Analysis of surveillance results of febrile respiratory syndrome in sentinel hospitals in Gansu Province
-
摘要:
目的 了解甘肃省发热呼吸道症候群(febrile respiratory syndrome，FRS)病原学监测情况，评价监测结果，为提升其监测能力提供参考依据。 方法 收集2009―2019年甘肃省17所哨点医院FRS监测病例，采用观察性研究，分析病原监测状况并评价其监测结果。 结果 甘肃省2009―2019年FRS病原总检测率为89.00%，总检出率为31.43%。所有病原(病毒/细菌)的检出能力高于任一病原(病毒/细菌)(P < 0.001)，其中任一病毒检测率及检出率均高于任一细菌(P < 0.05)，所有病毒检测率高于所有细菌(χ2=2 876.656，P < 0.001)，检出率低于所有细菌(χ2=84.237，P < 0.001)；病原检测种类方面，病毒以人流感病毒检测率最高(99.93%)、鼻病毒检测率最低(53.77%)，细菌以同时检测肺炎支原体与肺炎衣原体居多，检出率较低(4.15%)；临床症状以发热、咳嗽、咳痰为主，病原检测阴性者容易出现发热、胸痛、乏力和呼吸困难症状。监测结果评价显示病例类型的均衡性、采样时间的连续性有待提高。 结论 甘肃省FRS病原检测水平较高，建议通过合理调整病原检测种类、采集匹配的标本类型和重复检测阴性病例等措施提高病原检出能力，完善监测平台，提高监测能力。 Abstract:Objective To understand the etiological surveillance of febrile respiratory syndrome (FRS) in Gansu Province, and evaluate the monitoring results, so as to provide reference basis for improving its monitoring ability. Methods The cases of FRS surveillance in 17 sentinel hospitals were collected in Gansu Province from 2009 to 2019. The method of observational epidemiological study was used to analyze the status of pathogen surveillance and evaluate the surveillance results. Results The total testing rate of FRS pathogens was 89.00% in Gansu Province during 2009-2019, and the total detection rate was 31.43%. The detection ability of all pathogens (virus / bacteria) was higher than that of any pathogen (virus/bacteria) (P < 0.001), in which the detection rate of any virus was higher than that of any bacteria (P < 0.05). For all bacteria, the testing rate was lower than that of all viruses (χ2=2 876.656, P < 0.001), but the detection rate was higher than that of all viruses (χ2=84.237, P < 0.001). As for the types of pathogen detection, the testing rate of human influenza virus was the highest (99.93%), and that of rhinovirus was the lowest (53.77%). The bacteria were mostly simultaneous test for Mycoplasma pneumoniae and Chlamydia pneumoniae, but the detection rate was low (4.15%). The clinical symptoms were mainly fever, cough and expectoration, the cases with negative pathogens were prone to fever, chest pain, fatigue and dyspnea. The evaluation of surveillance results showed that the balance of case types and the continuity of sampling time needed to be improved. Conclusions The level of FRS pathogen testing is relatively high in Gansu Province. It is recommended that the detection capability of pathogens should be improved by reasonably adjusting the species of pathogen testing, collecting matched specimen types, and repeatedly testing negative cases to improve the monitoring platform and the monitoring system. -
Key words:
- Febrile respiratory syndrome /
- Virus /
- Bacteria /
- Surveillance
-
表 1 2009―2019年甘肃省各年度任一病原与所有病原的检测检出情况[n(%)]
Table 1. The detective situation of any pathogen and all pathogens in each year in Gansu Province from 2009 to 2019 [n(%)]
年度 标本数 任一病毒 任一细菌 所有病毒 所有细菌 检测数 检出数 检测数 检出数 检测数 检出数 检测数 检出数 2009 1 188 1 185(99.75) 305(25.74) 1(0.08) 0(0.00) 0(0.00) 0(0.00) 0(0.00) 0(0.00) 2010 1 612 1 545(95.84) 259(16.76) 84(5.21) 15(17.86) 7(0.43) 1(14.28) 8(0.50) 0(0.00) 2011 1 303 1 268(97.31) 264(20.82) 130(9.98) 12(9.23) 344(26.40) 130(37.79) 1(0.08) 0(0.00) 2012 443 381(86.00) 98(25.98) 240(54.18) 16(6.67) 190(42.89) 57(30.00) 14(3.16) 9(64.29) 2013 901 812(90.12) 203(25.00) 579(64.26) 239(41.28) 790(87.68) 193(24.43) 287(31.85) 202(70.38) 2014 1 076 830(77.14) 227(27.35) 736(68.40) 295(40.08) 801(74.44) 223(27.84) 384(35.69) 232(60.42) 2015 568 492(86.62) 167(33.94) 426(75.00) 135(31.69) 450(79.22) 163(36.22) 47(8.27) 12(25.53) 2017 366 323(88.25) 90(27.86) 203(55.46) 18(8.87) 321(87.70) 90(28.04) 0(0.00) 0(0.00) 2018 1 361 1 061(77.96) 310(29.22) 780(57.31) 107(13.72) 1 031(75.75) 294(28.52) 211(15.50) 47(22.27) 2019 1 245 674(54.14) 316(46.88) 461(37.03) 21(4.56) 626(50.28) 275(43.93) 181(14.54) 16(8.84) 合计 10 063 8 571(85.17) 2 239(26.12) 3 640(36.17) 858(23.57) 4 560(45.14) 1 426(31.27) 1 133(11.26) 518(45.72) χ2值 5 063.203a 8.787b 2 876.656c 84.237d P值 < 0.001a 0.003b < 0.001c < 0.001d 注：2016年为国家“十二五”与“十三五”交汇期，没有收集到哨点医院报告病例；a任一病毒与任一细菌在病原检测方面的差异；b任一病毒与任一细菌在病原检出方面的差异；c所有病毒与所有细菌在病原检测方面的差异；d所有病毒与所有细菌在病原检出方面的差异。 
下载: 导出CSV
表 2 2009―2019年甘肃省不同病毒种类的检测检出情况
Table 2. The detective situation of different virus species in Gansu Province from 2009 to 2019
检测种类 检测数 检出数 检出率(%) 人流感病毒 978 170 17.38 人流感病毒+呼吸道合胞病毒/腺病毒 7 7 100.00 人流感病毒+呼吸道合胞病毒+人副流感病毒+人腺病毒+人偏肺病毒+人冠状病毒 2 754 554 20.12 人流感病毒+呼吸道合胞病毒+人副流感病毒+人偏肺病毒+人冠状病毒+人博卡病毒+鼻病毒 43 29 67.44 人流感病毒+呼吸道合胞病毒+人副流感病毒+人腺病毒+人偏肺病毒+人冠状病毒+人博卡病毒 219 51 23.29 人流感病毒+呼吸道合胞病毒+人副流感病毒+人腺病毒+人偏肺病毒+人冠状病毒+人博卡病毒+鼻病毒 4 560a 1 426a 31.27a 其它 10 2 20.00 合计 8 571b 2 239b 26.12b 注：a和b分别为所有病毒与任一病毒的检测检出情况，二者检出率(%)比较时P＜0.001。
下载: 导出CSV
表 3 2009―2019年甘肃省不同细菌种类的检测检出情况
Table 3. The detective situation of different bacteria species in Gansu Province from 2009 to 2019
检测种类 检测数 检出数 检出率(%) 肺炎链球菌 106 22 20.75 肺炎支原体/肺炎衣原体 13 1 7.69 肺炎支原体+肺炎衣原体 1 493 62 4.15 肺炎链球菌+流感嗜血杆菌/金黄色葡萄球菌/军团菌 47 9 19.15 铜绿假单胞菌+肺炎克雷伯菌+金黄色葡萄球菌 71 8 11.27 肺炎链球菌+流感嗜血杆菌+肺炎支原体+肺炎衣原体+军团菌 277 163 58.84 铜绿假单胞菌+肺炎克雷伯菌+金黄色葡萄球菌+肺炎链球菌+流感嗜血杆菌+A组链球菌 244 4 1.64 肺炎链球菌+流感嗜血杆菌+A组链球菌+肺炎支原体+肺炎衣原体+军团菌 96 26 27.08 铜绿假单胞菌+肺炎克雷伯菌+金黄色葡萄球菌+肺炎链球菌+流感嗜血杆菌+A组链球菌+军团菌 81 6 7.41 铜绿假单胞菌+肺炎克雷伯菌+金黄色葡萄球菌+肺炎链球菌+流感嗜血杆菌+肺炎支原体+肺炎衣原体+军团菌 52 35 67.31 肺炎克雷伯菌+金黄色葡萄球菌+肺炎链球菌+A组链球菌+肺炎支原体+肺炎衣原体+军团菌/铜绿假单胞菌/流感嗜血杆菌 13 1 7.69 铜绿假单胞菌+肺炎克雷伯菌+金黄色葡萄球菌+肺炎链球菌+流感嗜血杆菌+A组链球菌+肺炎支原体+肺炎衣原体+军团菌 1 133a 518a 45.72a 其它 14 3 21.43 合计 3 640b 858b 23.57b 注：a和b分别为所有细菌与任一细菌的检测检出情况，二者检出率比较时P＜0.001。
下载: 导出CSV
表 4 2009―2019年甘肃省所有病原检测病例的临床症状分布情况[n(%)]
Table 4. The distribution of clinical symptoms of all pathogens testing cases in Gansu Province from 2009 to 2019 [n(%)]
临床症状 阳性病例 阴性病 Wald χ2值 P值 体温(℃) 17.809 < 0.001 < 38.0 362(53.31) 128(39.14) 38.0~ 198(29.16) 126(38.53) ≥39.0 119(17.53) 73(22.32) 咳嗽 0.009 0.924 是 585(86.16) 281(85.93) 否 94(13.84) 46(14.07) 咳痰 2.411 0.120 是 425(62.59) 188(57.49) 否 254(37.41) 139(42.51) 流涕 1.477 0.224 是 68(10.01) 25(7.65) 否 611(89.99) 302(92.35) 头痛 2.502 0.114 是 47(6.92) 32(9.79) 否 632(93.08) 295(90.21) 咽喉痛 0.122 0.727 是 67(9.87) 30(9.17) 否 612(90.13) 297(90.83) 胸痛 8.701 0.003 是 55(8.10) 46(14.07) 否 624(91.90) 281(85.93) 腹痛 - ＞0.999 是 4(0.59) 2(0.61) 否 675(99.41) 325(99.39) 腹泻(稀便≥ 3次/d) - ＞0.999 是 2(0.29) 1(0.31) 否 677(99.71) 326(99.69) 乏力 19.823 < 0.001 是 118(17.38) 97(29.66) 否 561(82.62) 230(70.34) 呼吸急促 0.014 0.905 是 106(15.61) 52(15.90) 否 573(84.39) 275(84.10) 呼吸困难 8.613 0.003 是 75(11.05) 58(17.74) 否 604(88.95) 269(82.26) 注：“―”为Fisher确切法计算。
下载: 导出CSV
-
[1] 杨玫, 孟蕾, 牛丽霞, 等. 2010-2015年甘肃省发热呼吸道症候群病原体监测结果[J].中华疾病控制杂志, 2018, 22(9):908-911. DOI: 10.16462/j.cnki.zhjbkz.2018.09.009.Yang M, Meng L, Niu LX, et al. Surveillance results of fever respiratory syndrome pathogens in Gansu Province from 2010 to 2015[J]. Chin J Dis Control Prev, 2018, 22(9):908-911. DOI: 10.16462/j.cnki.zhjbkz.2018.09.009. [2] Hodinnka RL. Respiratory RNA viruses[J]. Microbiol Spectr, 2016, 4(DMIH2/0028/20164):1-33. DOI: 10.1128/microbiolspec.DMIH2-0028-2016. [3] Nair H, Brooks WA, Katz M, et al. Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis[J]. Lancet, 2011, 378(9807):1917-1930. DOI: 10.1016/S0140-6736(11)61051-9. [4] 中国疾病预防控制中心.国家科技重大专项传染病监测技术平台项目进一步完善五大症候群监测采样要求[Z].北京, 2013.http://www.chinacdc.cn/zxdt/201312/t20131223_91664.html.Chinese Center for Disease Control and Prevention. National science and technology major special infectious disease surveillance technology platform project to further improve the sampling requirements of five syndrome surveillance[Z]. Beijing, 2013. http://www.chinacdc.cn/zxdt/201312/t20131223_91664.htm. [5] 中国疾病预防控制中心.发热呼吸道症候群监测技术方案(2012版)[S].北京: 中国疾病预防控制中心, 2011.Chinese Center for Disease Control and Prevention. Fever respiratory syndrome monitoring technology program (2012 version)[S]. Beijing: Chinese Center for Disease Control and Prevention, 2011. [6] 李翔, 方斌, 叶国军, 等.武汉市2012-2015年发热呼吸道症候群监测病例病毒检测结果分析[J].中华疾病控制杂志, 2018, 22(8):833-836. DOI: 10.16462/j.cnki.zhjbkz.2018.08.017.Li X, Fang B, Ye GJ, et al. Analysis of virus detection results of surveillance cases of febrile respiratory syndrome in Wuhan from 2012 to 2015[J]. Chin J Dis Control Prev, 2018, 22(8):833-836. DOI:10. 16462/j.cnki.zhjbkz.2018.08.017. [7] 许晶, 张蕾, 史伟, 等.西安市儿童呼吸道病毒感染谱分析[J].中华疾病控制杂志, 2015, 19(7):663-666. DOI: 10.16462/j.cnki.zhjbkz.2015.07.005.Xu J, Zhang L, Shi W, et al. Analysis of respiratory virus infection spectrum in children in Xi'an[J]. Chin J Dis Control Prev, 2015, 19(7):663-666. DOI: 10.16462/j.cnki.zhjbkz.2015.07.005. [8] 蒋小娟.兰州市2010―2013年发热呼吸道症候群及常见病毒病原流行规律研究[D].兰州: 兰州大学, 2014.Jiang XJ. Study on the epidemic pattern of fever respiratory syndrome and common viral pathogens in Lanzhou City from 2010 to 2013, China[D]. Lanzhou: Lanzhou University, 2014. [9] 周珺.湖南省郴州市5岁以下急性呼吸道感染住院儿童细菌性病原谱的病例对照研究[D].北京: 中国疾病控制中心, 2015.Zhou J. A case-control study on the bacterial pathogenic spectrum of hospitalized children with acute respiratory infection under 5 years old in Chenzhou, Hunan Province, China[D]. Beijing: Chinese Center for Disease Control, 2015. [10] 夏锡荣, 宋勇, 康晓明, 等.肺炎衣原体急性呼吸道感染的临床研究[J].中华结核和呼吸杂志, 1998, 5(21):280-283. http://doi.med.wanfangdata.com.cn/qk/zhjhhhx199805009Xia XR, Song Y, Kang XM, et al. Clinical study on acute respiratory infection of Chlamydia pneumoniae[J]. Chin J Tuberc Respir Dis, 1998, 5(21):280-283. http://doi.med.wanfangdata.com.cn/qk/zhjhhhx199805009 [11] 董晓春, 李琳, 李佳萌, 等.天津市发热呼吸道症候群不同类型样本的病毒病原特征分析[J].华南预防医学, 2013, 39(3):43-46. http://www.cnki.com.cn/Article/CJFDTotal-GDWF201303012.htmDong XC, Li L, Li JM, et al. Analysis of virus pathogenic characteristics of different types of samples in febrile respiratory syndrome in Tianjin[J]. South China J Prev Med, 2013, 39(3):43-46. http://www.cnki.com.cn/Article/CJFDTotal-GDWF201303012.htm -
