【摘要】：目的：了解珠海市恙蟲病流行病學(xué)特征，同時進(jìn)行恙蟲病東方體病原體的分離以及基因分型，，為臨床診斷、治療、指導(dǎo)有效預(yù)防及對本地疫苗、快速檢測試劑的制備提供理論依據(jù)。 方法：通過對珠海市100例臨床診斷恙蟲病患者的流行病學(xué)、臨床資料進(jìn)行描述性分析；其中60例行外斐氏試驗與恙蟲病抗體檢測，將結(jié)果進(jìn)行陽性率對比；以恙蟲病抗體陽性病例5例，采患者靜脈血床旁小白鼠腹腔接種法分離恙蟲病東方體；以恙蟲病抗體陽性病例10例的靜脈血清標(biāo)本采用nPCR進(jìn)行OtDNA檢測、擴增、測序及同源性分析與系統(tǒng)進(jìn)化樹分析。 結(jié)果：1、流行病學(xué)特征：珠海市以散發(fā)為主；病例數(shù)主要分布于4～12月，屬夏秋型；病例分布無明顯性別差異；各個年齡組均有病例分布，在41至70歲年齡段分布最多，占75%；患者職業(yè)以農(nóng)民分布病例數(shù)最多，占73㳠。 2、臨床資料分析結(jié)果顯示：（1）臨床特點：有野外或動物接觸史67例，占67%。發(fā)熱93例，占93%；其中有焦痂、潰瘍者各83例、9例，各占83%、9%；有皮疹者18例，占18%；有淋巴結(jié)腫大63例，占63%；脾臟腫大3例，占3%。（2）實驗室輔助檢查：①血常規(guī)：白細(xì)胞計數(shù)處于正常66例，占66%；白細(xì)胞計數(shù)升高者18例，占18%；白細(xì)胞計數(shù)降低者16例，占16%。②丙氨酸轉(zhuǎn)移酶69例增高，占69%；天門冬氨酸轉(zhuǎn)移酶74例增高，占74%。③83例患者CRP存在不同程度的增高，占83%。（3）治療及轉(zhuǎn)歸：采用多西環(huán)素、四環(huán)素治療后，均為治愈病例，治愈率達(dá)100%。 3、外斐氏試驗與恙蟲病抗體檢測陽性率對比：外斐氏試驗陽性6例，陽性率為10.0%；恙蟲病抗體檢測陽性49例，陽性率為81.6%，p0.01，具有統(tǒng)計學(xué)意義。（100例臨床診斷病例僅收集到60例患者血清作外斐氏反應(yīng)及恙蟲病抗體檢測，另40例病例未收集到標(biāo)本） 4、恙蟲病東方體分離：待腹腔接種的小鼠發(fā)病后，解剖取其腹壁刮液涂片、吉姆薩染色、鏡檢，鏡下見：紫紅色圓形、橢圓形、短桿狀恙蟲病東方體顆粒。 5、恙蟲病東方體分型結(jié)果顯示：與Yonchon型同源性最高達(dá)到95%以上。 結(jié)論：1、珠海市為恙蟲病疫源地，屬夏秋型。 2、珠海市存在Yonchon型恙蟲病東方體。 3、恙蟲病抗體檢測陽性率高，可建議推廣應(yīng)用于各醫(yī)院實驗室作為輔助檢查手段。
[Abstract]:Objective: to understand the epidemiological characteristics of tsutsugamushi disease in Zhuhai City, and to isolate the oriental pathogen of tsutsugamushi disease and genotyping it to provide clinical diagnosis, treatment, effective prevention and local vaccine. The preparation of rapid detection reagent provides theoretical basis. Methods: the epidemiology and clinical data of 100 patients with tsutsugamushi disease in Zhuhai were analyzed, and the positive rate was compared in 60 patients with tsutsugamushi disease. Origamushi tsutsugamushi was isolated by intraperitoneal inoculation in 5 cases with positive antibody to tsutsugamushi, and OtDNA was detected and amplified by nPCR in 10 venous blood samples of 10 cases with positive antibody to tsutsugamushi disease. Sequencing, homology analysis and phylogenetic tree analysis. Results: the epidemiological characteristics were as follows: in Zhuhai, the distribution was mainly sporadic, the number of cases was mainly distributed from April to December and belonged to the summer and autumn type. There was no significant gender difference in the distribution of cases, and there was a case distribution in all age groups, the most in the age group from 41 to 70 years old. The clinical data analysis showed: (1) Clinical characteristics: 67 cases (67 cases) had a history of field or animal contact. There were 93 cases of fever, accounting for 933%; among them, 83 cases had scab, 9 cases had ulcers, 9 cases had ulcer, 18 cases had rash, 18 cases had rash, 63 cases had lymphadenopathy, 63 cases had lymphadenopathy and 63 cases had splenomegaly, 3 cases had splenomegaly. (2) the blood routine of the laboratory assistant examination: the white blood cell count was in normal 66 cases, the white blood cell count was in 66 cases, the white blood cell count increased in 18 cases, the white blood cell count decreased in 16 cases, accounted for 16.2 alanine transferase in 69 cases, accounted for 69%. There were 74 cases of aspartate transferase increase, accounting for 74.383 cases of CRP increased, accounting for 833%. (3) treatment and outcome: doxycycline and tetracycline were all cured cases. The cure rate was 100. 3. The positive rates of Wafer's test and tsutsugamushi antibody test were compared: the positive rate was 10.0 in 6 cases by WFT test, and 49 cases by scrub typhus antibody test. The positive rate was 81.6% (P 0.01), which was statistically significant. (only 60 cases were collected from 100 cases of clinical diagnosis for the detection of Wafer's reaction and antibody against tsutsugamushi disease. The other 40 cases were not collected) 4. Orientalis tsutsugamushi: after the mice were inoculated intraperitoneally, the scrape smears of the abdominal wall were dissected, and the smears of the abdominal wall were stained by Gimsa. Under the microscope, they were seen as fuchsia round and oval, round, and oval. The results of oriental typhus showed that the highest homology with Yonchon was more than 95%. Conclusion: 1, Zhuhai is the foci of tsutsugamushi disease, which belongs to summer and autumn type. 2. There is Yonchon type tsutsugamushi virus in Zhuhai. 3. The positive rate of antibodies against tsutsugamushi disease is high. It is suggested that it should be applied to hospital laboratories as a means of auxiliary examination.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R513.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 林上進(jìn);郭憲國;;我國小板纖恙螨及其與人類疾病的關(guān)系[J];安徽農(nóng)業(yè)科學(xué);2012年01期

2 余素瓊;;恙蟲病58例臨床分析[J];當(dāng)代醫(yī)學(xué);2011年18期

3 何鳳屏;徐新;王江橋;柯昌文;周海燕;羅君;唐建紅;王箭;周建英;管振祺;劉玉蘭;鄭禮杰;劉鳳蓮;;某地區(qū)東方立克次體基因型和遺傳特征研究[J];國際檢驗醫(yī)學(xué)雜志;2012年05期

4 虞華珍;蔡衍珊;曾明深;陳志強;葉雙嵐;李小向;;一起恙蟲病暴發(fā)的調(diào)查分析[J];華南預(yù)防醫(yī)學(xué);2007年03期

5 彭志強;鐘豪杰;梁文佳;;廣東省2006—2011年恙蟲病流行病學(xué)分析[J];華南預(yù)防醫(yī)學(xué);2013年01期

6 盧發(fā)勇;唐榮玲;陳俊杰;覃一玲;馮百鈞;;25例恙蟲病合并肺部損傷的臨床分析[J];海南醫(yī)學(xué)院學(xué)報;2011年06期

7 查震球;吳家兵;劉紅;葉冬青;;175例恙蟲病病例的臨床和流行病學(xué)特征研究[J];中華疾病控制雜志;2010年08期

8 何似;謝忠杭;陳陽;陳亮;鄧艷琴;王靈嵐;;福建省2006-2009年恙蟲病流行特征分析[J];中華疾病控制雜志;2011年02期

9 陳香蕊,于強,張永國,牛華,鄭鄉(xiāng)占,張金桐,張雪穎,段桂枝,程聰;山西省恙蟲病調(diào)查與病原學(xué)研究[J];軍事醫(yī)學(xué)科學(xué)院院刊;2000年04期

10 陶開華,吳光華,郭恒彬;我軍恙蟲病流行病學(xué)研究回顧與展望[J];解放軍預(yù)防醫(yī)學(xué)雜志;2003年03期

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