徐州市2000年肠出血性大肠埃希菌O157：H7感染性腹泻的调查

目的 了解徐州市丰县和铜山县肠出血性大肠埃希菌（EHEC）O157：H7引起的出血性结肠炎（HC）在腹泻病患者中所占的比例，以及临床症状和肾功能变化的情况。方法 使用EHECO157胶体金快速检测试剂筛选粪便标本，阳性者使用免疫磁珠方法分离病原菌。对经过细菌学证实的EHECO157：H7引起的HC患者，进行临床症状的观察和生化检验指标分析。结果 2000年5月份，丰县由EHECO157：H7引起的HC占腹泻病患者0.98%，6月份铜山县的HC患者占腹泻病患者5.89%。在出现腹泻病症状的同时，18.5%患者的肾功能已经出现异常，表现为尿蛋白，血清肌苷或血尿素氮等指标的升高，在27例HC患者中，有14和13例分别分离到不产生志贺毒素和产生志贺毒素的EHECO157：H7菌株，根据分离菌株是否产生志贺毒素将患者分为两组进行比较，尿蛋白阳性患者的比例分别为4/13和1/14，血小板减少患者的比例分别为6/13和3/14，统计学分析有显著意义。提示分离到产生志贺毒素的EHECO157：H7菌株的患者，发生肾功能异常的可能性较大，结论 此次调查证实了EHECO157：H7感染所引起的HC在整个腹泻病患者中所占的比例随季节的变化而不同，感染产生志贺毒素EHECO157：H7菌株的患者，发生肾功能异常的可能性要比不产生志贺毒素的大，还证实了在该菌感染的初期，患者的肾功能就已经出现了异常。

Study on diarrhea disease caused by enterohemorrhagic Escherichia coli O157:H7 in Xuzhou city,Jiangsu province in 2000

OBJECTIVE: To investigate the proportion of hemorrhagic colitis (HC) caused by Escherichia coli O157:H7 in bacterial diarrhea in Xuzhou city, Jiangsu province. METHODS: All stool samples from patients with diarrhea were screened for O157 antigen, using Immuno-gold kits. Positive samples were cultured to detect the existence of pathogens. All of the HC patients confirmed by bacterial isolation and identification were investigated for clinical symptoms and laboratory tests. RESULTS: Of the diarrhea patients identified in Feng county in May, and in Tongshan county of Xuzhou city in June 2000, Jiangsu province 0.98% and 5.89% were caused by Escherichia coli O157:H7 respectively, confirmed by bacteriological isolation and identification of stool samples. At the early phase of hemorrhagic colitis, 18.5% patients had at least one abnormal clinical laboratory test results including protein in urea and increased BUN or creatinine that indicating the possibility of kidney damage. In 27 strains of E. coli O157:H7 isolated from those patients, 13 and 14 were identified as Shiga toxin producing and Shiga-toxin negative E. coli O157:H7 (Stx-positive or Stx-negative) respectively. By analysis of the two groups of patients divided by according to the nature of Shiga toxin, four of 13 patients of Stx-positive group showed positive urea protein. However only 1 of the 13 patients of Stx-negative group was urea protein positive. The decreased Platelets counts were observed in 6 of 13 patients with Stx-positive group, but only in 1 of 14 patients with stx-negative group. These differences were statistically significant. CONCLUSION: HC patients caused by E. coli O157:H7 were commonly seen (up to 5.89%) in Xuzhou city, Jiangsu province. Early laboratory tests should be conducted for HC patients as early as possible in order to find early indictor of kidney failure which was critical for prevention of hemolytic uremic syndrome.