目的

回顾性研究食源性疾病患者的病原学监测结果和临床特征，以期为防控食源性疾病提供依据。

方法

采用描述性研究，回顾性收集北京大学第三医院肠道门诊2014年1月至2023年8月所收治的食源性疾病患者的临床资料和病原学监测结果。按照病原学检测结果分为病原阳性组（494例）和病原阴性组（1 422例），比较两组患者人口学资料、临床表现和流行病学等指标。

结果

共收集病例1 916例，其中男性1 008例（52.6%），女性908例（47.4%）；职业类型主要为学生623例（32.5%）、干部职员498例（26.0%）。临床表现主要为腹泻5～10次/d（1 156例、60.3%）和水样便（1 433例、74.8%），其他症状主要有腹痛（1 123例、58.6%）、恶心（1 038例、54.2%）、呕吐（666例、34.8%）和发热（498例、26.0%）等。1 916例患者中，494例检出病原体，阳性检出率为25.8%，其中336例检出细菌，167例检出病毒，9例同时检出细菌和病毒。共检出504株病原体，主要包括大肠埃希菌169株（33.5%），沙门菌62株（12.3%）、弧菌59株（11.7%）、弯曲菌38株（7.5%）、诺如病毒131株（26.0%）和轮状病毒35株（6.9%）。病原阳性组与病原阴性组患者职业分布差异有统计学意义（χ² = 18.534、P = 0.029）；两组患者发病时间差异有统计学意义（χ² = 22.267、P ＜ 0.001），以第三季度（7～9月份）病原阳性例数最多（690例）。病原体检测阳性患者中，主要病原体为细菌和病毒，其中第一、二、三、四季度检出细菌的比例依次是8.9%（5/56）、66.7%（118/177）、94.0%（189/201）和40.0%（24/60），以第三季度最高。病原阳性组和阴性组中发热患者分别占32.8%（162/494）和23.6%（336/1 422），差异有统计学意义（χ² = 16.009、P ＜ 0.001）。病原阳性组和阴性组患者腹泻类型（χ² = 6.537、P = 0.037）和进食食品类型（χ² = 45.757、P ＜0.001）差异均有统计学意义。

结论

食源性疾病是腹泻患者常见病，夏秋季高发，有特征性的病原谱和流行病学特点，需针对重点人群加强和完善食品安全监测和防控。

Objective

To investigate the clinical characteristics of patients with foodborne diseases,retrospectively, and to provide a basis for the prevention and control of foodborne diseases.

Methods

A descriptive study was conducted to collect the cases of foodborne diseases and the results of pathogenic surveillance in the Intestinal Clinic of Peking University Third Hospital from January 2014 to August 2023,retrospectively, and the patients were divided into pathogen-positive group (494 cases) and pathogen-negative group (1 422 cases). The demographic data, clinical manifestations and epidemiology between the two groups were compared.

Results

Total of 1 916 cases were collected, including 1 008 males (52.6%) and 908 females(47.4%). The main occupational types were students (623 cases, 32.5%) and cadres (498 cases, 26.0%). The main clinical manifestations were diarrhea 5-10 times/day (1 156 cases, 60.3%) and watery stool (1 433 cases,74.8%), other symptoms were abdominal pain (1 123 cases, 58.6%), nausea (1 038 cases, 54.2%), vomiting(666 cases, 34.8%) and fever (498 cases, 26.0%), etc. Among the 1 916 patients, 494 cases were detected with pathogens, the positive detection rate was 25.8%, 336 cases were detected with bacteria, 167 cases were detected with virus, and 9 cases were detected with both bacteria and virus. Total of 504 strains of pathogens were detected, including 169 strains (33.5%) of Escherichia coli, 62 strains (12.3%) of Salmonella, 59 (11.7%)strains of Vibrio, 38 strains (7.5%) of Campylobacteria, 131 strains (26.0%) of norovirus and 35 strains(6.9%) of rotavirus. The stratification of occupation of patients in pathogen-positive group and pathogennegative group was significantly different (χ² = 18.534, P = 0.029); The onset time between the two groups was significantly different (χ² = 22.267, P ＜ 0.001), and the number of pathogen positive cases was the largest in the third quarter (July to September), which was 690 cases. Among the patients with positive pathogens,the main pathogens were bacteria and viruses, among which, the proportion of bacteria detected in the first,second, third and fourth quarters were 8.9% (5/56), 66.7% (118/177), 94.0% (189/201) and 40.0% (24/60),which was the highest in the third quarter. Patients with fever of pathogen-positive group and pathogennegative group were 32.8% (162/494) and 23.6% (336/1 422), respectively, with significant difference (χ² =16.009, P ＜ 0.001). The diarrhea type (χ² = 6.537, P = 0.037) and type of food being eaten (χ² = 45.757, P ＜0.001) of patients in pathogen-positive group and pathogen-negative group between the pathogen-positive group and the pathogen-negative group were significantly different.

Conclusions

Foodborne diseases are common in diarrhea patients, with a high incidence in summer and autumn, and with characteristic pathogen spectrum and epidemiological characteristics. It is necessary to strengthen and improve food safety monitoring and prevention and control for key groups.