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目的 查明某部连续两年发生以单项血清谷丙转氨酶 (ALT)升高为特征的肝损害病因 ,传播途径和临床特点等 ,彻底控制疫情。方法 用流行病学调查方法对某部进行调查 ,检查全体指战员肝功能及各种病毒标志物 ,对所有ALT升高者进行个案调查 ,对部分病人进行肝穿活检、肝组织免疫组化和TTVDNA原位杂交实验。结果 115名指战员ALT升高 88人 (占76 .5 2 % )。其中TTVDNA阳性占 88.6 4% ,HBV -M阳性占 3.4 1% ,病原学未明占 7.95 % ;ALT升高者中干部占 2 .2 7% ,战士占 97.73%。机关干部、战士发病率很低 ,3名职工ALT均正常 ,发病有明显用餐的聚集性。 9例患者肝组织免疫组化实验甲、乙、丙、戊型肝炎病毒标志物均阴性 ,TTVDNA原位杂交 8例阳性。结论 初步认为该部暴发型肝炎是一种肠道传播性肝炎 ,病原是TTV ,传播途径是饮食密切接触。
Objective To identify the cause, route of transmission and clinical features of liver damage characterized by the elevation of single serum alanine aminotransferase (ALT) in a certain department for two consecutive years and to completely control the outbreak. Methods An epidemiological investigation method was used to investigate a certain department. The liver function and various virus markers of all officers and soldiers were examined. All ALT patients were investigated on a case-by-case basis. Some patients underwent liver biopsy, liver tissue immunohistochemistry and TTVDNA In situ hybridization experiments. Results Eleven combatants ALT increased by 88 (76.52%). Among them, TTVDNA positive accounted for 88.6%, HBV-M positive accounted for 3.4%, etiology did not account for 7.95%, ALT increased cadres accounted for 2.27%, soldiers accounted for 97.73%. Organizations cadres, the incidence of soldiers is very low, three workers were normal ALT, the incidence of significant meal aggregation. Nine cases of liver tissue immunohistochemistry A, B, C, hepatitis E virus markers were negative, TTVDNA in situ hybridization in 8 cases were positive. Conclusion It is initially believed that the Ministry of Hepatitis B is an intestinal infectious hepatitis, the pathogen is TTV, and the route of transmission is close diet.