常规检验及治疗与急性感染性腹泻病原学诊断的关系

doi:10.3969/j.issn.1673-8640.2018.05.001

摘要/Abstract

摘要：

目的分析急性感染性腹泻患者的血常规、粪常规检验结果及治疗方案与病原学诊断的关系,为感染性腹泻的临床诊疗提供参考依据。方法收集962例急性感染性腹泻患者的临床样本,鉴定病原体,并进行血常规和粪常规检验,分析血常规、粪常规检验结果及治疗方案与急性感染性腹泻病原学诊断结果的关系。结果从962例急性感染性腹泻患者的粪便样本中分离出病原体295例,其中细菌239例、病毒56例。血常规检验结果中,细菌性腹泻与病毒性腹泻患者的白细胞（WBC）计数、中性粒细胞百分比（NE%）以及NE%和淋巴细胞百分比（LYM%）异常者所占比例差异有统计学意义（P<0.05）;粪常规检验结果中,病毒性腹泻患者发生水样便的比例明显高于细菌性腹泻患者（P=0.002）,而发生黏液便的比例明显低于细菌性腹泻患者（P=0.049）。临床经验用药与患者病原学诊断结果的符合率为72.2%（213/295）。结论常规检验对急性感染性腹泻的诊疗有一定的参考价值,但应进行更准确、全面的病原学检测,以便为临床诊疗提供更精准的参考依据。

关键词: 血常规检验, 粪常规检验, 常规用药, 急性感染性腹泻, 相关性

Abstract:

Objective To analyze the relationship of routine examinations and treatment with the etiological diagnosis of acute infectious diarrhea,and to provide a reference for the diagnosis and treatment of acute infectious diarrhea. Methods Totally,962 specimens of acute infectious diarrhea patients were collected,and the pathogens were identified. Blood routine examination and stool routine examination were performed. The relationship of the results of blood routine examination and stool routine examination and treatment with the etiological diagnosis was analyzed. Results A total of 295 pathogens,including 239 bacteria and 56 viruses,were determined from 962 specimens. There was statistical significance for the abnormal proportions of white blood cell （WBC） count,neutrophil percentage （NE%）,abnormal NE% and lymphocyte percentage （LYM%） between patients infected with bacteria and viruses（P<0.05）. The proportion of water stool was higher in patients infected with viruses than that in patients infected with bacteria （P=0.002）,and the proportion of mucous stool was higher in patients infected with bacteria （P=0.049）. The consistency rate was 72.2%（213/295） between empirical treatment and pathological diagnosis results. Conclusions The routine examinations could provide a reference for the diagnosis and treatment of acute infectious diarrhea,while accurate and comprehensive pathogenic determination is also needed for its precious clinical diagnosis and treatment.

Key words: Blood routine examination, Stool routine examination, Empirical treatment, Acute infectious diarrhea, Correlation

中图分类号:

R446.5

杨峰, 张景皓, 方毅, 郭明权, 刘越, 赵虎, 张艳梅. 常规检验及治疗与急性感染性腹泻病原学诊断的关系[J]. 检验医学, 2018, 33(5): 379-383.

YANG Feng, ZHANG Jinghao, FANG Yi, GUO Mingquan, LIU Yue, ZHAO Hu, ZHANG Yanmei. Relationship of routine examinations and treatment with the etiological diagnosis of acute infectious diarrhea[J]. Laboratory Medicine, 2018, 33(5): 379-383.

图/表 4

参考文献 15

[1]	LOZANO R, NAGHAVI M, FOREMAN K, et al.Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010[J]. Lancet, 2012, 380(9859): 2095-2128.
[2]	GBD 2015 Mortality and Cause of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015BD 2015 Mortality and Cause of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015[J]. Lancet, 2016, 388(10053): 1459-1544.
[3]	DAS J K, BHUTTA Z A.Global challenges in acute diarrhea[J]. Curr Opin Gastroenterol, 2016, 32(1): 18-23.
[4]	RIDDLE M S, DUPONT H L, CONNOR B A.ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults[J]. Am J Gastroenterol, 2016, 111(5): 602-622.
[5]	JIA L, LIN C, GAO Z, et al.Prevalence and factors associated with different pathogens of acute diarrhea in adults in Beijing, China[J]. J Infect Dev Ctries, 2016, 10(11): 1200-1207.
[6]	FARTHING M, SALAM M A, LINDBERG G, et al.Acute diarrhea in adults and children: a global perspective[J]. J Clin Gastroenterol, 2013, 47(1): 12-20.
[7]	SCALLAN E, HOEKSTRA R M, ANGULO F J, et al.Foodborne illness acquired in the United States-major pathogens[J]. Emerg Infect Dis, 2011, 17(1): 7-15.
[8]	崔恩博, 陈素明, 张成龙, 等. 2009—2013年我国16省市社区获得性细菌性腹泻病原菌分布及临床耐药分析[J]. 传染病信息,2014,27(3): 143-147.
[9]	骆玲飞, 王小光, 李翠珍, 等. 2014—2016年上海市闵行区病毒性腹泻病病原学监测研究[J]. 复旦学报(医学版), 2017, 44(5): 617-620.
[10]	HILMARSDOTTIR I, BALDVINSDOTTIR G E, HAROARDOTTIR H, et al.Enteropathogens in acute diarrhea: a general practice-based study in a Nordic country[J]. Eur J Clin Microbiol Infect Dis, 2012, 31(7): 1501-1509.
[11]	HUHULESCU S, KISS R, BRETTLECKER M, et al.Etiology of acute gastroenteritis in three sentinel general practices, Austria 2007[J]. Infection, 2009, 37(2): 103-108.
[12]	BLAIR J M, WEBBER M A, BAYLAY A J, et al.Molecular mechanisms of antibiotic resistance[J]. Nat Rev Microbiol, 2015, 13(1): 42-51.
[13]	胡付品, 郭燕, 朱德妹, 等. 2016年中国CHINET细菌耐药性监测[J]. 中国感染与化疗杂志, 2017, 17(5): 481-491.
[14]	WATTS T, BARIGOU M, NASH G B.Effects of vessel size, cell sedimentation and haematocrit on the adhesion of leukocytes and platelets from flowing blood[J]. Biorheology, 2015, 52(5-6): 391-404.
[15]	何彦海. 成人急性水样便腹泻的治疗[J]. 实用医技杂志, 1997, 4(10): 780-781.

组别	例数	WBC计数（×10⁹/L）	NE%（%）	LYM%（%）	HCT（%）
细菌性腹泻组	239	10.88±3.12	76.79±13.94	17.82±9.65	42.02±3.88
病毒性腹泻组	56	9.39±4.40	73.20±11.28	18.81±8.37	41.87±3.74
t值		1.98	1.53	1.33	1.08
P值		0.019	0.044	0.480	0.793

组别	例数	WBC计数（×10⁹/L）	NE%（%）	LYM%（%）	HCT（%）
细菌性腹泻组	239	10.88±3.12	76.79±13.94	17.82±9.65	42.02±3.88
病毒性腹泻组	56	9.39±4.40	73.20±11.28	18.81±8.37	41.87±3.74
t值		1.98	1.53	1.33	1.08
P值		0.019	0.044	0.480	0.793

组别	例数	WBC计数>10×10⁹/L		NE% >75.00%		LYM%<20.00%		HCT>49.00%
组别	例数	例数	构成比（%）	例数	构成比（%）	例数	构成比（%）	例数	构成比（%）
细菌性腹泻组	239	105	43.9	148	61.9	156	65.3	13	5.4
病毒性腹泻组	56	19	33.9	22	39.3	27	48.2	5	8.9
P值		0.172		0.002		0.026		0.326

组别	例数	WBC计数>10×10⁹/L		NE% >75.00%		LYM%<20.00%		HCT>49.00%
组别	例数	例数	构成比（%）	例数	构成比（%）	例数	构成比（%）	例数	构成比（%）
细菌性腹泻组	239	105	43.9	148	61.9	156	65.3	13	5.4
病毒性腹泻组	56	19	33.9	22	39.3	27	48.2	5	8.9
P值		0.172		0.002		0.026		0.326

组别	例数	WBC阳性	酵母及虫卵	粪便性状
组别	例数	WBC阳性	酵母及虫卵	糊便	稀便	水样便	黏液便	脓血便
细菌性腹泻组	239	57(23.8)	0（0.0）	58（24.3）	91（38.1）	72（30.1）	16（6.7）	2（0.8）
病毒性腹泻组	56	12(21.4)	0（0.0）	7（12.5）	19（33.9）	29（51.8）	0（0.0）	1（1.8）
P值	0.700			0.056	0.564	0.002	0.049	0.469