婴幼儿腹泻病原学及其快速诊断

目的探讨小儿腹泻标本病原学特点及流行病学特征,寻求小儿感染性腹泻的快速诊断方法。方法对我院2003年10月至2005年9月门诊及住院的1160例2个月-5岁腹泻患儿的腹泻标本进行细菌学检查及pH检测。结果(1)1160例患儿腹泻标本病原学阳性605例(52.16%),检出病原20种621株,外源性肠道病原菌、内源性肠道条件致病菌以及轮状病毒3种病原构成比依次为35.75%、32.69%、31.56%。主要病原:(1)轮状病毒196株(31.56%),志贺菌118株(19.00%),克雷伯菌86株(13.8%),枸橼酸杆菌67株(10.79%),致泻性大肠埃希菌60株(9.66%)。(2)1160例患儿腹泻标本6个月-2岁患儿占881例(69.91%)。轮状病毒腹泻多发于秋冬季、大便为水样、多见于2岁以内婴幼儿,志贺菌以夏秋季与脓血便检出率较高。(3)病原菌分离阳性腹泻标本pH>7占明显优势,轮状病毒阳性标本、病原检查阴性标本、健康体检对照标本pH<6占明显优势,前者pH与后三者pH统计学比较,差异有高度显著性(P<0.01)。结论引起小儿腹泻的病原种类繁多,轮状病毒居首位,内源性肠道条件致病菌在腹泻标本中的构成比已接近外源性肠道致病菌而成为腹泻的重要病原菌,大便pH可作为急性腹泻病早期简单、快速、准确、价廉的初步诊断及合理应用抗生素的重要指标。

Pathogenic bacteria and the freqent diagnostic in infant with diarrhea

Objective To discuss the pathogenic bacterial characteristic in children with diarrhea and their epidemiology,seeking the freqent diagnostic methods of children infective diarrhea.Method To analyze the result of bacteriological examination and pH value of 1160 stool specimens of children with diarrhea from October of 2004 to September of 2005.Results There were 1160 stool specimens of children with diarrhea,which contained 881(69.91%) cases from 6 months to 2 years old,605(52.16%) positive-strains cases were isolated from 1160 stool specimens,of which is composed 20 kinds,621 strains.The component proportion of exterior enteric pathogenic bacteria,endogenous enteric conditionsl pathogenic bacteria and rotavirus were 35.75%,32.69%,31.56%.Main pathogeny:Rotavirus occupied 31.56%,Shigella occupied 19.00%,Klebsiella occupied 13.85%,Citrobacter occupied 10.79%,diarrheal E.colic occupied 9.66%.One hand,Rotavirus diarrhea mostly happened in autumn and winter whose shape of stool looks like water,on the other hand,Shigella were mostly found in bloody and mucoid feces in summer and autumn.And what's more,pathogenic bacteria positive-strains cases' pH value are mostly above 7,while pH value of positive-rotavirus specimens,negative-pathogeny specimens were the first and the last three(P<0.01).Conclusions Rotavirus was the major pathogenic microorganism in children with diarrhea.The component proportion of endogenous enteric conditional pathogenic bacteria was approached to exterior enteric pathogenic bacteria,so it became the important pathogenic bacteria.what' more,the pH value of stool was considered as one frequent diagnostic method of examining children' bacterial infective diarrhea,and the important characteristic of using antibiotic in reason.