本文選題：小腸結(jié)腸炎耶爾森菌 + 兒童�。� 參考：《中國疾病預防控制中心》2017年碩士論文

【摘要】：目的:掌握致病性小腸結(jié)腸炎耶爾森菌在我國5歲以下兒童的流行特征,確定優(yōu)勢流行型別。了解我國5歲以下兒童感染致病性小腸結(jié)腸炎耶爾森菌的三間分布與臨床特征,為小腸結(jié)腸炎耶爾森菌的臨床診斷與防控策略提供科學依據(jù)。方法:分為基于病原學診斷的總體調(diào)查和專項調(diào)查。總體調(diào)查在全國10個省份的哨點醫(yī)院開展小腸結(jié)腸炎耶爾森菌的病原學監(jiān)測,采集因急性腹瀉就診的病例糞便,進行小腸結(jié)腸炎耶爾森菌的檢測分離與分子分型。專項調(diào)查重點通過一家兒童哨點醫(yī)院開展深入調(diào)查,在總體調(diào)查的基礎(chǔ)上開展病例個案信息調(diào)查,分析小腸結(jié)腸炎耶爾森菌感染病例的三間分布與臨床特征,同時納入一家成人腹瀉病例哨點醫(yī)院形成比較研究。,結(jié)果:1.總體調(diào)查2010—2015年全國10省共計納入5歲以下兒童腹瀉病例7304例,經(jīng)病原學確診共43例病例糞便分離到致病性小腸結(jié)腸炎耶爾森菌,平均感染率為0.59%,3/0:3型小腸結(jié)腸炎耶爾森菌為主要流行型別(41/43)。男性約占全部感染病例2/3(27/43),2歲以下約占全部病例70%(30/43)。85.19%(23/27)參加便常規(guī)檢查的感染病例檢出糞便白細胞。存在三例長期慢性排菌病例,排菌時間最長可達3個月。腹瀉兒童分離到的致病性小腸結(jié)腸炎耶爾森菌多數(shù)(36/43)與豬只或農(nóng)家犬分離菌株具有相同的PFGE帶型,少數(shù)未在動物菌株中發(fā)現(xiàn)一致帶型。與豬或犬菌株具有相同帶型的兒童菌株中,多數(shù)(30/36)與同一省份的豬或犬菌株帶型相同,少數(shù)(6/36)與其他省份的豬菌株帶型一致。我國罕見的4/0:3型菌株與我國流行的3/0:3型菌株P(guān)FGE帶型不存在交叉。2.專項調(diào)查2011—2015年共計納入5歲以下兒童腹瀉病例2127例,成人腹瀉病例1904例,經(jīng)病原學確診共有13例兒童與2例成人病例分離到致病性小腸結(jié)腸炎耶爾森菌,兒童腹瀉病例的感染率(0.61%,13/2127)高于成人(0.11%,2/1904),兒童與成人各有1例2/0:9型感染病例,余為3/0:3型感染。腹瀉兒童與腹瀉成人感染致病性小腸結(jié)腸炎耶爾森菌均不存在年齡、性別或季節(jié)差異。檢出糞便白細胞的腹瀉兒童致病性小腸結(jié)腸炎耶爾森菌感染率(1.79%)高于未檢出糞便白細胞的腹瀉兒童(0.00%);伴有發(fā)熱的腹瀉兒童感染率(2.07%)高于不伴有發(fā)熱的腹瀉兒童(0.42%);感染致病性小腸結(jié)腸炎耶爾森菌的腹瀉兒童比一般腹瀉兒童具有更高的發(fā)熱與糞便白細胞陽性率。成人感染致病性小腸結(jié)腸炎耶爾森菌與發(fā)熱或糞便白細胞無關(guān)。生物1A型小腸結(jié)腸炎耶爾森菌在腹瀉成人的分離率(1.52%)高于5歲以下腹瀉兒童(0.28%),多數(shù)成人(20/29)與全部兒童(6/6)腹瀉病例分離的生物1A型菌株攜帶ystB基因。2歲以上腹瀉兒童的分離率高于2歲以下,5歲以下兒童的夏季分離率高于秋季,兒童腹瀉病例的分離率不存在性別差異;成人腹瀉病例的分離率與年齡、性別或季節(jié)無關(guān)。腹瀉兒童與成人生物1A型菌株的分離率與是否發(fā)熱、糞便是否檢出白細胞無關(guān)。結(jié)論:我國5歲以下兒童致病性小腸結(jié)腸炎耶爾森菌的感染率不亞于發(fā)達國家,流行型別為生物血清型3/0:3型。發(fā)熱與糞便白細胞是腹瀉兒童感染致病性小腸結(jié)腸炎耶爾森菌的臨床特征。屠宰豬和農(nóng)家犬與5歲以下腹瀉兒童感染致病性小腸結(jié)腸炎耶爾森菌密切相關(guān)。目的:初步確認我國致病性耶爾森菌中具有差異性和代表性的小腸結(jié)腸炎耶爾森菌、假結(jié)核耶爾森菌在目前完成圖測序菌株中的系統(tǒng)發(fā)育關(guān)系,尤其是兼具典型的致病性與非致病性小腸結(jié)腸炎耶爾森菌毒力基因表型的aill+ystB+小腸結(jié)腸炎耶爾森菌在三種致病性耶爾森菌中的系統(tǒng)發(fā)育地位。方法:選取具有差異性和代表性的小腸結(jié)腸炎耶爾森菌、假結(jié)核耶爾森菌進行三代完成圖測序、數(shù)據(jù)組裝、全基因組組分分析、功能注釋與比較基因組分析,包括基于核心基因組的系統(tǒng)發(fā)育分析與基于SNP的系統(tǒng)發(fā)育分析。結(jié)果:1.基于核心基因組的系統(tǒng)發(fā)育分析a.在基于核心基因組(1419個單拷貝核心基因的氨基酸序列)的系統(tǒng)發(fā)育樹中,小腸結(jié)腸炎耶爾森菌、鼠疫耶爾森菌、假結(jié)核耶爾森菌之間無交叉。本研究測序的假結(jié)核耶爾森菌與鼠疫耶爾森菌位于同一支,相對于其他假結(jié)核耶爾森菌距離鼠疫耶爾森菌的系統(tǒng)發(fā)育關(guān)系更近。b.小腸結(jié)腸炎耶爾森菌內(nèi),典型的致病性小腸結(jié)腸炎耶爾森菌內(nèi)部存在血清型聚集性。c.小腸結(jié)腸炎耶爾森菌內(nèi),非致病性小腸結(jié)腸炎耶爾森菌與兼具致病性與非致病小腸結(jié)腸炎耶爾森菌毒力基因表型的非典型菌株分為兩支。2.基于SNP的系統(tǒng)發(fā)育分析與基于核心基因組的系統(tǒng)發(fā)育分樹相比,區(qū)別在于:a.本研究測序的假結(jié)核耶爾森菌與鼠疫耶爾森菌分屬兩支,并與NCBI的假結(jié)核耶爾森菌測序株聚為一支。b.典型的致病性小腸結(jié)腸炎耶爾森菌分支內(nèi),0:9血清型菌株QH2011-2-63B位于所有0:3和0:9血清型致病性小腸結(jié)腸炎耶爾森菌的外側(cè)。c.非致病性小腸結(jié)腸炎耶爾森菌聚在非典型菌株分離地菌株的內(nèi)部。結(jié)論:1.小腸結(jié)腸炎耶爾森菌內(nèi)部在既有典型致病性小腸結(jié)腸炎耶爾森菌分支、非致病性小腸結(jié)腸炎耶爾森菌分支的基礎(chǔ)上,新增一支兼具致病性與非致病小腸結(jié)腸炎耶爾森菌毒力基因表型的非典型小腸結(jié)腸炎耶爾森菌分支,該分支與非致病性小腸結(jié)腸炎耶爾森菌的系統(tǒng)發(fā)育關(guān)系更近。2.本研究組測序的假結(jié)核耶爾森菌較其他國家完成圖測序的假結(jié)核耶爾森菌距離鼠疫耶爾森菌的系統(tǒng)發(fā)育關(guān)系更近。
[Abstract]:Objective: to understand the epidemic characteristics of the pathogenic Jerson bacteria under 5 years old in China and determine the dominant epidemic types. To understand the three distribution and clinical characteristics of the pathogenic Jerson bacteria infected with pathogenic small enterocolitis under 5 years of age in China, and provide a scientific basis for the clinical diagnosis and prevention and control strategy of Jerson bacteria enterocolitis. Methods: the general survey and special investigation were conducted on the basis of etiological diagnosis. The overall survey was conducted in the sentinel Hospital of 10 provinces in China to carry out the etiological monitoring of Yersinia enterocolitica, collect the cases of the cases of acute diarrhoea and carry out the detection and separation of yerssinia enterocolitica and the molecular classification. The children's sentinel hospital carried out an in-depth investigation and carried out case case information survey on the basis of the overall survey to analyze the three distribution and clinical features of the cases of Jerson infection of enterocolitis, and to make a comparative study of a sentinel hospital for adult diarrhoea cases. Results: 1. overall survey from 2010 to 2015 in 10 provinces in the whole country included 5 7304 cases of children with diarrhea under the age of age were diagnosed as pathogenic enterocolitis of 43 cases of Jerson bacteria, the average infection rate was 0.59%, and the main epidemic type (41/43) of type 3/0:3 enterocolitis was 41/43. The male accounted for all cases of 2/3 (27 /43), and the total cases were 70% (30/43).85.19% (23/27) under the age of 2. Three cases of chronic chronic bacteria exclusion were found in three cases of chronic chronic bacterial infection, and the longest time for bacteria exclusion was up to 3 months. Most of the pathogenic enterocolitis (36/43) isolated from diarrhoea children (36/43) had the same PFGE band as that of pig or farm dog isolates, and a few were unfound in the animal strains. The majority (30/36) is the same as the pig or dog strain in the same province, and a few (6/36) is the same as the pig strains in other provinces. The rare 4/0:3 strain of our country and the PFGE band of the popular 3/0:3 strain of our country do not have a cross.2. special investigation 2011 to 2015. There were 2127 cases of diarrhea in children under 5 years of age and 1904 cases of adult diarrhea. A total of 13 cases of children and 2 cases of adult cases were isolated to the pathogenic Jerson bacteria. The infection rate of children with diarrhea (0.61%, 13/2127) was higher than that of adults (0.11%, 2/1904). There were 1 cases of 2/0:9 infection in children and adults, and the other was 3/0:3 type. Infection. There was no age, sex or seasonal difference in the prevalence of pathogenic enterocolitis in diarrhoea children and adults with diarrhoea. The incidence of Jerson bacteria infection in diarrhoea children with diarrhoea in fecal leukocytes (1.79%) was higher than that of diarrhoea children who had not detected fecal white blood cells (0%), and the infection rate of diarrhoea children with fever (2.07). %) was higher than non fever diarrhea children (0.42%); the diarrhea children infected with Jerson bacteria of pathogenic enterocolitis had higher fever and fecal leukocyte positive rate than those with general diarrhea. The adult infected Jerson bacteria of the pathogenic enterocolitis were not related to the fever or fecal white cells. The biological 1A type enterocolitis was in the abdomen. The separation rate of diarrhoea (1.52%) was higher than that of children under 5 years of age (0.28%). Most adults (20/29) and all children (6/6) isolated from diarrhoea cases had higher separation rate than 2 years old, and the separation rate of children under the age of.2 was higher than that of 2 years old. The separation rate of children under 5 years old was higher than that in autumn, and the separation rate of children with diarrhea was not present. The separation rate of adult diarrhea cases was independent of age, sex or season. The separation rate of 1A type strains in diarrhoea children and adult organisms was not related to fever and whether the detection of white blood cells in feces. Conclusion: the infection rate of pathogenic Yersinia enterocolitica in children under 5 years of age in our country is no less than that in developed countries, and the epidemic type is the biological sera. Type 3/0:3 type. Fever and fecal leukocytes are the clinical features of Jerson bacteria infected with pathogenic enterocolitis in diarrhoea children. Slaughtered pigs and farm dogs are closely related to the infection of Jerson in children under 5 years of age. Objective: to preliminarily identify the differential and representative small intestinal knot in the pathogenic Jerson bacteria in China. The phylogenetic relationship of the strains of Jerson, Jerson, and Jerson, especially the typical pathogenicity and non pathogenic Jerson's virulence gene phenotype, in the phylogenetic status of Jerson bacteria of aill+ystB+ enterocolitis in three pathogenic yelson bacteria. The difference and representative Jerson bacteria of the enterocolitis and the three generation of Jerson bacterium tuberculosis were sequenced, data assembly, whole genome component analysis, functional annotation and comparative genome analysis, including phylogenetic analysis based on core genome and SNP based phylogenetic analysis. Results 1. the system based on the core genome Phylogenetic analysis A., in the phylogenetic tree based on the amino acid sequences of the core genome (1419 single copy core genes), does not cross between Jerson, Yersinia pestis, and Jerson bacteria. The sequence of this study is the same branch of the sequenced Mycobacterium tuberculosis and the Yersinia pestis, relative to other pseudo tuberculosis. The phylogenetic relationship between ersinia pestis and Yersinia pestis is closer to.B. in the.C. bacteria of.B. enterocolitis. The typical pathogenic enterocolitis of Jerson has a seroaggregated.C. enterocolitis, the non pathogenic Jerson and the non pathogenic and non pathogenic small intestinal colitis. The atypical strains of virulent gene phenotypes were divided into two.2. based SNP based phylogenetic analysis and the phylogenetic tree based on the core genome. The difference was that the A. of Yersinia pestis and Yersinia pestis were divided into two branches, and the sequence of Yersinia pestis from NCBI was a typical pathogenicity of.B.. In the branch of Jerson bacteria of enterocolitis, the 0:9 serotype QH2011-2-63B is located within all 0:3 and 0:9 serotype QH2011-2-63B pathogenic Jerson non pathogenic Jerson bacteria in the atypical isolates. Conclusion: the internal of Jerson bacteria of 1. enterocolitis is typical pathogenicity On the basis of the branching of the Jerson bacteria of enterocolitis and the branch of the non pathogenic enterocolitis, a new branch of atypical enterocolitis, which has both pathogenicity and non pathogenic Jerson's virulence gene phenotypes, is added to the branch of the atypical enterocolitis, which is closely related to the phylogenetic relationship of the non pathogenic Jerson of the enterocolitis, which is more close to.2. In this study, the sequence of the false tuberculosis Jerson bacteria is closer than that of other countries in the phylogenetic relationship between the false tuberculosis Jerson strain and the bacterium Jerson.

【學位授予單位】：中國疾病預防控制中心
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R725.1;R181.3

【參考文獻】

相關(guān)期刊論文 前1條

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