3955例细菌性痢疾病例临床特征

目的了解细菌性痢疾病例的临床特征和大便常规检查情况,为提高临床诊断和鉴别诊断提供依据。方法2008年5月—2014年10月在位于天津市区、近郊地区、滨海新区和远郊地区的医疗机构设立监测点,将细菌性痢疾的成人和儿童病例作为研究对象,采用统一的流行病学调查表,经患者或儿童家长知情同意后,收集患者临床特征和大便常规结果。结果共收集细菌性痢疾病例流调表3 955份,其中检出志贺菌229份。195例5岁以上检出志贺菌的病例中,脓血便者占22.05%,里急后重者59.49%,体温≥39.0℃的为16.92%,检出志贺菌的病例中脓血便、里急后重和体温≥39.0℃的比例高于未检出的病例,差异均有统计学意义(P0.05)。34例5岁以下检出志贺菌的病例中,体温≥39.0℃的为32.35%,大便常规检测显示白细胞数≥15个/HPF者为88.24%,检出志贺菌的病例体温≥39.0℃和白细胞数≥15个/HPF者的比例高于未检出病例,差异有统计学意义(P0.05)。结论细菌性痢疾病例的临床特征已不明显,诊断标准中重要的临床症状、体征等诊断指标愈加少见。临床诊断需要充分考虑实验室发现,参考流行病学资料。

Clinical characteristics of 3 955 cases of bacillary dysentery

Objective To understand the clinical features and the stool routine examination of bacillary dysentery,and we provide evidence for clinical diagnosis and differential diagnosis.Methods From May 2008 to October 2014,medical institutions in urban,suburban areas,outer suburbs and Binhai New Area of Tianjin City were set up monitoring points of bacillary dysentery cases in adults and children as the research object.Using the same epidemiological questionnaire,the children's parents or patients after informed consent to collect the clinical characteristics of patients and conventional stool routine examination results.Results There were 3 955 flow transfer tables of the bacterial dysentery cases,of which the detection of Shigella was 229 tables.195 cases of more than 5 years old was Shigella,pus and blood accounted for 22.05％,fever for 59.49％,more than 39.0 ℃ for 16.92％,there were statistical significance of detection of Shigella in cases of pus and blood stool,more than 39.0 ℃ higher than the proportion of un-detected cases(P ＜ 0.05).34 cases under the age of 5 years of temperature more than 39.0 ℃ for more than 32.35％,stool detection showed that white blood cell number greater than 15/HPF was 88.24％,there was statistical significance differences in the temperature more than 39.0 ℃ temperature and white blood cell count greater than 15/HPF of Shigella strains detected cases were higher than the un-detected cases (P＜ 0.05).Conclusion The clinical features of bacterial dysentery are not obvious,and the diagnostic criteria such as important clinical symptoms and signs are rare.Clinical diagnosis needs to take full account of laboratory findings,reference epidemiological data.