中国寄生虫学与寄生虫病杂志 ›› 2017, Vol. 35 ›› Issue (2): 150-155.

• 论著 • 上一篇    下一篇

上海市输入性疟疾临床流行病学特征分析

蒋旭华1, 黄玉仙1,2, 凌云1, 朱爱红1, 叶善可1, 黄琴1,*()   

  1. 1 复旦大学附属上海市公共卫生临床中心,上海 201508
    2 复旦大学附属华山医院,上海 200040
  • 收稿日期:2017-01-23 出版日期:2017-04-20 发布日期:2017-05-02
  • 通讯作者: 黄琴

Clinical epidemiological analysis of imported malaria in Shanghai

Xu-hua JIANG1, Yu-xian HUANG1,2, Yun LING1, Ai-hong ZHU1, Shan-ke YE1, Qin HUANG1,*()   

  1. 1 Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508,China
    2 Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China
  • Received:2017-01-23 Online:2017-04-20 Published:2017-05-02
  • Contact: Qin HUANG

摘要:

目的评估上海地区输入性疟疾流行病学特征及重症疟疾的危险因素。方法 回顾性收集2013-2015年收治于上海市公共卫生临床中心的输入性疟疾病例资料,分析人口学、流行病学、实验室检查数据。组间比较采用Mann-Whitney法和Fisher’s精确检验,logistic回归分析危险因素评估。结果共收集输入性疟疾病例87例,平均发病年龄为36.4岁,男性82例(94.3%),女性5例(5.7%)。其中中国患者79例(90.8%),南苏丹3例(3.4%),印度2例(2.3%),喀麦隆、尼日利亚、布隆迪各1例(1.1%)。在75例能够明确感染来源地国家的病例中,感染来源地为非洲国家的多达63例(84.0%),其次为亚洲(11例,14.7%)。实验室确诊病例78例(89.7%),临床诊断病例9例(10.3%)。在实验室确诊病例中,感染恶性疟原虫(Plasmodium falciparum)最多,为66例(84.6%),感染间日疟原虫(P. vivax)10例(12.8%)。20例(23.0%)患者既往有疟疾史。患者发病至住院的中位数时间为5 d,30例(34.5%)患者在发病后的48 h内服用抗疟疾药物。符合重症疟疾标准的18例,其中1例为脑型疟,17例总胆红素 > 43 μmol/L,3例血清肌酐 > 265 μmol/L。多因素logistic回归分析显示,发病后48 h内服用抗疟药是预测重症疟疾的独立的危险因子(OR = 0.05,95%置信区间0.01~0.43,P < 0.05)。结论恶性疟原虫是本市输入性疟疾病例感染的主要虫种,非洲是主要的感染来源地。发病后及时给予抗疟治疗可降低重症疟疾的发生风险。

关键词: 输入性疟疾, 流行病学特征, 危险因素, 重症疟疾, 恶性疟原虫

Abstract:

Objective To evaluate the epidemiological characteristics of imported malaria and analyze the risk factors for severe malaria in Shanghai, China. Methods A retrospective review was made on imported malaria cases treated in Shanghai Public Health Clinical Center during 2013-2015, focusing on the demographic information, epidemiological data, and laboratory data. Comparisons between groups were made with Mann-Whitney test and Fisher’s exact test, and risk factors were analyzed with multivariate logistic regression. Results Eighty-seven imported malaria cases (82 males and 5 females) were reviewed, with an average onset age of 36.4, comprising 79 Chinese (90.8%), 3 South Sudanese (3.4%), 2 Indians (2.3%), and one from each of Cameroon, Nigeria, and Burundi (1.1%). Seventy-five cases had a defined region of malaria source, with a dominance in African countries (63, 84.0%) and then in Asia (11, 14.7%). Seventy-eight (89.7%) were confirmed by laboratory tests while 9(10.3%) were clinically diagnosed. Among the laboratory confirmed cases, 89.7% were infected with Plasmodium falciparum and 10.3% with P. vivax. Twenty cases(23.0%) had a history of malaria infection. The median of duration from symptom onset to admission was 5 days and 30 (34.5%) patients received anti-malaria drug treatment within 48 hours after onset. Eighteen patients met the diagnostic criteria of severe malaria, of whom 1 showed cerebral malaria, 17 had serum total bilirubin elevating to > 43 μmol/L and 3 had a high serum creatinine level above 265 μmol/L. Multivariate logistic regression showed that medication within 48 h after onset was an independent risk factor for severe malaria (OR = 0.05, 95%CI 0.01-0.43, P < 0.05). Conclusion Plasmodium falciparum remains a major pathogen for imported malaria in Shanghai. Africa is the major region of malaria source. Timely medication after disease onset reduces the risk for sever malaria.

Key words: Imported malaria, Clinical epidemiology, Risk factor, Severe malaria, Plasmodium falciparum

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