首页> 中文期刊> 《广西医学》 >广西桂林市1999~2008年甲型副伤寒病后带菌队列研究▲

广西桂林市1999~2008年甲型副伤寒病后带菌队列研究▲

         

摘要

Objective To investigatus the status of paratyphoid fever A carriers ,and to explore its relation-ship with LPS IgG antibody titers .Methods Three hundred and twenty-eight patients with paratyphoid fever A who were confirmed in 1999-2008 in Guilin City were followed up in the historical cohort study .Their stool specimens were collected three times to culture Salmonella paratyphi A ,and their serum specimens were collected to test LPS IgG anti-body titer.Results Three hundred and twenty-eight cases were from 9 counties and 43 towns/streets.Of 328 cases, 6 carriers was found in 20 convalescents,the positive rate was 30.00%,95% confidence interval(CI) 12%-54%. The treatment for the convalescents were not standard in the onset phase .A chronic carrier was found in other 308 previous paratyphoid fever A patients ,the positive rate of chronic carrier was 0.32%,95%CI 0.1%-5.6%.This chronic carrier was a middle-aged obese women with gallbladder stones accompanied by renal cysts ,and was still iden-tified to be a chronic carrier 18 months after onset of paratyphoid fever A .Seven carriers were treated with ampicillin and levofloxacin for two weeks and then became negative .The mean serum LPS IgG titer in carriers was significantly higher than that in non-carriers (1 ∶97.14 vs 1 ∶8.59,P <0.05).Conclusion Case management should be strengthened ,and the standard ,reasonable ,full-course use of antibiotics should be adapted in the prevention and con-trol of paratyphoid fever A .We should pay attention to the patients with biliary tract disease or chronic urinary disease in the treatment of paratyphoid fever A .If the patient is not treated completely ,he or she may easily become a chronic carrier.%目的了解甲型副伤寒病后带菌情况及带菌状态与脂多糖( LPS ) IgG抗体滴度的关系。方法采用历史性队列研究方法,随访桂林市1999~2008年发病的甲型副伤寒患者328例,采集其3次粪便标本培养甲型副伤寒菌,同时采集血样进行LPS IgG测定。结果328例分布于9个县区43个乡镇(街道)。328例中处于恢复期病例20例,检出带菌6例,恢复期带菌率30.00%,95%CI(12%,54%);恢复期带菌者主要原因为发病时用药不规范。处于慢性期患者308例,检出慢性带菌1例,慢性带菌率为0.32%,95%CI (0.1%,5.6%);该慢性带菌者为伴胆囊结石和肾囊肿的中年肥胖女性,病后18个月仍携带甲型副伤寒菌。7例带菌者予氨苄青霉素加左氧氟沙星联合用药连续2周,消除带菌状态。带菌者血清LPS IgG平均滴度1∶97.14,高于无带菌状态的既往病例平均滴度1∶8.59(P<0.05)。结论防控甲型副伤寒中应做好病例管理,规范、合理、全程使用抗生素;在治疗甲型副伤寒病人时,应注意伴胆道疾患或慢性泌尿系统疾患者,如治疗不彻底易发展成慢性带菌。

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