浙江省鼠及主要鼠传疾病综合监测试点研究

目的 探索病媒生物及相关疾病综合监测模式.方法 在浙江省选择2个病媒生物监测点进行现场研究,整合鼠及鼠疫、肾综合征出血热(HFRS)和钩端螺旋体病(钩体病)监测方案,协调机构和人员在市和县两个层面上开展综合监测;鼠类综合监测时间为2009年6、8、10月,采用鼠笼法捕鼠.结果 在浙江省丽水市和龙游县完成鼠密度、季节消长和鼠传疾病综合监测.2009年丽水市报告钩体病3例,发病率为0.13/10万,HFRS 58例,发病率为2.44/10万;龙游县报告钩体病2例,发病率为0.49/10万,HFRS 1例,发病率为0.25/10万.两地区均无鼠疫病例报告.丽水市共捕获鼠类91只,鼠密度为4.17%;龙游县捕获鼠类37只,鼠密度为1.18%.丽水市以黑线姬鼠为主,龙游县以黄胸鼠为主.丽水市对493只鼠进行媒介昆虫监测,染蚤鼠共51只,染蚤率为10.34%.两地区鼠疫病原学及血清学监测结果均为阴性.丽水市HFRS抗原阳性率为10.42%,明显高于龙游县的4.59%.两地阳性鼠种均为黑线姬鼠.龙游县鼠血标本HFRS抗体阳性率为3.70%;丽水市鼠肾培养钩体阴性,龙游县鼠肾钩体阳性率为0.98%;龙游县鸭血钩体抗体阳性率为80%.结论 对鼠群及鼠疫、HFRS和钩体病开展病媒生物综合监测是可行的,建议加强鼠及鼠传疾病综合监测.     

浙江省鼠及主要鼠传疾病综合监测试点研究

目的 探索病媒生物及相关疾病综合监测模式.方法 在浙江省选择2个病媒生物监测点进行现场研究,整合鼠及鼠疫、肾综合征出血热(HFRS)和钩端螺旋体病(钩体病)监测方案,协调机构和人员在市和县两个层面上开展综合监测;鼠类综合监测时间为2009年6、8、10月,采用鼠笼法捕鼠.结果 在浙江省丽水市和龙游县完成鼠密度、季节消长和鼠传疾病综合监测.2009年丽水市报告钩体病3例,发病率为0.13/10万,HFRS 58例,发病率为2.44/10万;龙游县报告钩体病2例,发病率为0.49/10万,HFRS 1例,发病率为0.25/10万.两地区均无鼠疫病例报告.丽水市共捕获鼠类91只,鼠密度为4.17%;龙游县捕获鼠类37只,鼠密度为1.18%.丽水市以黑线姬鼠为主,龙游县以黄胸鼠为主.丽水市对493只鼠进行媒介昆虫监测,染蚤鼠共51只,染蚤率为10.34%.两地区鼠疫病原学及血清学监测结果均为阴性.丽水市HFRS抗原阳性率为10.42%,明显高于龙游县的4.59%.两地阳性鼠种均为黑线姬鼠.龙游县鼠血标本HFRS抗体阳性率为3.70%;丽水市鼠肾培养钩体阴性,龙游县鼠肾钩体阳性率为0.98%;龙游县鸭血钩体抗体阳性率为80%.结论 对鼠群及鼠疫、HFRS和钩体病开展病媒生物综合监测是可行的,建议加强鼠及鼠传疾病综合监测.     

浙江省龙泉市汉坦病毒宿主动物自然感染状况研究

目的 调查浙江省龙泉市肾综合征出血热(HFRS)疫源地小动物中汉坦病毒(HV)的自然感染情况及其流行的基因型.方法 用鼠笼在龙泉市查田镇、小梅镇、小梅镇黄南村捕鼠.捕获的小动物进行分类鉴定并解剖取肺脏,用间接免疫荧光法(IFA)检测肺组织中HV抗原,用RT-PCR对HV抗原阳性的样本扩增部分S片段核苷酸序列并测序,构建系统发生树进行基因分型.结果 共捕获小动物319只,其中野外312只,室内7只.黑线姬鼠和东方田鼠为野外优势鼠种.肺组织标本中共检测到9份抗原阳性,带病毒率为4.97%,用部分S片段(620～999nt)的核苷酸序列构建系统发生树,结果表明均为汉滩病毒(HTNV),并与Z251分离株的亲缘关系最近.结论 龙泉市野外主要存在以黑线姬鼠为宿主的HTNV感染,且携带率较高.

Abstract：

Objective To investigate the situation of the natural infection of hantaviruses (HV) in small mammals and to provide evidence for the control and prevention of hemorrhagic fever with renal syndrome (HFRS) in Longquan area,Zhejiang province. Methods Small mammals were captured by night trap, and lung tissue samples were collected and stored in liquid nitrogen. HV antigens were detected by indirect immuno-fluorescence assay (IFA). The partial S genome segment sequences were amplified by RT-PCR. DNAStar program was used for editing and comparing the sequences. Phylogeny was analyzed through PAUP*4.0 software. Results 319 small animals were collected in Longquan, and 9 hantavirus antigen-positive samples were identified. The positive rate of hantavirus in Apodemus agrarius was 4.97% . Phylogenetic tree constructed by partial S segment (620-999 nt) showed that the 9 strains carried by A agrarius from Longquan all belonged to HTNV,and had a closer evolutionary relationship with isolate Z251 from Zhejiang province. Conclusion Our results indicated that the main host was A. agrarius and the infection rate of HTNV was high in Longquan area.     

诺维本与顺铂治疗非小细胞肺癌

To evaluate the effect by “standard/chem otherapy with navelbine (NVB) plus cisplatin (PDD) in the treatment of nonsm all cell lung cancer (NSCLC). ”Methods There were 40 NSCLC patients in this study. 38 were male and 2 female. The median age of the patients was 52 years old. Squam ous carcinom a was the most conmon type of malignancy (36 cases).Sixteen patients were inthe stage Ⅲ a and 20 patients in stage Ⅲb-Ⅳ Twenty patients had no prior chemotherapy and 20 received previous chemotherapy. Results Complete response was observed in 4 patients and partial response in 15 patients. The overall response rate was 47.5 %. The response rate of the primary chemothera-py was 60%. The secondary chemotherapy was 35%. The main toxity of NVB was neutropenia which was seen in all treated cases (80.5 % in Grade Ⅱ and Ⅲ) The local venous toxity was observed in 35 % of the patients. Conclusion The so-called standard chemotherapy with NVB plus PDD in the treatment of NSCLC may obtain a higher response rate and lower toxity. It is effective especially for the patients of in an earlier stage.     

浙江省嘉兴地区初孕妇女自然流产状况研究

Objective To study the current status of spontaneous abortion of primigravid women in Jiaxing areas of Zhejiang province of China. Methods We analyzed the data from both perinatal healthcare surveillance program and spontaneous abortion, collected in Jiaxing areas by the Institute of Reproductive and Child Health, Peking University. The study population consisted of 14 769 primigravid women (excluding induced abortion, ectopic pregnancy and molar pregnancy as outcomes) attempting to become pregnant who registered between 1993 and 1995. Results 1454 spontaneous abortion cases were identified, with the spontaneous abortion rate as 9.8% (95% CI:9.3%-10.3%). The mean gestational weeks at pregnancy diagnosis were 7.6±2.1 weeks, the mean gestational weeks at miscarriage were (10.1±3.1) weeks and the incidence of first-trimester (≤12 weeks) spontaneous abortion was 7.3%(95%CI: 6.8%-7.7%), accounting for 73.7% of all the spontaneous abortion cases. A peak for risk of miscarriage was around 8-13 weeks, accounting for 37.7% of all spontaneous abortion. The observed multiple Cox regression model showed that increased spontaneous abortion rates were observed in women with age at pregnancy ≥30, being peasants and with higher education level. Conclusion The spontaneous abortion rate of primigravid women in Jiaxing areas was higher than in other areas of China. The maximum occurrence of spontaneous abortions was during period of 8-13 gestation weeks.     

自身免疫性肝炎与病毒性肝炎的临床病理特点对照研究

Objective To explore the character of clinical manifestations and liver pathological features of autoimmune hepatitis (AIH) and improve the diagnostic accuracy in early stage of AIH patients. Methods 78 patients with AIH,31 patients with acute viral hepatitis(AH) and 31 patients with chronic hepatitis B (CHB) were collected. The liver function and immunoglobulins were compared among them as well as the comparison of chronic and acute onset AIH groups. A part of patients underwent liver, biopsy and HBsAg immunohistochemistry examination. Results AIH patients were dominated by female (94.87%) over 40 years old (78.21%). The level of AST/ALT, γ-glutamyl transferase (CGT), alkaline phosphatase(ALP), IgG, IgM and γ-globulin in AIH group were significantly higher than those in CHB and AH groups. Furthermore, the level of γ-globulin in chronic AIH group was higher than that in acute onset AIH group (P< 0.05). The positive rate of smooth muscle antibody(SMA) was 6.41%, and the positive rate of anti-nuclear antibody(ANA) was 79.49% in AIH patients. There was no difference in the titer of ANA between acute and chronic AIH groups(P> 0.03). Regarding the appearance of liver pathology, it was easy to distinguish AIH from AH, but difficult to differentiate AIH from CHB. liver tissues, loose degeneration, spotty necrosis and piecemeal necrosis accompanying with bridging necrosis were very common in AM. There were great numbers of lymphocyte infiltration in portal area that was often accompanied with varying degrees of fibrosis. The degree of hepatic inflammation and fibrosis were similar in acute and chronic AIH ( P > 0.05). Ihe degree of hepatic lesions in 2 AIH patients suffered with subacute liver failure didn' t agree with the severe clinical manifestations. Conclusions AIH patients are dominated with female over 40-year-old who often accompanied with elevation of AST/ALT, GGT, ALP and y-globulin as well as the appearance autoantibodies. The appearance of liver pathology is multiplicity that piecemeal of necrosis accompanying with bridging necrosis and lymphocytes infiltration is common. The degree of hepatic lesions is similar in aeute and chronic AIH. It's important to check the liver tissue for diagnose in early stage correctly.     

自身免疫性肝炎与病毒性肝炎的临床病理特点对照研究

Objective To explore the character of clinical manifestations and liver pathological features of autoimmune hepatitis (AIH) and improve the diagnostic accuracy in early stage of AIH patients. Methods 78 patients with AIH,31 patients with acute viral hepatitis(AH) and 31 patients with chronic hepatitis B (CHB) were collected. The liver function and immunoglobulins were compared among them as well as the comparison of chronic and acute onset AIH groups. A part of patients underwent liver, biopsy and HBsAg immunohistochemistry examination. Results AIH patients were dominated by female (94.87%) over 40 years old (78.21%). The level of AST/ALT, γ-glutamyl transferase (CGT), alkaline phosphatase(ALP), IgG, IgM and γ-globulin in AIH group were significantly higher than those in CHB and AH groups. Furthermore, the level of γ-globulin in chronic AIH group was higher than that in acute onset AIH group (P< 0.05). The positive rate of smooth muscle antibody(SMA) was 6.41%, and the positive rate of anti-nuclear antibody(ANA) was 79.49% in AIH patients. There was no difference in the titer of ANA between acute and chronic AIH groups(P> 0.03). Regarding the appearance of liver pathology, it was easy to distinguish AIH from AH, but difficult to differentiate AIH from CHB. liver tissues, loose degeneration, spotty necrosis and piecemeal necrosis accompanying with bridging necrosis were very common in AM. There were great numbers of lymphocyte infiltration in portal area that was often accompanied with varying degrees of fibrosis. The degree of hepatic inflammation and fibrosis were similar in acute and chronic AIH ( P > 0.05). Ihe degree of hepatic lesions in 2 AIH patients suffered with subacute liver failure didn' t agree with the severe clinical manifestations. Conclusions AIH patients are dominated with female over 40-year-old who often accompanied with elevation of AST/ALT, GGT, ALP and y-globulin as well as the appearance autoantibodies. The appearance of liver pathology is multiplicity that piecemeal of necrosis accompanying with bridging necrosis and lymphocytes infiltration is common. The degree of hepatic lesions is similar in aeute and chronic AIH. It's important to check the liver tissue for diagnose in early stage correctly.     

四川省青海田鼠疫源地媒介蚤的研究

目的 分析2000-2008年四川省青海田鼠疫源地媒介蚤各指标的变化.方法 统计分析四川省2000-2008年鼠疫监测工作资料.结果 青海田鼠疫源地存在蚤类4科10属19种,以细钩盖蚤为主(62.79%),直缘双蚤指名亚种次之(30.90%);青海田鼠寄生蚤染蚤率和蚤指数有明显的季节变化,10月染蚤率及蚤指数较高,12月和3月则较低;可自然感染鼠疫的蚤类有3种(细钩盖蚤、直缘双蚤指名亚种和五侧纤蚤邻近亚种).结论 青海田鼠疫源地染疫动物和蚤类持续存在,应加强鼠疫监测.

Abstract：

Objective To analyzed the variant information on the indices regarding fleas from natural foci of Microtus plague in Sichuan epidemic area during 2000 to 2008.Methods Statistical and analytical methods were used on the surveillance data regarding Microtus fuscus plague.Results There were 19 flea species identified and the share of Callopsylla sparsilis was 62.79 percent while the share of Amphipsylla tuta tuta was 30.90 percent on Microtus fuscus plague.The infection rate of fleas and the flea index were the highest in October and the lowest in December and March.Species as Callopsylla sparsilis,Amphipsylla tuta tuta and Rhadinopsylla dahurica vicina could naturally infect the Yersinia pestis.Conclusion Microtus fuscus plague could become epidemic when animals and flea species were infected.We should emphasis on plague monitoring program so as to prevent the occurrence of the disease.     

粤东地区四种性传播疾病病原感染的流行状况

Objective To investigate the infection situation of Ureaplasma urealyticum, Nersseria gonorrhoeae, Chlamydia trachomatis and HSV- Ⅱ among the people in east Guangdong. Methods 4404 cases of out-patients with self-clinical symptoms or suspicious reproductive tract infection were selected as study subject and were examined for UU, NG, CT and HSV- Ⅱ . Results Among the 4404 cases, 864 cases were UU positive(41.90%), 72 were NG positive (10.70%), 192 were CT positive(12.90%) and 24 were HSV-Ⅱ positive(12.90%). Of the 1152 cases of above positive patients, the highest infection rate was in the patients of 20 to 40 years old(86.55%), and the females were ob-viously higher than the males. Conclusions In the people of east Guangdong, the situation of UU, NG, CT and HSV- Ⅱ infection was severe, especially in 20 to40 ages.It is very important to detect the sex transmitted disease agents in high risk people and is also the key link to control UU, NG, CT and HSV- Ⅱ infection.     

粤东地区四种性传播疾病病原感染的流行状况

Objective To investigate the infection situation of Ureaplasma urealyticum, Nersseria gonorrhoeae, Chlamydia trachomatis and HSV- Ⅱ among the people in east Guangdong. Methods 4404 cases of out-patients with self-clinical symptoms or suspicious reproductive tract infection were selected as study subject and were examined for UU, NG, CT and HSV- Ⅱ . Results Among the 4404 cases, 864 cases were UU positive(41.90%), 72 were NG positive (10.70%), 192 were CT positive(12.90%) and 24 were HSV-Ⅱ positive(12.90%). Of the 1152 cases of above positive patients, the highest infection rate was in the patients of 20 to 40 years old(86.55%), and the females were ob-viously higher than the males. Conclusions In the people of east Guangdong, the situation of UU, NG, CT and HSV- Ⅱ infection was severe, especially in 20 to40 ages.It is very important to detect the sex transmitted disease agents in high risk people and is also the key link to control UU, NG, CT and HSV- Ⅱ infection.     

2009年安义县肾综合征出血热监测研究

目的了解安义县2009年肾综合征出血热（hemorrhagic fever with renal syndrome,HFRS）的流行特征,为防治提供科学依据。方法对安义县2009年HFRS疫情及宿主动物监测资料进行分析。结果 2009年安义县HFRS发病率5.47/10万,无死亡病例。病人以青壮年农民为主。捕获鼠类7种240只,其中居民区鼠密度为7.99%,以小家鼠、黄胸鼠为优势鼠种;野外鼠密度为7.61%,野外鼠以黑线姬鼠、黄毛鼠为优势鼠种。鼠带毒率为0.83%,均检自野外鼠黑线姬鼠,鼠血总抗体阳性率为4.58%。结论安义县HFRS发病上升较快,加强疫情监测,大力开展灭鼠工作,提高人群免疫力,控制HFRS的发病率回升。     

2007年安义县肾综合征出血热监测分析

目的了解安义县2007年肾综合征出血热（HFRS）的流行特点和流行趋势,为防治提供依据。方法对安义县2007年人间疫情及宿主动物监测资料进行分析。结果2007年安义县HFRS发病率为6．13／10万,5—6月和11—12月发病较多,占全年病例总数的81．25％。人群隐性感染率高,达21．00％,无死亡病例。捕获鼠类7种207只,其中居民区以褐家鼠为优势种,野外以黑线姬鼠为优势种;鼠带病毒率为1．49％,带病毒鼠均为居民区小家鼠。鼠血总抗体阳性率为12．08％。结论安义县HFRS符合家鼠型为主的混合型疫区流行特征。2007年发病率上升较快,应继续加强疫情监测,贯彻“灭鼠和免疫并重”的措施,控制HFRS的发病率.     

临沂市河东区肾综合征出血热防制研究

目的　摸清临沂市河东区肾综合征出血热 (HFRS)人间及兽间疫情 ,以便有效控制HFRS流行。方法　收集患者的流行病学资料 ;用间接免疫荧光法 (IFAT)检查病人及健康人群HFRS特异抗体 ;用夹夜法调查鼠密度 ;以IFAT检测鼠肺汉坦病毒抗原 ;采用灭鼠、疫苗接种和健康教育等措施控制HFRS流行。结果　 1973～ 2 0 0 2年共发生HFRS 2 112例 ,年平均发病率为 14 .2 9/10万 ,死亡 91例 ,病死率为 4.3 1%。 1973～ 1984年河东区为姬鼠型HFRS疫区 ,1985年起 ,出现家鼠型HFRS流行。本区有鼠类 2目 6种 ,野外以黑线姬鼠为优势种 (77.2 9% ) ,室内以褐家鼠为优势种(5 0 .64 % ) ,带病毒率分别为 4.5 6%和 4.12 %。健康人群隐性感染率 ,随着疫区时间的推移而增高。结论　临沂市河东区由姬鼠型HFRS疫区演变为以家鼠型为主的混合型HFRS疫区 ,开展以灭鼠为主的综合性防制措施能有效控制HFRS流行。     

浙江省2002年肾综合征出血热监测研究

目的 为掌握肾综合征出血热(HFRS)流行规律与疫源地类型，以制定防制对策。方法 采用间接免疫荧光法(IFAT)检测HFRs病人血清中抗体，采用直接免疫荧光法(FAT)检测鼠肺汉坦病毒(HV)抗原。结果 全省1499例病人，主要分布在绍兴、衢州、宁波、丽水、台州等市，夏季和冬春季有两个发病高峰，以青壮年农民发病为主。结论 对以姬鼠型为主的混合型疫区，应选择双价疫苗进行预防接种，以降低发病率。     

1961-2005年南充市肾综合征出血热监测研究

目的探索肾综合征出血热(HFRS)在南充市的流行规律与特征,为制定防制对策提供科学依据。方法统计历年HFRS疫情,开展动物密度、种群、带病毒率及人群抗体水平监测,并对其进行综合分析。结果45年来南充市HFRS平均发病率为4·30/10万,死亡率为0·18/10万,病死率为4·09%。发病率最高是三区(7·83/10万)、蓬安(6·52/10万)和营山(4·02/10万),发病呈现5-7月和10月至翌年1月2个高峰;年龄以16~55岁组为多(85·70%);职业以农民为高(78·50%),健康人群隐性感染率为3·31%;宿主动物以黑线姬鼠与褐家鼠为优势鼠种。鼠肺HFRS抗原阳性率为5·20%,鼠带病毒率以黄胸鼠、小家鼠、黑线姬鼠为高,黑线姬鼠与褐家鼠,褐家鼠与四川短尾带病率均有统计学意义。结论南充市是以姬鼠型为主的混合HFRS疫区,发病呈高度散发和相对集中的流行特点。主要宿主动物及传染源是黑线姬鼠与褐家鼠,HFRS发病与鼠类总密度和居住区内褐家鼠密度密切相关。     

砀山县1997—2002年肾综合征出血热流行病学调查

目的:分析砀山县1997～2002年肾综合征出血热(HFRS)人间疫情及宿主动物,探讨HFRS的流行因素与防治对策。方法:主要采取流行病学、血清学的方法,开展现场调查、实验室检测。结果:6年来HFRS疫情稳步下降,2002年发病率较1997年降低了76.48%,发病季节呈现秋冬单峰型,男性青壮年农民为该病的高危人群。室内以小家鼠、室外以黑线姬鼠为优势鼠种,室外黑线姬鼠带毒率为2.94%(1/34)、抗体阳性率为14.71%(5/34),健康人群抗体水平阳性率3.7%(2/54)。结论:砀山县1997～2002年HFRS疫情大幅度下降,但流行因素仍广泛存在。     

颖上县肾综合征出血热储存宿主的调查

本文指出，用间接荧光技术从安徽省颖上县本病的地方性流行区所捕获的6种鼠中，査到4种鼠携带本病特异性抗原。其中黑线姬鼠534只，阳性鼠29只，带毒率为5.4%；褐家鼠132只，阳性鼠11只，带毒率为8.3%；小家鼠19只，阳性鼠1只，其带毒率为5.3%；大仓鼠433只，阳性鼠2只，其带毒率为0.5%，因此认为，在该农村型HFRS的流行区，其主要宿主为褐家鼠和黑线姬鼠。从而指出褐家鼠在引起农村型HFRS的流行方面，也具有重要意义。
另外，本文还用模式图，分析了该区各鼠种生活活动区间的关系，指出这些鼠种间的特定生态学联系，在本病的鼠间传播和病毒在自然界的循环中，可能具有重要作用。     

贵州省1984～2000年肾综合征出血热疫源地监测

目的 阐明贵州省肾综合征出血热(HFRS)不同类型疫源地之间的相互关系。方法 运用流行病学监测的技术方法，在不同类型疫源地连续进行多年监测。结果 在定点监测中，姬鼠型疫源地遵义县黑线姬鼠平均带病毒率为3．39％、褐家鼠为1．61％，家鼠型疫源地石阡县褐家鼠平均带病毒率为3．19％、黑线姬鼠不带病毒，显示姬鼠、家鼠型两类疫源地相对稳定。但开阳县落旺河桥两岸即东岸姬鼠型和西岸家鼠型疫源地类型在缓慢变化，1983～1984年间西岸的黑线姬鼠未检出HFRS病毒抗原(0／99)，1995～1998年间的黑线姬鼠感染率为13．85％(抗原1／65，抗体8／65)。结论 姬鼠、家鼠型两类疫源地在相对稳定中出现缓慢变化，相邻的姬鼠、家鼠型疫源地相互渗透形成疫源地重叠而成为混合型疫源地。