【摘要】：嚴(yán)重急性呼吸綜合征(Serve Acute Respiratory Syndrome,SARS,亦稱傳染性非典型肺炎)是近期出現(xiàn)的一種新發(fā)傳染病。2002年11月在我國廣東佛山市出現(xiàn)第一例病例后,便迅速在全球蔓延,波及到全球30多個國家和地區(qū),其中疫情以我國尤為嚴(yán)重。由于SARS臨床癥狀重、傳染性強,并可通過密切接觸等途徑造成區(qū)域性暴發(fā),因而受到WHO和各國政府的廣泛關(guān)注,我國將其納入法定報告?zhèn)魅静」芾怼２筷犎巳菏且粋�特殊群體,由于部隊的聚集性、流動性的特點很容易發(fā)生疫情并造成區(qū)域內(nèi)的暴發(fā)、流行。因此,掌握部隊人群SARS的流行規(guī)律,是防止疫情在部隊蔓延的關(guān)鍵。本研究利用現(xiàn)場流行病學(xué)、血清流行病學(xué)和分子生物學(xué)技術(shù)相結(jié)合的方法,從SARS傳播鏈分析、抗體變化規(guī)律、病原體動態(tài)監(jiān)測及病毒變異等多角度對部隊人群SARS流行規(guī)律進(jìn)行了系統(tǒng)研究。 首先,針對SARS病例傳播快,易造成區(qū)域性聚集發(fā)病的特點,對部隊3起典型聚集暴發(fā)案例進(jìn)行了描述和分析。從首發(fā)病例(指征病例)入手,追蹤調(diào)查所有在同一傳播鏈中的繼發(fā)病例,用SPSS、Excel等軟件對病例的人群、時間、空間分布進(jìn)行分析,繪制暴露關(guān)系和傳播鏈圖,探討SARS的潛伏期、傳播途徑及暴發(fā)的可能原因。第二,選擇部隊醫(yī)院臨床確診SARS病例、醫(yī)護(hù)人員(高暴露人群)和正常人群(對照),應(yīng)用間接免疫熒光法(IFA)和酶聯(lián)免疫吸附試驗(ELISA)進(jìn)行血清抗SARS—CoV IgG抗體檢測,探討SARS病人發(fā)病后血清抗體產(chǎn)生和變化規(guī)律以及醫(yī)護(hù)人員和正常人群有無隱性感染情況,從而為臨床診斷和開展血清流行病學(xué)調(diào)查提供依據(jù)。第三,本研究從SARS病毒排毒角度進(jìn)行以下幾方面的研究:①確診SARS患者病毒排出途徑及變化規(guī)律研究,通過對不同病程SARS確診病例的糞便、痰液、血液等標(biāo)本的病原體檢測,了解病毒在機體內(nèi)生長與排泄的動態(tài)變化、病毒的排出途徑及期限,為臨床檢驗提供可靠數(shù)據(jù);②病毒檢測陽性病例的排毒持續(xù)時間研究,通過對病毒檢測陽性病例隊列進(jìn)行長期追蹤觀察,持續(xù)檢測標(biāo)本以明確不同標(biāo)本病毒排出持續(xù)時間,并對排毒持續(xù)時間的影響因素進(jìn)行分析,為制定合理的檢疫和隔離期限提供科學(xué)依據(jù)。第四,針對SARS病毒變異較多的特點,縱向上動態(tài)研究病毒變異與不同疾病流行階段間的關(guān)系、病毒在“流行簇”病例間連續(xù)傳播時發(fā)生的變異,同一病人不同發(fā)病階
[Abstract]:Severe Acute Respiratory Syndrome (Serve Acute Respiratory Syndrome,SARS,) is a newly emerging infectious disease. After the first case occurred in Foshan City, Guangdong Province in November 2002, it spread rapidly around the world. Spread to more than 30 countries and regions, especially in China. Because of the serious clinical symptoms of SARS, strong infectivity, and the regional outbreak can be caused by close contact, WHO and the governments of various countries pay more attention to it, so our country has brought it into the management of notifiable infectious diseases. The army crowd is a special group. Because of the aggregation of troops, the characteristic of mobility is very easy to occur epidemic situation and cause the outbreak and epidemic in the region. Therefore, mastering the epidemic rule of SARS is the key to prevent the spread of SARS in the army. In this study, the methods of field epidemiology, seroepidemiology and molecular biology were used to analyze the transmission chain of SARS. The epidemic rule of SARS in army population was systematically studied from the point of view of pathogen dynamic surveillance and virus variation. Firstly, according to the characteristics of rapid transmission of SARS cases and easy to cause regional aggregation, three typical outbreak cases in army were described and analyzed. Starting with the first case (indication case), all secondary cases in the same transmission chain were tracked and investigated. The population, time and space distribution of the case were analyzed with SPSS,Excel software, and the exposure relationship and transmission chain map were drawn. To explore the latent period, transmission pathway and possible cause of SARS outbreak. Secondly, select clinical confirmed cases of SARS in military hospital, medical staff (high exposure population) and normal population (control), use indirect immunofluorescence (IFA) and Elisa (ELISA) to detect anti-SARS-CoV IgG antibody in serum. In order to provide basis for clinical diagnosis and seroepidemiology investigation, the occurrence and change of serum antibody in patients with SARS were discussed, as well as the hidden infection among medical staff and normal population. Third, from the perspective of SARS virus detoxification, the following aspects are studied: 1 the way of virus excretion and its variation in confirmed SARS patients, and the detection of pathogens in feces, sputum, blood and other samples of confirmed cases of SARS with different course of disease. To understand the dynamic changes of virus growth and excretion in the body, the route and duration of virus excretion, and to provide reliable data for clinical examination. (2) study on the duration of virus detoxification in the positive cases of virus detection, through the long-term follow-up observation of the cohort of positive cases of virus detection, the continuous detection of specimens was carried out to determine the duration of virus excretion from different specimens. The factors affecting the duration of detoxification were analyzed to provide a scientific basis for establishing a reasonable quarantine and isolation period. Fourthly, according to the characteristic of SARS virus variation, the relationship between virus variation and different disease epidemic stage is studied in longitudinal dynamic way. The variation of virus in the continuous transmission of "epidemic cluster" cases is different in the same patient.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2004
【分類號】：R82

【共引文獻(xiàn)】

相關(guān)期刊論文 前10條

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4 李，

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