本文選題：附紅細(xì)胞體 + 感染率��； 參考：《浙江大學(xué)》2009年碩士論文

【摘要】： 背景和目的不明原因的血液炎癥、反復(fù)的上呼吸道感染,這些常見的亞健康癥狀,可能是一種人畜共患病—附紅細(xì)胞體感染引起的。根據(jù)現(xiàn)有資料,附紅細(xì)胞體是條件致病性病原體,感染后多為潛伏狀態(tài),在機(jī)體抵抗力下降或處于某些應(yīng)激狀態(tài)(生理性或病理性)時(shí)發(fā)病。在臨床表現(xiàn)上與感冒、瘧疾、貧血等疾病易相混淆,醫(yī)療單位又缺乏特異的實(shí)驗(yàn)診斷手段,致使病例不易被發(fā)現(xiàn)。近些年國內(nèi)剛剛開始報(bào)道這一疾病,而根據(jù)上海近千例白領(lǐng)的體檢報(bào)告,其中有三成人已被感染主要原因是生吃肉食以及外出就餐不潔所致。一般認(rèn)為人類對附紅細(xì)胞體普遍易感,其感染率與性別、年齡無明顯關(guān)系,具有家庭聚集性及一定職業(yè)分布特點(diǎn),獸醫(yī)、奶牛飼養(yǎng)員、屠宰工人、禽獸肉類加工人員等人群感染率高于其他職業(yè)人群。目前,人附紅細(xì)胞體病診斷主要依據(jù)有可疑流行病學(xué)接觸史,出現(xiàn)可疑的臨床癥狀、體征,又難以用其他疾病予以解釋者,加上實(shí)驗(yàn)室檢查有陽性結(jié)果可作為確診的主要依據(jù)。附紅細(xì)胞體病作為一種新發(fā)現(xiàn)的人獸共患病,許多醫(yī)務(wù)工作者對其還較陌生,對其研究還剛起步,從80年代以后國內(nèi)外學(xué)者才對附紅細(xì)胞體感染人畜及其發(fā)病情況研究的越來越多,1986年P(guān)untaric首次報(bào)道了1例人附紅細(xì)胞體病。在我國,1992年首次報(bào)道,隨后在江蘇、河北、廣西、廣東、新疆、甘肅等地均有發(fā)現(xiàn)。 全國有部分地區(qū)針對附紅細(xì)胞體感染的流行情況開展過調(diào)查,結(jié)果表明,各地的感染率差別非常懸殊,在3.27%～97.29%之間。而在浙江省尚未見有關(guān)附紅體感染情況的研究報(bào)道。本研究通過調(diào)查杭州市肉聯(lián)廠的職工和其內(nèi)外對照人群有關(guān)附紅細(xì)胞體感染情況,掌握杭州市特殊人群附紅體感染的比例;初步探討附紅體感染的危險(xiǎn)因素;同時(shí)摸索附紅體感染檢測技術(shù)。該研究結(jié)果有助于了解附紅細(xì)胞體的感染途徑,為相關(guān)部門制訂預(yù)防附紅細(xì)胞體感染的決策提供科學(xué)依據(jù)。 材料與方法根據(jù)文獻(xiàn)復(fù)習(xí)結(jié)果,結(jié)合杭州市的實(shí)際,根據(jù)估計(jì)附紅細(xì)胞體感染率約30%,容許誤差0.2P,以及顯著性水平為P=0.05,計(jì)算外對照人群樣本量約為233人。該人群要求為杭州在杭州持續(xù)居住半年以上,接受調(diào)查時(shí)未患急性疾病或未處于疾病急性期,采集血樣并做問卷調(diào)查。職業(yè)人群根據(jù)調(diào)查時(shí)在崗人員符合條件者納入。特定人群1:杭州市肉類聯(lián)合加工廠直接進(jìn)行屠宰、去毛、開膛、分割、包裝等接觸生肉類的工作。特定人群1內(nèi)對照:杭州市肉類聯(lián)合加工廠未直接進(jìn)行屠宰、去毛、開膛、分割、包裝等接觸生肉類的工作的人員,包括管理科室、銷售、后勤等人員。特定人群2:杭州市奶業(yè)有限公司接觸活畜人群,包括擠奶工、畜類飼養(yǎng)員及獸醫(yī)。 使用調(diào)查問卷調(diào)查研究對象在被調(diào)查前一年內(nèi)所居住地區(qū)域(城區(qū)、城鄉(xiāng)結(jié)合部、郊區(qū)、農(nóng)村)、家中飼養(yǎng)寵物情況、接觸家畜(豬、牛、羊等)產(chǎn)品情況、接觸后及時(shí)洗手情況、使用洗滌劑或肥皂洗手情況、接觸時(shí)手、臂皮膚破損情況、接觸時(shí)手部防護(hù)情況、食用肉類情況、食用頻率、肉類的烹飪方式、食用未熟透的肉類情況、在外就餐情況、常外出就餐的場所、以及患有慢性病、發(fā)熱、貧血情況。 采集研究對象靜脈血標(biāo)本2ml,將采集到的血液壓制成血涂片,姬-瑞氏快速液染色、鏡檢。 陽性判定標(biāo)準(zhǔn):以同一個(gè)視野中發(fā)現(xiàn)符合附紅細(xì)胞體特征的為陽性。 統(tǒng)計(jì)分析方法:數(shù)據(jù)采用Epidata平行雙錄入,并設(shè)置核查及邏輯檢錯(cuò)。使用Spss13.0軟件進(jìn)行統(tǒng)計(jì)分析。使用描述性統(tǒng)計(jì)方法對資料的基本情況進(jìn)行描述,使用卡方檢驗(yàn)對分類資料進(jìn)行統(tǒng)計(jì)分析,使用非條件Logistic回歸篩選危險(xiǎn)因素。 結(jié)果本次研究共調(diào)查了580人,其中外對照人群351人,肉聯(lián)廠從事屠宰等操作的工人64人,肉聯(lián)廠內(nèi)對照118人,畜牧場工人35名,獸醫(yī)12名。經(jīng)染色鏡檢,共檢出附紅體感染者共54名,總體陽性率為9.31%。其中外對照人群感染率為7.12%(25/351),肉聯(lián)廠從事屠宰等操作工感染率20.31%(13/64);畜牧場工人、獸醫(yī)染率21.28%(10/47),三者感染率之間有統(tǒng)計(jì)學(xué)差異(x2=14.45,P＜0.05)。 外對照人群各年齡組感染率無顯著差異(Fisher精確檢驗(yàn),P＞0.05);未發(fā)現(xiàn)男性和女性附紅體感染率有差異(x2=1.179,P＞0.05);未發(fā)現(xiàn)不同季節(jié)附紅體感染率存在不同(Fisher精確檢驗(yàn),P＞0.05);城區(qū)、城鄉(xiāng)結(jié)合部、郊區(qū)及農(nóng)村人群感染率也沒有明顯差異(Fisher精確檢驗(yàn)P＞0.05);感染率從小學(xué)級別到大學(xué)級別逐漸降低,但經(jīng)過趨勢卡方檢驗(yàn),無統(tǒng)計(jì)學(xué)意義(x2=2.98,P＞0.05);人群中未養(yǎng)寵物者(主要指犬、貓等常見寵物)及豢養(yǎng)寵物者的感染率差異無顯著性(x2=0.82,P＞0.05);接觸動(dòng)物皮毛、生肉、動(dòng)物排泄物等的人群附紅體感染率與不接觸的人群并無統(tǒng)計(jì)學(xué)差異(x2=0.178,P=0.67),但是接觸后及時(shí)洗手的人群感染率則低于不及時(shí)洗手的人群無統(tǒng)計(jì)學(xué)意義(x2=11.36,P＜0.05);而以肥皂等清潔用品洗手的人群感染率低于只用水洗手的人群(x2=6.76,P＜0.05);在日常生活中與動(dòng)物皮毛、排泄物、生肉等的接觸時(shí)是否受傷對附紅體感染沒有明顯的影響(x2=0.033,P＞0.05);另外,分析發(fā)現(xiàn),經(jīng)常食用牛肉、羊肉、豬肉或者雞肉的人群附紅體感染率與不食用者無統(tǒng)計(jì)學(xué)差異。食用肉類頻率不同的人群感染率也無統(tǒng)計(jì)學(xué)差異。食用生或者半生的肉類人群的感染率與未食用者感染率無統(tǒng)計(jì)學(xué)差異。在外就餐情況與附紅體感染無顯著性差異。選取該人群中附紅體陽性感染者作為病例,未感染者作為對照,進(jìn)行Logistic回歸分析。暫未發(fā)現(xiàn)居住區(qū)域、豢養(yǎng)寵物、接觸動(dòng)物皮毛、生肉、動(dòng)物排泄物等、以及外傷、就餐情況等為附紅體感染的危險(xiǎn)因素。而發(fā)現(xiàn)文化程度越高者比文化程度低者感染附紅體的危險(xiǎn)性要小,但結(jié)果有待進(jìn)一步驗(yàn)證。 本次使用的改良瑞氏-姬氏快速染色法,與其他染色法比較,陽性檢出率較高,染色背景清晰,雜質(zhì)較少,具有對胞漿和核的染色效果好,層次對比非常明顯,結(jié)構(gòu)更為清晰,容易辨認(rèn),染色速度快等優(yōu)點(diǎn)。 結(jié)論此次調(diào)查初步掌握了杭州地區(qū)附紅體感染情況,了解了杭州市人群附紅體感染的危險(xiǎn)因素,確定附紅體感染的高危人群;通過比較確定了改良的瑞氏-姬氏快速染色法為較優(yōu)的實(shí)驗(yàn)室檢驗(yàn)方法,并根據(jù)調(diào)查結(jié)果提出采取針對性預(yù)防措施。
[Abstract]:In recent years , it has been reported in 1992 that there is no obvious relationship between the infection rate and the sex and age , and it is not easy to be explained . In the past few years , it has been reported in 1992 that the infection rate and sex and age are not obvious . In our country , the first report in 1992 has been reported in 1992 , and then in Jiangsu , Hebei , Guangxi , Guangdong , Xinjiang , Gansu and so on .



The prevalence of red blood cell infection was investigated in some parts of China . The results showed that the infection rate was very different from 3.27 % to 97.29 % .



Materials and Methods According to the literature review results , according to the actual situation of Hangzhou , according to the estimated rate of infection rate of the attached red cell body is about 30 % , the allowable error is 0 . 2P , and the significance level is P = 0.05 , and the sample size of the external control population is about 233 . The specific group 1 : Hangzhou meat joint processing plant is not directly slaughtered , dehaired , opened , divided , packaged and so on to contact raw meat . The specific group 2 : Hangzhou Milk Industry Co . , Ltd . is in contact with the live animal population , including milking workers , livestock keepers and veterinary .



Use survey questionnaires to study the situation of the objects in the areas of residence ( urban , rural , suburban , rural ) , home - fed pets , contact domestic animals ( pigs , cattle , sheep , etc . ) within one year prior to the investigation , wash hands in time after exposure , use detergent or soap to wash hands , contact with hands , arm skin damage , contact with hand protection , eating meat , eating frequency , cooking mode of meat , eating uncooked meat , eating outside meals , frequent absence of meals , and people suffering from chronic diseases , fever , and anemia .



2 ml of venous blood from the study object were collected , and the collected blood was pressed into a blood smear , and the Agaricus Blaise rapid liquid staining and microscopic examination were performed .



Positive criteria : positive in the same field of view were found to be consistent with the characteristics of the red blood cells .



Statistical analysis method : Epidata parallel double entry is adopted , and verification and logical error detection are set up . Spss13.0 software is used for statistical analysis . Descriptive statistics method is used to describe the basic condition of the data , and the classification data is statistically analyzed by using the Chi - square test , and the risk factors are screened using non - conditional logistic regression .



Results The total positive rate was 9.31 % . The infection rate was 7.12 % ( 25 / 351 ) and 21.28 % ( 10 / 47 ) in meat factory . There was a significant difference between the infection rates among the three ( x2 = 14.45 , P < 0.05 ) .



There was no significant difference in the rate of infection between male and female ( x2 = 1.179 , P > 0.05 ) . There was no significant difference in the rate of infection among people with different seasons ( x2 = 6.76 , P > 0.05 ) . The higher the cultural degree , the higher the risk of infection with the red body , but the results need to be further verified .



Compared with other dyeing methods , the modified Rayleigh - Ji ' s fast staining method has the advantages of high positive detection rate , clear dyeing background , less impurities , good dyeing effect on cytoplasm and core , obvious hierarchy comparison , clearer structure , easy identification , quick dyeing speed and the like .



Conclusion The investigation has preliminarily mastered the situation of red body infection in Hangzhou area , the risk factors of red body infection in Hangzhou population , the determination of the high - risk population with red - body infection , and the comparison of the improved method for laboratory test with the improved reeldrin - Ji ' s fast staining method , and put forward the targeted preventive measures according to the results of the investigation .

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2009
【分類號】：R181.3

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