal infectious disease with high incidence. It is harmful to the health of children and adults for a long time.China has a high incidence of infectious diarrhea, including bacterial diarrhea, viral diarrhea, parasitic diarrhea, and so on, among which common bacteria are diarrhoeal Escherichia coli, Salmonella, Shigella, vibrio cholerae (Vibrio cholerae, Vibrio cholerae, etc.)Vibrio parahaemolyticus, Pseudomonas shigella, Aeromonas hydrophila, Yersinia enterocolitica, etc.Common viruses include rotavirus, calix virus, intestinal adenovirus, stellate virus and so on.Diarrhoeal Escherichia coli is a common cause of bacterial diarrhea. Zhejiang Province has always been a high incidence area of infectious diarrhea, but there is a lack of relevant detailed data, so we chose Hangzhou area.To investigate the pathogeny of diarrhea in the region and to study the distribution of diarrhoeal Escherichia coli.Methods: a total of 532 fecal specimens were collected from patients with acute diarrhea in the first affiliated Hospital of Zhejiang University in 2013. The common intestinal pathogenic bacteria were isolated and cultured by routine microbiological test procedure, and the virus was detected by RT-PCR technique.The strains of DEC were identified and classified by multiple PCR technique, and the bacteria and viruses that caused acute diarrhea were analyzed by using the epidemiological data collected through a unified questionnaire.Results: 1. From January 2013 to December 2013, 532 fecal specimens were collected.285 strains of diarrhea pathogens were detected and the detection rate was 53.6%.Among them, 158 bacteria (55.4%), 127 viruses (44.6%).Two or more pathogens were detected in 48 specimens at the same time, of which 28 were mixed positive with bacteria, accounting for 9.8, and 20 were mixed positive with bacteria and virus, accounting for 7.0.2.In viral diarrhea, 72 strains of Norovirus (56.7%), 42 strains of rotavirus (33.1%), 10 strains of virus (7.9%), 3 strains of stellate virus (2.4%), no adenovirus was detected.Type I and type II accounted for 9.7% and 90.33%, respectively.Among the diarrhea Escherichia coli, 53.4% were concentrated Escherichia coli, 15.9% were enterotoxin-producing Escherichia coli, 8.0% were Escherichia coli and 1.1% were invasive Escherichia coli. No enterohemorrhagic Escherichia coli was detected.A total of 19 strains (21. 6%) were identified as virulence genes.From the total detection rate of DEC, there was statistical difference among different age groups, and the detection rate was similar between different sex or different seasons.Conclusion 1.In 2013, emergency patients with infectious diarrhea in Hangzhou were mainly caused by Escherichia coli, Vibrio parahaemolyticus, calix virus and rotavirus. Surveillance, prevention and control should be actively strengthened to reduce the incidence of infectious diarrhea.The detection rate of norovirus was much higher than that of rotavirus, and the detection rate of norovirus was much higher than that of Zanru virus.EAEC was the main cause of diarrhea Escherichia coli. There were significant differences in the detection rate of EAEC between different age groups in summer and autumn and in winter and spring.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R446.5

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