| Through retrospective analysis of adult tetanus cases,studies the epidemiological and clinical characteristics of the disease,and discusses the risk factors for tetanus prognosis;investigating the level of tetanus antibody to understand the immune level and characteristics of tetanus in general population.Monitoring the dynamic serum antibody of tetanus patients to understand the influence of TIG on tetanus antibody and related factors.The purpose of this study is to conduct a comprehensive analysis of the prevalence of tetanus so as to provide a theoretical basis for the prevention and treatment of tetanus in the future.This study consists of three parts.Part One:Epidemiological analysis of tetanus.Descriptive analysis of clinical characteristics of 59 tetanus patients admitted to Qilu Hospitalof Shandong University during the past 2010-2017 years was carried out by collecting clinical data.In 59 tetanus patients,30 were male and 29 were female.The age of the patient is between 28-81 years,the average age of the patients is 54.25 ± 12.60 years,the average age of the male patients is 50.90 + 11.33 years,the average age of the female patients is 57.72 ±13.10 years.Elderly patients accounted for 33.90%of total tetanus patients,and 91.52%of tetanus patients were born before 1978.There were 6 cases in grade Ableet I,30 cases in grade Ⅱ,16 cases in grade Ⅲ,and 7 cases in grade Ⅳ.51 cases had a clear history of trauma.92.16%(47/51)patients were not treated with debridement after injury.The median incubation period of tetanus patients was 9.0(6.0-11.0)days,the time of oral feeding was 17.50(15.00-22.50)days,and the average time of hospitalization was 22.02± 10 days.During treatment,16 cases underwent tracheal intubation or tracheotomy,28 cases with pulmonary infection,6 cases with self-regulated instability,2 cases with fracture and 1 cases with acute rena]failure.The total mortality of tetanus was 15.25%(9/59).The rate of misdiagnosis was 25.42%(15/59).The study shows that the population born before 1978 is the main cause of tetanus.Besides common injury factors,oral cavity,nasal cavity operation and chronic skin ulcer can cause tetanus infection.The total mortality of tetanus has declined,but respiratory and cardiac arrest is still the main cause of death in patients with severe tetanus.The severity of the disease,the underlying diseases,and tracheal intubation during treatment are closely related to the prognosis of tetanus patients.But there is no significant correlation with sex,age,incubation period and complications.Part Two:Investigation on the immunity of tetanus at the present stage.The antibody concentration of tetanus was detected in 688 human serum specimens collected from Qilu Hospital of Shandong University from April 1,2017 to June 30,2017 to analyze the immune level and characteristics of all age groups.The results showed that the number of maternal tetanus antibodies decreased gradually with the increase of age.The protective rates of<1 month old,1-2 months old,≥2 months old infants were 87.7%,52.30%and 41.18%respectively.Infants began tetanus vaccination at third months after birth,and the protective rate gradually increased with age group.For children aged 3 month old to 1,children aged 2 to 5,and 6 to 11 years old children,the protective rates of tetanus antibodies were 60.47%,84%and 90%respectively.The protective rate of tetanus antibody remained at 89.47%in the 12 year old group.Among the pregnant women,the protective rate of tetanus antibody was 98.04%,90.38%and 87.50%in the age group 20-29,30-39 and 40,respectively.The protective rate of age group over 60 was significantly decreased,only 54.62%.Compared with other age groups,the protective rate of tetanus antibody was low in<3 months old infants and the elderly.The protective rate of tetanus antibody was higher in pregnant women.There was no significant difference in the antibody concentration between primipara and parturient.Part three:he dynamic changes of serum antibodies in tetanus patients.Collected from February 2017 to September 2017 in Qilu Hospital of Shandong University,7 cases of tetanus patients dynamic serum,tetanus antibody concentration dynamic detection.Time points were selected before injection of TIG,first days after injection,second days,fifteenth days.Before injection of Human Tetanus Immunoglobulin,the serum antibody level of 5 patients reached the level of 0.16-0.47IU/ml.The antibody concentration in 2 tetanus patients was lower than that in the protection level.After injection of TIG24h and 48h,4 cases of tetanus protective tetanus antibody levels were observed to increase rapidly.1 patients did not respond to immunization,and their antibody concentrations did not reach 0.11U/ml after 24h and 48h.More human data need to be collected to further study the definition of protective antibody levels.At the same time,we should further study the related factors that affect TIG absorption.Tetanus is a very serious and potentially fatal disease.But vaccination can be used to prevent the disease.Although the prevention and treatment of tetanus has made great progress,the prevention and treatment of tetanus still faces many challenges.First of all,the treatment of severe tetanus is still a medical problem.Autonomic dysfunction has become the main cause of death in tetanus patients.There are no guidelines on tetanus treatment in China,and there is no consensus on the use of TIG.In addition,there was a lack of knowledge about tetanus,and exposure factors remained a risk factor for tetanus.Tetanus immunization in children has achieved good results.However,the investigation of serum tetanus antibody found that there was a large immune gap in less than 3 month old of the infants and the elderly.A perfect monitoring system is needed to monitor the incidence of tetanus and the change in mortality,the coverage of the vaccine,the level of antibody,the safety and effectiveness of the vaccine. |
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