CAJ | 학술논문

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。
목적료해갑형부상한병후대균정황급대균상태여지다당（ LPS ） IgG항체적도적관계。방법채용역사성대렬연구방법，수방계림시1999～2008년발병적갑형부상한환자328례，채집기3차분편표본배양갑형부상한균，동시채집혈양진행LPS IgG측정。결과328례분포우9개현구43개향진（가도）。328례중처우회복기병례20례，검출대균6례，회복기대균솔30．00％，95％CI（12％，54％）；회복기대균자주요원인위발병시용약불규범。처우만성기환자308례，검출만성대균1례，만성대균솔위0．32％，95％CI （0．1％，5．6％）；해만성대균자위반담낭결석화신낭종적중년비반녀성，병후18개월잉휴대갑형부상한균。7례대균자여안변청매소가좌양불사성연합용약련속2주，소제대균상태。대균자혈청LPS IgG평균적도1∶97．14，고우무대균상태적기왕병례평균적도1∶8．59（P＜0．05）。결론방공갑형부상한중응주호병례관리，규범、합리、전정사용항생소；재치료갑형부상한병인시，응주의반담도질환혹만성비뇨계통질환자，여치료불철저역발전성만성대균。
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.