臺灣博碩士論文加值系統

研究背景：諾羅病毒(Norovirus)是非細菌性腸胃炎群突發中最常見的致病因；僅次於輪狀病毒，是兒童非細菌性腸胃炎第二常見的致病原。本研究欲瞭解諾羅病毒在南台灣兒童急性腸胃炎致病原中扮演的角色，並建立南台灣諾羅病毒的臨床及分子流行病學資料。研究方法：西元2006年5月至2007年4月間，在高雄醫學大學附設中和紀念醫院小兒科住院，診斷為急性腸胃炎的兒童，收集其糞便檢體，以反轉錄聚合酵素連鎖反應 (RT-PCR)檢測諾羅病毒的感染。並紀錄病童的年齡、性別、臨床表現及實驗室檢查結果。研究結果：共採得了373位患者的糞便。年齡分布最小為1個月，最大為17歲。其中有86位被偵測出有諾羅病毒，陽性率為23.1%，且皆為基因型II/4。諾羅病毒好發於1歲的兒童，主要流行於秋冬兩季。諾羅病毒腸胃炎的臨床表現，有嘔吐(86.0%，中位數2天)、腹瀉(96.5%，中位數4天)及發燒(70.9%)，住院五天以上佔45.3%。在實驗室檢查結果方面，患者的血中白血球大多偏高，C-反應蛋白多在正常範圍內，約49%有糞便潛血反應，但少見糞便中出現白血球的情形。結論：諾羅病毒基因型GII/4是造成南台灣兒童急性腸胃炎的重要原因。在輪狀病毒疫苗開始在台灣施打的今日，非細菌性腸胃炎的分子流行病學的變化特別值得注意。

Background: Norovirus is the leading cause of nonbacterial acute gastroenteritis outbreaks worldwide. Surveillance using reverse- transcription polymerase chain reaction (RT-PCR) by many laboratories has shown that norovirus is a most important cause, after rotaviruses, of pediatric gastroenteritis. In this study, we addressed the role of norovirus infection in pediatric gastroenteritis and the molecular epidemiology of norovirus in southern Taiwan. Methods: 373 fecal specimens were collected from patients with acute gastroenteritis attending inpatient departments in Kaohsiung Medical University Hospital during the period from May 2006 to April 2007. The prevalence of norovirus was carried out by using RT-PCR. Clinical data including age, gender, symptoms & signs, and laboratory findings will also be analyzed. Results: Norovirus was detected in 86 (23.1%) of the samples, of which 13 (15.1%) were mixed infections with rotavirus. Infants up to 1-year-old were the most affected and a peak of virus detection was observed in autumn and winter seasons. Vomiting (86.0%, median duration 2 days), diarrhea (96.5%, median duration 4 days) and fever (70.9%) were the major clinical manifestations. Sporadic healthcare-associated norovirus infections were noted in 11 cases. Phylogenetic analysis showed that genogroup II and GII/4 were prevalent. Conclusions: This study demonstrated the importance of norovirus infection causing acute gastroenteritis in children in southern Taiwan. Molecular epidemiology surveillance determining the circulation pattern of different genotypes is helpful for designing prevention strategies of norovirus transmission in children. Studies concerning the prevalence and the molecular epidemiology of gastroenteric viruses in hospitalized children are particularly important to evaluate the impact of the rotavirus vaccine in Taiwan.

壹、中文摘要 1
貳、英文摘要 2
參、致謝辭 4
肆、目次 5
伍、前言
一、諾羅病毒之簡介 8
二、諾羅病毒之流行病學 9
三、諾羅病毒之臨床表現 11
四、諾羅病毒之診斷 12
五、諾羅病毒之分子流行病學 13
六、研究目的 14
陸、材料與方法
一、臨床定義 16
二、樣本來源 16
三、檢體處理 17
四、病毒RNA之萃取 17
五、反轉錄聚合酵素連鎖反應 18
六、基因序列分析和種系分析 18
七、統計 19
柒、結果
一、諾羅病毒盛行率、臨床表現及年齡分布 20
二、諾羅病毒感染與輪狀病毒感染 21
三、醫療照護相關感染與社區感染之比較 22
四、種系分析 23
捌、討論 24
玖、結論 34
拾、參考文獻 35
拾壹、附錄 47

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