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目的阐明云南省西双版纳州鼠型斑疹伤寒的流行状况。方法收集云南省鼠型斑疹伤寒病例资料。于2011年6-9月在西双版纳地区采集鼠型斑疹伤寒临床诊断病例的急性期和恢复期血清,并在发病地区的居民区捕鼠,采集鼠血液和脾脏标本。用间接免疫荧光试验检测患者和鼠血清中的鼠型斑疹伤寒立克次体的IgM和IgG抗体,用实时荧光PCR试验检测急性期病人血块和鼠脾脏中的鼠型斑疹伤寒立克次体热休克蛋白基因(groELgene)。结果 2004-2011年,云南省共报告鼠型斑疹伤寒病例8 361例,所有州(市)均有病例报告,其中西双版纳州发病数和发病率最高(86.6/10万),占全省总病例数的73.1%(6 111/8 361)。发病数具有逐年上升之势,全年均有病例发生,6-10月为主要流行期。2011年云南省共报告鼠型斑疹伤寒1 369例,其中西双版纳州报告病例1 157例,发病率为102.10/10万,病例数占云南省病例数的84.51%。勐海县、勐腊县和景洪市分别占全州病例数的79.95%(n=925,278.74/10万)、18.06%(n=209,74.10/10万)和1.99%(n=23,4.42/10万),勐海县发病率显著高于勐腊县(2χ=346.3,P<0.001)和景洪市(2χ=1369,P<0.001)。对2011年的80例病人进行了实验室检测,在80例急性期病人血清标本中有63例为IgM抗体阳性;75例病人双份血清标本中有61例的恢复期血清滴度高于急性期4倍及以上;80例患者急性期血块中有8例为PCR阳性。依据实验室诊断标准,74例被确诊为鼠型斑疹伤寒,其中血清学诊断73例(包含7例同时为分子诊断),分子诊断1例,临床诊断和实验室检测符合率为92.50%(74/80)。黄胸鼠血清鼠型斑疹伤寒立克次体IgG抗体阳性率为14.0%(14/100),脾脏的PCR阳性率为9.0%(9/100)。结论西双版纳州存在较为严重的鼠型斑疹伤寒流行,其中勐海县流行最为严重。
Objective To clarify the epidemic situation of murine typhus in Xishuangbanna of Yunnan Province. Methods The data of murine typhus in Yunnan province were collected. The acute and convalescent sera of clinical diagnosis of murine typhus were collected from June to September in 2011 in Xishuangbanna, and the murine blood and spleen samples were collected from the settlements in the affected areas. Indirect immunofluorescence assay was used to detect IgM and IgG antibodies against murine typhus Rickettsia in both patient and rat sera, and real-time fluorescence PCR was used to detect murine typhus Rickettsia in clot and murine spleen Body heat shock protein gene (groELgene). Results From 2004 to 2011, a total of 8361 cases of murine typhus were reported in Yunnan Province. All the states (cities) reported cases. The highest incidence and the highest incidence were in Xishuangbanna Prefecture (86.6 / 100 000) 73.1% of cases (6 111/8 361). The incidence of the disease has the potential to rise year by year, cases occur throughout the year, 6-10 months as the main epidemic period. In 2011, a total of 1 369 murine typhus cases were reported in Yunnan Province, of which 1 157 cases were reported in Xishuangbanna Prefecture, with an incidence rate of 102.10 / 100,000. The number of cases accounted for 84.51% of the cases in Yunnan Province. Menghai County, Mengla County and Jinghong City accounted for 79.95% (n = 925,278.74 / 100,000), 18.06% (n = 209,74.10 / 100,000) and 1.99% (n = 23,4.42 / 100,000). The incidence of Menghai County was significantly higher than that of Mengla County (2χ = 346.3, P <0.001) and Jinghong (2χ = 1369, P <0.001). Laboratory tests were performed on 80 patients in 2011, of which 63 were IgM positive in serum samples of 80 patients with acute phase; 61 patients in 75 serum samples from two sera of patients had convalescent serum titer higher than acute 4 times and above; 80 cases of acute blood clots in 8 cases of PCR-positive. According to laboratory diagnostic criteria, 74 cases were diagnosed as murine typhus, of which serological diagnosis of 73 cases (including 7 cases of molecular diagnosis at the same time), molecular diagnosis in 1 case, clinical diagnosis and laboratory tests with a rate of 92.50% ( 74/80). The positive rate of Rickettsia rickettsi IgG antibody in the serum of S. rhamnoides was 14.0% (14/100) and that of the spleen was 9.0% (9/100). Conclusion Xishuangbanna prefecture has a relatively severe epidemic of murine typhus, of which Menghai County is the most prevalent.