旅行者腹泻区域间病因学差异分析

秦佳，韩晓辉，李俊，周启明，叶魏，张琳，章琪

　　上海国际旅行卫生保健中心，上海 200335

　　摘要：目的 比较旅行者腹泻（traveler’s diahrrea,TD）病原体的区域间差异，以期为预防和治疗提供依据。方法检索1973年至今发表于Pubmed(Medline)和中国知网的TD相关文献，对TD发生次数、人数、病原体、区域等因素进行整理及分析。结果经统计，肠产毒性大肠杆菌(Enterotoxic escherichia coli,ETEC)为最常见病原体，占总TD发病人数的30.86%(1 944/6300)，其中拉丁美洲、非洲和南亚阳性率最高，分别占该区域TD总数的33.59%（1 109/3 302）、31.22%（385/1233）和30.42%（223/733）。其余较高的病原体为肠黏附性大肠杆菌(Enteroadherent Escherichiacoli，EAEC)和诺如病毒（Norovirus, NV）。ETEC、EAEC、肠致病性大肠杆菌(EnteropathogenicEscherichia coli, EPEC)、肠出血性大肠杆菌(Enterohemorrhagic Escherichiacoli,EHEC)、弯曲杆菌、志贺氏菌、沙门氏菌、气单孢菌、毗邻单胞菌、非霍乱弧菌、贾第鞭毛虫、隐孢子虫、阿米巴原虫的感染均有地区间差异。结论TD的病原体存在地区间差异，了解该差异对TD的预防和治疗具有一定指导意义。

　　关键词：旅行者腹泻；病原体；区域间；病因学；分析

　　中图分类号：R181.3　文献标识码：B

　　Etiologic analysis of traveler's diahrrea in different geographicregion

　　QIN Jia, HAN Xiao-hui, LI Jun, ZHOU Qi-ming, YE Wei, ZHANGLin-lin, ZHANG Qi

　　Shanghai International Travel Healthcare Center, Shanghai200335,China

　　Abstract:   Objective   To analyze the regionaldifferences of pathogen of traveler’s diahrrea(TD), and to preservethe basis for clinical prevention and treatment.  Methods  The literatures on TD published on Pubmed (Medline) and CNKIdata base were retrieved, and the factors such as frequency,pathogen and regions were analyzed.  Results  Enterotoxigenic E. coli (ETEC) was the most common pathogen whichwas detected in 30.86% (1 944/6 300), with Latin America 33.59%（1109/3 302）, Africa 31.22%（385/1 233）, Southeast Asia30.42%（223/733）of all the TD numbers in the region,respectively.The second and third most common pathogen detected were enteroadherent Escherichia coli(EAEC) and Norovirus(NV). Othersignificantly regional differences were seen for EnteroadherentEscherichia coli, Enteropathogenic Escherichia coli,Enterohemorrhagic Escherichia coli, Campylobacter, Shigella,Salmonella, Aeromonas, Plesiomonas, Non-cholerae Vibrio Species,Giardia,Cryptosporidium, E.histolytica.  Conclusion  There are regional differences on TD pathogens. The identificationof TD pathogen in different regional will serve as a baseline forantimicrobial therapy recommendations and prophylaxisstrategies.

　　Key words:   Traveler’s diahrrea; Pathogen; Inter-regional;Etiologic; Analysis

　　《中国国境卫生检疫杂志》2013年12月刊