北京市海淀区2006年临床诊断与实验室确诊菌痢症状分析

目的探讨实验室确诊细菌性痢疾（简称菌痢）与临床诊断菌痢的症状差别,提供确诊菌痢症状特征,降低临床误诊率。方法菌痢检测应用国标GB16002-1995标准进行细菌培养鉴定,对实验室确诊菌痢、其他致病菌和未检出者个案资料进行对照分析。结果确诊菌痢发热占87.50%;恶心占81.25%;里急后重占56.25%;腹泻7次以上占68.75%,脓血便仅占12.5%。其他致病菌发热占29.41%;恶心占76.47%;里急后重占29.41%;腹泻7次以上占43.75%;脓血便仅占6.25%。未检出者发热占56.04%;恶心占69.23%;里急后重占29.44%;腹泻7次以上占46.74%;脓血便仅占3.30%。确诊菌痢均在第1天到医院就诊,有1例为外地带入性确诊菌痢。结论确诊菌痢非典型病例可占1/3左右,未检出者具有典型菌痢临床表现可占1/5的比例,其他致病菌也可占1/5的份额,总体临床诊断误诊率极高,须加强临床医生的综合业务培训。

Symptoms of bacillary dysentery by laboratory confirmation and clinical diagnosis in 2006 at Haidian District,Beijing

Objective To study difference in symptoms of cases of bacillary dysentery by clinical diagnosis and laboratory confirmation, and to establish criteria for its diagnosis in order to reduce clinical misdiagnosis.Methods Stool of the patient with bacillary dysentery was cultured and identified for Shigella dysenteriae according to the national criteria for bacillary dysentery （GB 16002-1995）. Clinical data of the patients with bacillary dysentery confirmed by bacteriologic culture were compared to those caused by other bacteria or those with no pathogen detected by laboratory.Results Fever could be seen in 87.50% of cases with bacillary dysentery confirmed by culture, nausea in 81.25%, tenesmus in 76.47%, more than seven stools per day in 68.75% and pussy and bloody stool in 12.5% of them. But, in patients with baciallry dysentery caused by other pathogens, fever could be found in 29.41%, nausea in 76.47%, tenesmsu in 29.41%, more than seven stools per day in 43.75% and pussy and blood stool in 6.25% of them. And, in patients with bacillary dysentery with no pathogen detected, fever could be found in 56.04%, nausea in 69.23%, tenesmus in 29.44%, more than seven stools per day in 46.74% and pussy and bloody stool in 3.30% of them. Diagnosis of bacillary dysentery was established for all the cases on the first day when they visited hospitals and one confirmed case was imported from other place outside Beijing.Conclusion One third of the confirmed cases of bacillary dysentery had no typical symptoms, and fifth of those with no pathogen detected or caused by other pathogen had typical symptoms of bacillary dysentery. Misdiagnosis for bacillary dysentery is common in clinical practice, so comprehensive professional training for clinicians should be strengthened.