【摘要】： 目的分析合肥市流行性腦脊髓膜炎流行特征、臨床表現與實驗室檢測結果,為臨床診治提供依據;并建立流腦疫情預測模型GM(1,1),探討其應用于預測流腦發(fā)病率的可行性。同時探討氣象因素與流行性腦脊髓膜炎發(fā)病的關系,為實施流腦的預防和控制策略提供科學依據。 方法描述流行病學方法分析和回顧性分析合肥市2003-2007年流腦疫情資料;根據合肥市2002-2006年流腦發(fā)病率數據建立流腦發(fā)病率預測灰色模型GM(1,1),并做擬合效果檢驗,外推預測2007年合肥市流腦發(fā)病率,從而評價合肥市2007年流腦防制效果。運用描述性流行病學方法和回歸分析研究合肥地區(qū)2003-2007年流行性腦脊髓膜炎發(fā)病率與相關氣象影響因素(氣溫、降水量、日照時數和相對濕度)。將合肥市2003-2007年流行性腦脊髓膜炎月平均發(fā)病數據進行分析,對可能影響流行性腦脊髓膜炎發(fā)病的氣溫、降水量、日照時數和相對濕度4項研究變量進行單因素相關分析和多元逐步分析。 結果 1.合肥市2003-2007年累積發(fā)病394例,其中2007年度發(fā)病率最高(2.84/10萬);經實驗室確診共130例(33.0%),結果均為C群;病例年齡中位數為14.32歲(最小為2個月,最大為78歲),發(fā)病率最高年齡組為15-19歲組(6.04/10萬),該年齡組病例占總病例的比例也最高(29.11%);在校學生占所有病例的50.80%,并且在校學生發(fā)病構成比逐年上升,2007年占57.58%;冬春季發(fā)病高峰明顯,80.9%的病例發(fā)生在1-4月份;共發(fā)生21起(56例)聚集性流腦疫情,8起發(fā)生在學校,其中職業(yè)學校4起,實驗室結果顯示均是C群。 2.首發(fā)癥狀以發(fā)熱+頭暈+嘔吐,發(fā)熱+頭暈,僅發(fā)熱為主,分別占23.6%、12.4%、10.9%,發(fā)病后在首次在私人門診就診的占11.2%,鄉(xiāng)鎮(zhèn)衛(wèi)生院占3.8%,縣級醫(yī)療機占17.5%,市級醫(yī)療機構占29.9%,省級醫(yī)療機構占36.3%,不詳者占1.3%,暴發(fā)病例與散發(fā)病例在首次就診不同單位的構成比有統(tǒng)計學差異(P0.05);普通型占79.66%,暴發(fā)型占19.31%,輕型占1.03%,對其中C群病例分型結果顯示普通型占81.73%,暴發(fā)型占17.31%,輕型占0.97%,C群和所有病例的臨床分型差異無統(tǒng)計學意義(P0.05);臨床癥狀主要有發(fā)熱、嘔吐、惡心、頸項強直、劇烈頭痛、皮膚瘀點瘀斑、皮膚出血點和神志不清,構成比均超過50%,布氏征在所有病例和C群病例的分布有統(tǒng)計學差異(P0.05); 3. 8例出現血白細胞數下降,其中C群流腦占2例,15例出現血中性粒細胞數下降,其中C群流腦占3例;死亡病例有2例出現了血中性粒細胞數下降。 4.流腦發(fā)病率預測模型為Yt = 0. 49927e0 .556t?0.40827,經擬合檢驗,模型擬合精度好(C=0.2931,P=1.00)。利用本模型對合肥市2007年流腦發(fā)病率進行外推,估計2007年合肥市流腦發(fā)病率為5.985/100 000,實際發(fā)病率為2.84/100 000,降幅達210.8%。 5.流腦的發(fā)病與氣溫和相對濕度呈顯著負相關,回歸方程為:Y=9.015-0.747 x1+0.067x4,x1和x4分別代表氣溫和相對濕度。 結論C群代替了A群成為合肥市近幾年的流行優(yōu)勢菌株,并引起流腦疫情的反彈上升,病例年齡分布出現上移趨勢,需要進一步的監(jiān)測研究。C群流腦在首發(fā)癥狀、臨床分型、臨床表現等方面并沒有發(fā)現比所有病例嚴重;流腦病例中出現了血白細胞和中性粒細胞數下降的現象,值得我們關注。該模型較好地擬合了合肥市流腦發(fā)病趨勢,預測結果具有一定的參考價值。2007年合肥市流腦實際發(fā)病率遠遠低于預測值,提示我市流腦防治工作取得了明顯的效果。氣溫和相對濕度成為影響流腦發(fā)病的主要氣象因素。氣象因素可以對流腦的發(fā)病起到一定的預測作用。
[Abstract]:Objective to analyze the epidemic characteristics of epidemic cerebrospinal meningitis in Hefei, to provide the basis for clinical diagnosis and treatment, and to establish a prediction model of epidemic cerebrospinal meningitis (GM (1,1)), and to explore the feasibility of its application in predicting the incidence of epidemic cerebrospinal meningitis. A scientific basis for the prevention and control strategy is provided.
Methods descriptive epidemiological methods were used to analyze and retrospective analysis the data of 2003-2007 year epidemic cerebrospinal epidemics in Hefei. According to the data of the 2002-2006 year cerebrovascular incidence in Hefei, the grey model GM (1,1) was set up, and the fitting effect was tested. The incidence of flow brain in Hefei in 2007 was extrapolated to evaluate the prevention and control of the flow of brain in Hefei in 2007. The incidence of 2003-2007 year epidemic cerebrospinal meningitis in Hefei area and related meteorological factors (temperature, precipitation, sunshine hours and relative humidity) were studied by descriptive epidemiological method and regression analysis. The data of monthly average incidence of meningitis in 2003-2007 years in Hefei city were analyzed, which could affect the prevalence of epidemic cerebrospinal meningitis. Single factor correlation analysis and multivariate stepwise analysis were conducted on 4 variables, including temperature, precipitation, sunshine duration and relative humidity, in cerebrospinal meningitis.
Result
1. there were 394 cases of cumulative incidence in Hefei for 2003-2007 years, of which the incidence of 2007 was the highest (2.84/10 million); 130 cases (33%) were confirmed by laboratory diagnosis. The results were all C group; the median age of case age was 14.32 years (the smallest was 2 months, the largest was 78 years old), the highest incidence was in the 15-19 years group of 15-19 years (6.04/10 million), and the proportion of the age group was also the proportion of the total cases. The highest (29.11%); the students accounted for 50.80% of all cases, and the incidence of school students increased year by year, accounting for 57.58% in 2007; in winter and spring, the peak of incidence was obvious and 80.9% of the cases occurred in 1-4 months; 21 (56 cases) had aggregated epidemic cerebrospinal epidemics, 8 of them occurred in school, of which the vocational schools were 4, the laboratory results showed C groups.
2. first symptoms were fever + dizziness + vomiting, fever + dizziness, fever + dizziness, fever and dizziness, only fever, accounting for 23.6%, 12.4%, 10.9% respectively, 11.2% in the private clinic, 3.8% in township hospitals, 17.5% in township hospitals, 29.9% in the municipal medical institutions, 36.3% in the provincial medical institutions, 1.3% at the provincial level, 1.3% of the unknown, and the outbreaks of cases and sporadic cases were the first in the first The composition ratio of the different units was statistically different (P0.05), the common type accounted for 79.66%, the violent style accounted for 19.31%, and the light accounted for 1.03%. The classification results of C group cases showed that the common type was 81.73%, the violent style accounted for 17.31%, and the light accounted for 0.97%. The clinical classification difference between the C group and all cases was not statistically significant (P0.05); clinical symptoms mainly had fever, vomiting. Vomiting, nausea, neck ankylosis, severe headache, skin ecchymosis, skin bleeding point and unconsciousness were more than 50%, and the distribution of brucellus sign in all cases and C group cases was statistically different (P0.05).
The number of blood leucocyte decreased in 3.8 cases, of which 2 cases were C group and 15 cases of blood neutrophils decreased, of which 3 cases were C group and 2 cases of death cases had the decrease of blood neutrophil number.
4. Yt = 0. 49927e0.556t? 0.40827, after fitting test, the model fitting accuracy is good (C=0.2931, P=1.00). Using this model to extrapolate the incidence of Hefei in 2007, the incidence of Hefei is estimated to be 5.985/100 000, the actual incidence of 2.84/100 000, a decrease of 210.8%.
5. there was a significant negative correlation between the incidence of cerebrospinal meningitis and temperature and relative humidity. The regression equation was Y=9.015-0.747 x1+0.067x4, X1 and X4 respectively representing temperature and relative humidity.
Conclusion C group instead of A group became the dominant strain of Hefei in recent years, and caused the bounce of epidemic cerebrospinal epidemics, the age distribution of cases increased, and further monitoring and study of the first symptoms, clinical typing and clinical manifestations of.C group were not more serious than all cases. The decline of white blood cells and neutrophils is worthy of our attention. This model is better fitting the trend of the epidemic in Hefei. The prediction results have a certain reference value in.2007 years in Hefei, the actual incidence of the flow of brain in the city is far below the predicted value, suggesting that the prevention and control of the flow of brain in our city has achieved obvious effect. Meteorological factors may play a certain role in predicting the incidence of epidemic cerebrospinal meningitis.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2009
【分類號】：R515.2;R181.3

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