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Article(id=1311350410485530900, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202511372, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1763913600000, receivedDateStr=2025-11-24, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579901571, onlineDateStr=2026-09-28, pubDate=1787587200000, pubDateStr=2026-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579901571, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579901571, creator=13701087609, updateTime=1790579901571, updator=13701087609, issue=Issue{id=1311350363295417204, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='16', pageStart='2881', pageEnd='3072', issueExtLink='null', onlineDate='null', pubDate='1787587200000', pubDateStr='2026-08-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=null, createTime=1790579890321, creator='13701087609', updateTime=1790584112451, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311368072267653663, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311368072267653664, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=3034, endPage=3040, ext={EN=ArticleExt(id=1311350410720411925, articleId=1311350410485530900, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Risk factors for severe disease and economic burden of non-neonatal tetanus, Suzhou City, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the epidemiological characteristics, disease burden, and risk factors for severe tetanus in non-neonatal patients in Suzhou, Jiangsu Province.

Methods

A retrospective study was conducted on 72 tetanus inpatients admitted to medical institutions in Suzhou, 2013-2025. Patients were divided into severe and non-severe groups according to the Ablett classification. Intergroup comparisons and multivariate logistic regression analysis were performed.

Results

The median age of patients was 59.0 years, with males accounting for 65.3%. The peak incidence occurred in summer (June-August), accounting for 36.1% of cases. The proportion of severe cases in patients aged ≥65 years (72.4%) was higher than that in the 0-40 years group(22.2%) and the 41-64 years group (44.1%) (P=0.011). The median incubation period in the severe group was 8.0 days, shorter than 11.0 days in the non-severe group, and the median total hospitalization cost (￥125 641.5) was 5.42 times that of the non-severe group (P=0.007). Multivariate logistic regression showed that age ≥65 years (OR=3.10, 95%CI: 1.05-9.65) was an independent risk factor for severe tetanus.

Conclusion

Non-neonatal tetanus in Suzhou peaks in summer, predominantly affects the elderly, and severe cases have shorter incubation periods and higher treatment costs. Enhanced health education and immunization targeting the elderly are needed to reduce their risk of severe disease and death.

, authors=Ying ZHANG1, Ben-feng ZHENG2, Jiang-tao YU3, Na LIU2, Zhi-yuan ZHU4, Zhuo-yu ZHANG2, Lin LUAN1, 2, authorsList=Ying ZHANG, Ben-feng ZHENG, Jiang-tao YU, Na LIU, Zhi-yuan ZHU, Zhuo-yu ZHANG, Lin LUAN, authorCompany=null, correspAuthors=Lin LUAN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1311350411248894232, articleId=1311350410485530900, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=苏州市非新生儿破伤风重症危险因素及疾病负担分析, columnId=1228016573844226129, journalTitle=现代预防医学, columnName=疾病预防控制, runingTitle=null, highlight=null, articleAbstract=
目的

了解江苏省苏州市非新生儿破伤风的流行病学特征及疾病负担，探讨重症破伤风的危险因素。

方法

采用病例回顾研究，纳入2013—2025年苏州市各级医疗机构收治的72例破伤风住院患者，根据Ablett分级标准划分为重症组与非重症组，进行组间比较与多因素logistic回归分析。

结果

患者中位年龄为59.0岁，男性占65.3%。夏季（6—8月）为发病高峰（36.1%）。≥65岁患者的重症比例为72.4%，高于0～40岁组（22.2%）和41～64岁组（44.1%）（P＝0.011）。重症组的中位潜伏期为8.0天，短于非重症组的11.0天，且其中位住院总费用（125 641.5元）是后者的5.42倍（P=0.007）。多因素logistic回归分析显示，年龄≥65岁（OR=3.10，95%CI：1.05～9.65）是重症破伤风的独立危险因素。

结论

苏州地区非新生儿破伤风夏季高发、老年人群易感、重症患者潜伏期较短且治疗费用更高。应重点加强老年人群的健康教育与免疫接种，以降低其重症与死亡风险。

, authors=张颖1, 郑本锋2, 俞江涛3, 刘娜2, 朱志远4, 张琢玉2, 栾琳1, 2, authorsList=张颖, 郑本锋, 俞江涛, 刘娜, 朱志远, 张琢玉, 栾琳, authorCompany=null, correspAuthors=栾琳, authorNote=

张颖和郑本锋为共同第一作者

张颖（2001—），女，硕士在读，研究方向：疾病控制；

郑本锋（1983—），男，硕士，研究方向：疾病控制

, correspAuthorsNote=
栾琳，E-mail：
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PLoS Neglected Tropical Diseases, 2022, 16(3): e0010235., articleTitle=Factors associated with in-hospital mortality of adult tetanus patients-a multicenter study from Bangladesh, refAbstract=null), Reference(id=1311350424452563320, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, doi=null, pmid=null, pmcid=null, year=2023, volume=16, issue=1, pageStart=7427, pageEnd=7434, url=null, language=null, rfNumber=[22], rfOrder=24, authorNames=Hirai J, Mori N, Shibata Y, journalName=Infection and Drug Resistance, refType=null, unstructuredReference=Hirai J, Mori N, Shibata Y, et al. Tetanus following canine bite in Japan: a case report and literature review［J］. Infection and Drug Resistance, 2023, 16(1): 7427-7434., articleTitle=Tetanus following canine bite in Japan: a case report and literature review, refAbstract=null), Reference(id=1311350424544838009, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, doi=null, pmid=null, pmcid=null, year=2023, volume=77, issue=2, pageStart=116, pageEnd=122, url=null, language=null, rfNumber=[23], rfOrder=25, authorNames=Jensen HAR, Lau CJ, Davidsen M, journalName=Journal of Epidemiology and Community Health, refType=null, unstructuredReference=Jensen HAR, Lau CJ, Davidsen M, et al. Agreement between self-reported diseases from health surveys and national health registry data: a Danish nationwide study［J］. Journal of Epidemiology and Community Health, 2023, 77(2): 116-122., articleTitle=Agreement between self-reported diseases from health surveys and national health registry data: a Danish nationwide study, refAbstract=null)], funds=[Fund(id=1311350420778352989, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, awardId=202308, language=CN, fundingSource=外伤后破伤风预防处置门诊规范建设试点项目(202308), fundOrder=null, country=null), Fund(id=1311350422422520158, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, awardId=KJFWBPSF202505, language=CN, fundingSource=扩大破伤风医防协同一体化建设试点项目(KJFWBPSF202505), fundOrder=null, country=null), Fund(id=1311350422502211935, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, awardId=GSWS2023065, language=CN, fundingSource=苏州市政府姑苏卫生人才培养项目(GSWS2023065), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1311350411492163865, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, xref=1., ext=[AuthorCompanyExt(id=1311350411500552474, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, companyId=1311350411492163865, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China), AuthorCompanyExt(id=1311350411508941083, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, companyId=1311350411492163865, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.南京医科大学公共卫生学院，江苏 南京 211166)]), AuthorCompany(id=1311350411571855644, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, xref=2., ext=[AuthorCompanyExt(id=1311350411584438557, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, companyId=1311350411571855644, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.苏州市疾病预防控制中心)]), AuthorCompany(id=1311350411659936030, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, xref=3., ext=[AuthorCompanyExt(id=1311350411668324639, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, companyId=1311350411659936030, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.杭州市富阳区疾病预防控制中心)]), AuthorCompany(id=1311350411760599328, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, xref=4., ext=[AuthorCompanyExt(id=1311350411768987937, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, companyId=1311350411760599328, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4.苏州市卫生健康信息中心)])], figs=[ArticleFig(id=1311350419503284561, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, language=EN, label=Fig.1, caption=Incidence of non-neonatal tetanus in suzhou, 2013-2025, figureFileSmall=NwW+IqMED/s+CMfsAZTnGQ==, figureFileBig=Wd3fkBJyj2BLdqJIgU2ZRw==, tableContent=null), ArticleFig(id=1311350419629113682, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, language=CN, label=图1, caption=2013—2025年苏州市非新生儿破伤风发病情况, figureFileSmall=NwW+IqMED/s+CMfsAZTnGQ==, figureFileBig=Wd3fkBJyj2BLdqJIgU2ZRw==, tableContent=null), ArticleFig(id=1311350419868189011, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, language=EN, label=Table 1, caption=

Severity classification of non-neonatal tetanus

, figureFileSmall=null, figureFileBig=null, tableContent=
严重程度牙关紧闭（上、下切牙切缘间最大距离）肌肉痉挛发作#吞咽困难呼吸窘迫自主神经功能障碍
轻型大于2 cm无无或轻度无无
中型1~2 cm轻至中度、短暂中度呼吸频率30~40次/min无
重型小于1 cm重度、持续重度呼吸频率超过40次/min、言语无法正常发音心率超过120次/min
特重型小于1cm重度、持续重度呼吸频率超过40次/min、言语无法正常发音严重且持续高血压、心动过速，或低血压、心动过缓
), ArticleFig(id=1311350419952075092, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, language=CN, label=表1, caption=

非新生儿破伤风的严重程度分级

, figureFileSmall=null, figureFileBig=null, tableContent=
严重程度牙关紧闭（上、下切牙切缘间最大距离）肌肉痉挛发作#吞咽困难呼吸窘迫自主神经功能障碍
轻型大于2 cm无无或轻度无无
中型1~2 cm轻至中度、短暂中度呼吸频率30~40次/min无
重型小于1 cm重度、持续重度呼吸频率超过40次/min、言语无法正常发音心率超过120次/min
特重型小于1cm重度、持续重度呼吸频率超过40次/min、言语无法正常发音严重且持续高血压、心动过速，或低血压、心动过缓
), ArticleFig(id=1311350420056932693, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, language=EN, label=Table 2, caption=

Characteristics of non-neonatal tetanus patients at admission［n(%)］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总体(n=72)按病情严重程度分组χ2P值
重症组(n=38)非重症组(n=34)
户籍地-0.528a
苏州城区30(41.7)15(50.0)15(50.0)
苏州县区34(47.2)20(58.8)14(41.2)
非苏州地区8(11.1)3(37.5)5(62.5)
性别0.4190.517
男性47(65.3)23(48.9)24(51.1)
女性25(34.7)15(60.0)10(40.0)
年龄-0.011a
0~409(12.5)2(22.2)7(77.8)
41~6434(47.2)15(44.1)19(55.9)
≥6529(40.3)21(72.4)8(27.6)
职业-0.974a
农民8(11.1)5(62.5)3(37.5)
工人9(12.5)5(55.6)4(44.4)
失业49(68.1)25(51.0)24(49.0)
其他6(8.3)3(50.0)3(50.0)
季节-0.566a
春季(3-5月)16(22.2)7(43.8)9(56.2)
夏季(6-8月)26(36.1)13(50.0)13(50.0)
秋季(9-11月)22(30.6)12(54.5)10(45.5)
冬季(12-2月)8(11.1)6(75.0)2(25.0)
慢性病史3.8940.048
无41(56.9)17(41.5)24(58.5)
有31(43.1)21(67.7)10(32.3)
), ArticleFig(id=1311350420145013078, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, language=CN, label=表2, caption=

非新生儿破伤风患者入院时特征［n(%)］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总体(n=72)按病情严重程度分组χ2P值
重症组(n=38)非重症组(n=34)
户籍地-0.528a
苏州城区30(41.7)15(50.0)15(50.0)
苏州县区34(47.2)20(58.8)14(41.2)
非苏州地区8(11.1)3(37.5)5(62.5)
性别0.4190.517
男性47(65.3)23(48.9)24(51.1)
女性25(34.7)15(60.0)10(40.0)
年龄-0.011a
0~409(12.5)2(22.2)7(77.8)
41~6434(47.2)15(44.1)19(55.9)
≥6529(40.3)21(72.4)8(27.6)
职业-0.974a
农民8(11.1)5(62.5)3(37.5)
工人9(12.5)5(55.6)4(44.4)
失业49(68.1)25(51.0)24(49.0)
其他6(8.3)3(50.0)3(50.0)
季节-0.566a
春季(3-5月)16(22.2)7(43.8)9(56.2)
夏季(6-8月)26(36.1)13(50.0)13(50.0)
秋季(9-11月)22(30.6)12(54.5)10(45.5)
冬季(12-2月)8(11.1)6(75.0)2(25.0)
慢性病史3.8940.048
无41(56.9)17(41.5)24(58.5)
有31(43.1)21(67.7)10(32.3)
), ArticleFig(id=1311350420228899159, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, language=EN, label=Table 3, caption=

Therapeutic management of non-neonatal tetanus patients［n(%)］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总体(n=72)按病情严重程度分组χ2/ZP值
重症组(n=38)非重症组(n=34)
住院时长［M(P25, P75),d］22.5(6.0, 35.8)30.0(9.3, 43.5)14.0(4.3, 32.3)1.7930.073
受伤到治疗时间［M(P25, P75),d］15.0(10.0, 15.0)15.0(9.3, 15.0)15.0(10.5, 20.3)-0.6540.501
潜伏期［M(P25, P75),d］10.0(7.0, 13.8)8.0(6.0, 13.0)11.0(8.0, 14.0)-2.2650.023
受伤部位-0.095a
未知14(19.4)8(57.1)6(42.9)
上肢和头部24(33.3)15(62.5)9(37.5)
下肢28(38.9)10(35.7)18(64.3)
躯干6(8.3)5(83.3)1(16.7)
伤后自行处理0.310.578
无52(72.2)29(55.8)23(44.2)
有20(27.8)9(45.0)11(55.0)
住院后的紧急治疗
机械通气6.6940.003
无41(56.9)15(36.6)26(63.4)
有31(43.1)23(74.2)8(25.8)
HTIG7.8100.010
无24(33.3)7(29.2)17(70.8)
有48(66.7)31(64.6)17(35.4)
TAT1.3930.238
无36(50.0)22(61.1)14(38.9)
有36(50.0)16(44.4)20(55.6)
HTIG+TAT25(34.7)15(60.0)10(40.0)0.4190.517
均未接种13(18.1)6(46.2)7(53.8)0.0490.825
结局-0.895a
治愈60(83.3)31(51.7)29(48.3)
未愈6(8.3)3(50.0)3(50.0)
死亡6(8.3)4(66.7)2(33.3)
), ArticleFig(id=1311350420308590936, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, language=CN, label=表3, caption=

非新生儿破伤风患者的治疗情况［n(%)］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总体(n=72)按病情严重程度分组χ2/ZP值
重症组(n=38)非重症组(n=34)
住院时长［M(P25, P75),d］22.5(6.0, 35.8)30.0(9.3, 43.5)14.0(4.3, 32.3)1.7930.073
受伤到治疗时间［M(P25, P75),d］15.0(10.0, 15.0)15.0(9.3, 15.0)15.0(10.5, 20.3)-0.6540.501
潜伏期［M(P25, P75),d］10.0(7.0, 13.8)8.0(6.0, 13.0)11.0(8.0, 14.0)-2.2650.023
受伤部位-0.095a
未知14(19.4)8(57.1)6(42.9)
上肢和头部24(33.3)15(62.5)9(37.5)
下肢28(38.9)10(35.7)18(64.3)
躯干6(8.3)5(83.3)1(16.7)
伤后自行处理0.310.578
无52(72.2)29(55.8)23(44.2)
有20(27.8)9(45.0)11(55.0)
住院后的紧急治疗
机械通气6.6940.003
无41(56.9)15(36.6)26(63.4)
有31(43.1)23(74.2)8(25.8)
HTIG7.8100.010
无24(33.3)7(29.2)17(70.8)
有48(66.7)31(64.6)17(35.4)
TAT1.3930.238
无36(50.0)22(61.1)14(38.9)
有36(50.0)16(44.4)20(55.6)
HTIG+TAT25(34.7)15(60.0)10(40.0)0.4190.517
均未接种13(18.1)6(46.2)7(53.8)0.0490.825
结局-0.895a
治愈60(83.3)31(51.7)29(48.3)
未愈6(8.3)3(50.0)3(50.0)
死亡6(8.3)4(66.7)2(33.3)
), ArticleFig(id=1311350420392477017, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, language=EN, label=Table 4, caption=

Medical costs of non-neonatal tetanus patients ［M(P25, P75),Yuan］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量住院费用按病情严重程度分组RatioZP值
重症组非重症组
总费用53 209.2(11 548.9, 167 943.7)125 641.5(34 016.5, 201 798.3)23 191.6(8 926.2, 111 326.2)5.42-2.6850.007
综合类总费用9 159.9(2 846.5, 38 422.5)24 745.3(7 875.5, 44 164.6)4 876.6(1 862.0, 16 592.7)5.07-2.7300.006
诊断类总费用10 731.8(3 222.7, 25 925.0)17 123.3(5 479.1, 29 113.8)4 754.5(2 450.9, 1 2845.9)3.60-3.0910.002
治疗类总费用492.0(0.0, 930.5)790.0(218.6, 1 026.5)119.0(0.0, 818.0)6.64-1.9700.049
药物类总费用2 2436.9(4 910.9, 87 189.4)58 091.1(10 639.9, 102 352.6)12 375.6(3 292.4, 60 939.0)4.69-2.0420.041
耗材类总费用1 643.9(97.0, 7 384.0)4 895.5(614.6, 9 542.0)314.6(11.2, 2 612.3)15.56-3.3560.001
其他费用0.0(0.0, 51.8)0.00(0.00, 4.00)18.0(0.0, 88.0)0.00-2.6920.007
), ArticleFig(id=1311350420463780186, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, language=CN, label=表4, caption=

非新生儿破伤风患者的医疗费用［M(P25, P75)，元］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量住院费用按病情严重程度分组RatioZP值
重症组非重症组
总费用53 209.2(11 548.9, 167 943.7)125 641.5(34 016.5, 201 798.3)23 191.6(8 926.2, 111 326.2)5.42-2.6850.007
综合类总费用9 159.9(2 846.5, 38 422.5)24 745.3(7 875.5, 44 164.6)4 876.6(1 862.0, 16 592.7)5.07-2.7300.006
诊断类总费用10 731.8(3 222.7, 25 925.0)17 123.3(5 479.1, 29 113.8)4 754.5(2 450.9, 1 2845.9)3.60-3.0910.002
治疗类总费用492.0(0.0, 930.5)790.0(218.6, 1 026.5)119.0(0.0, 818.0)6.64-1.9700.049
药物类总费用2 2436.9(4 910.9, 87 189.4)58 091.1(10 639.9, 102 352.6)12 375.6(3 292.4, 60 939.0)4.69-2.0420.041
耗材类总费用1 643.9(97.0, 7 384.0)4 895.5(614.6, 9 542.0)314.6(11.2, 2 612.3)15.56-3.3560.001
其他费用0.0(0.0, 51.8)0.00(0.00, 4.00)18.0(0.0, 88.0)0.00-2.6920.007
), ArticleFig(id=1311350420564443483, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, language=EN, label=Table 5, caption=

Analysis of risk factors for severe case of non-neonatal tetanus

, figureFileSmall=null, figureFileBig=null, tableContent=
变量(参照组)单因素logistic回归分析多因素logistic回归分析
OR值（95%CI）P值OR值（95%CI）P值
年龄(ref:<65岁)
≥65岁4.01(1.45~11.11)-0.0083.10(1.05~9.65)0.044
性别(ref:男性)
女性1.57(0.59~4.19)0.372
地区(ref:苏州城区)
苏州县区1.43(0.53~3.84)0.480
非苏州地区0.6(0.12~2.97)0.532
职业(ref:农民)
工人0.75(0.11~5.24)0.772
失业0.63(0.13~2.91)0.549
其他0.6(0.07~5.14)0.641
季节(ref:春季)
夏季1.29(0.37~4.5)0.694
秋季1.54(0.42~5.64)0.512
冬季3.86(0.59~25.29)0.159
慢性病史(ref:无)
有2.96(1.12~7.87)0.0291.94(0.65~5.74)0.229
受伤部位(ref:未知)
上肢和头部1.25(0.33~4.79)0.745
下肢0.42(0.11~1.55)0.190
躯干3.75(0.34~41.08)0.279
受伤到治疗时间(ref:<15天)
≥15天1.07(0.42~2.76)0.883
伤后自行处理(ref:无)
有0.65(0.23~1.83)0.414
), ArticleFig(id=1311350420652523868, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350410485530900, language=CN, label=表5, caption=

非新生儿破伤风患者重症相关危险因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量(参照组)单因素logistic回归分析多因素logistic回归分析
OR值（95%CI）P值OR值（95%CI）P值
年龄(ref:<65岁)
≥65岁4.01(1.45~11.11)-0.0083.10(1.05~9.65)0.044
性别(ref:男性)
女性1.57(0.59~4.19)0.372
地区(ref:苏州城区)
苏州县区1.43(0.53~3.84)0.480
非苏州地区0.6(0.12~2.97)0.532
职业(ref:农民)
工人0.75(0.11~5.24)0.772
失业0.63(0.13~2.91)0.549
其他0.6(0.07~5.14)0.641
季节(ref:春季)
夏季1.29(0.37~4.5)0.694
秋季1.54(0.42~5.64)0.512
冬季3.86(0.59~25.29)0.159
慢性病史(ref:无)
有2.96(1.12~7.87)0.0291.94(0.65~5.74)0.229
受伤部位(ref:未知)
上肢和头部1.25(0.33~4.79)0.745
下肢0.42(0.11~1.55)0.190
躯干3.75(0.34~41.08)0.279
受伤到治疗时间(ref:<15天)
≥15天1.07(0.42~2.76)0.883
伤后自行处理(ref:无)
有0.65(0.23~1.83)0.414
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苏州市非新生儿破伤风重症危险因素及疾病负担分析
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张颖 1 , 郑本锋 2 , 俞江涛 3 , 刘娜 2 , 朱志远 4 , 张琢玉 2 , 栾琳 1, 2
现代预防医学 | 疾病预防控制 2026,53(16): 3034-3040
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现代预防医学 |疾病预防控制 2026 , 53 (16) : 3034 -3040
苏州市非新生儿破伤风重症危险因素及疾病负担分析
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张颖1, 郑本锋2, 俞江涛3, 刘娜2, 朱志远4, 张琢玉2, 栾琳1, 2
作者信息
  • 1.南京医科大学公共卫生学院，江苏 南京 211166
  • 2.苏州市疾病预防控制中心
  • 3.杭州市富阳区疾病预防控制中心
  • 4.苏州市卫生健康信息中心
通讯作者:
栾琳，E-mail：
作者简介:

张颖和郑本锋为共同第一作者

张颖（2001—），女，硕士在读，研究方向：疾病控制；

郑本锋（1983—），男，硕士，研究方向：疾病控制

Risk factors for severe disease and economic burden of non-neonatal tetanus, Suzhou City
Ying ZHANG1, Ben-feng ZHENG2, Jiang-tao YU3, Na LIU2, Zhi-yuan ZHU4, Zhuo-yu ZHANG2, Lin LUAN1, 2
Affiliations
  • School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China
出版时间: 2026-08-25 doi: 10.20043/j.cnki.MPM.202511372
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摘要
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目的

了解江苏省苏州市非新生儿破伤风的流行病学特征及疾病负担，探讨重症破伤风的危险因素。

方法

采用病例回顾研究，纳入2013—2025年苏州市各级医疗机构收治的72例破伤风住院患者，根据Ablett分级标准划分为重症组与非重症组，进行组间比较与多因素logistic回归分析。

结果

患者中位年龄为59.0岁，男性占65.3%。夏季（6—8月）为发病高峰（36.1%）。≥65岁患者的重症比例为72.4%，高于0～40岁组（22.2%）和41～64岁组（44.1%）（P＝0.011）。重症组的中位潜伏期为8.0天，短于非重症组的11.0天，且其中位住院总费用（125 641.5元）是后者的5.42倍（P=0.007）。多因素logistic回归分析显示，年龄≥65岁（OR=3.10，95%CI：1.05～9.65）是重症破伤风的独立危险因素。

结论

苏州地区非新生儿破伤风夏季高发、老年人群易感、重症患者潜伏期较短且治疗费用更高。应重点加强老年人群的健康教育与免疫接种，以降低其重症与死亡风险。

破伤风  /  住院  /  重症  /  危险因素
Objective

To investigate the epidemiological characteristics, disease burden, and risk factors for severe tetanus in non-neonatal patients in Suzhou, Jiangsu Province.

Methods

A retrospective study was conducted on 72 tetanus inpatients admitted to medical institutions in Suzhou, 2013-2025. Patients were divided into severe and non-severe groups according to the Ablett classification. Intergroup comparisons and multivariate logistic regression analysis were performed.

Results

The median age of patients was 59.0 years, with males accounting for 65.3%. The peak incidence occurred in summer (June-August), accounting for 36.1% of cases. The proportion of severe cases in patients aged ≥65 years (72.4%) was higher than that in the 0-40 years group(22.2%) and the 41-64 years group (44.1%) (P=0.011). The median incubation period in the severe group was 8.0 days, shorter than 11.0 days in the non-severe group, and the median total hospitalization cost (￥125 641.5) was 5.42 times that of the non-severe group (P=0.007). Multivariate logistic regression showed that age ≥65 years (OR=3.10, 95%CI: 1.05-9.65) was an independent risk factor for severe tetanus.

Conclusion

Non-neonatal tetanus in Suzhou peaks in summer, predominantly affects the elderly, and severe cases have shorter incubation periods and higher treatment costs. Enhanced health education and immunization targeting the elderly are needed to reduce their risk of severe disease and death.

Tetanus  /  Severe  /  Hospitalization  /  Risk Factors
张颖, 郑本锋, 俞江涛, 刘娜, 朱志远, 张琢玉, 栾琳. 苏州市非新生儿破伤风重症危险因素及疾病负担分析. 现代预防医学, 2026 , 53 (16) : 3034 -3040 . DOI: 10.20043/j.cnki.MPM.202511372
Ying ZHANG, Ben-feng ZHENG, Jiang-tao YU, Na LIU, Zhi-yuan ZHU, Zhuo-yu ZHANG, Lin LUAN. Risk factors for severe disease and economic burden of non-neonatal tetanus, Suzhou City[J]. Modern Preventive Medicine, 2026 , 53 (16) : 3034 -3040 . DOI: 10.20043/j.cnki.MPM.202511372
正文
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非新生儿破伤风是指年龄超过28天的个体因破伤风梭状芽孢杆菌经皮肤或黏膜伤口侵入，产生外毒素所引起的急性、特异性、中毒性疾病，其主要特征为全身骨骼肌强直与痉挛［1］。重症患者常因喉痉挛所致窒息、严重缺氧，继发肺部感染及多器官功能衰竭而危及生命［2-3］。即使经过积极的治疗，病死率仍高达30%~50%［1］。我国目前尚未将该病纳入法定报告传染病体系，因而缺乏系统的流行病学监测数据，实际发病情况不清［4］。部分地区调查显示，非新生儿破伤风发病率仍处较高水平：2015—2017年桂林市该病的年均发病率为0.43/10万［5］；2014—2018年，石家庄市和南京市分别为0.42/10万和0.17/10万［6］，其中65岁以上老年人群的发病率更高，分别为1.32/10万和0.45/10万，显著高于发达国家0.01/10万的报告水平［7］。
为掌握苏州市非新生儿破伤风的流行特征与疾病负担，本研究系统回顾分析了2013—2025年该地区收治的非新生儿破伤风住院病例，通过比较重症与非重症患者的人口学特征、临床治疗及预后差异，深入探讨重症破伤风的危险因素，为未来优化区域破伤风防控与临床管理策略提供循证依据。
1　对象和方法
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1.1　研究对象
本研究通过苏州市卫生健康信息中心及病案系统，收集2013—2025年苏州市各级医疗机构登记的非新生儿破伤风病例和其临床资料。以同期苏州市年均常住人口数为分母计算发病率，人口数来源于历年《苏州统计年鉴》。由两位研究者审阅和评估病案，设计统一的表格提取诊疗信息，最后由第三位研究人员进行仲裁。本研究符合《赫尔辛基宣言》，所收集的信息不涉及个人隐私，经去标识化处理，无法回溯相关患者。
1.2　诊断标准
纳入标准为年龄超过28天且出院诊断为破伤风的患者。排除标准为医疗记录不完整或根据《非新生儿破伤风诊疗规范（2024年版）》其破伤风诊断无法确认的患者。参照该规范并结合临床实践共识，本研究采用基于Ablett分级法的诊断标准，将破伤风严重程度划分为四个等级［1,8］，见表1。
1.3　研究方法
所有临床资料均来源于病历。收集并分析患者的社会人口学和诊疗信息，包括性别、年龄、职业、损伤部位、潜伏期、伤后处置、主要临床症状、治疗史、疾病严重程度、住院时间、住院费用、疾病转归等。根据分级是否≥重型，将研究对象分为重症组和非重症组。
1.4　统计分析
所有数据经Microsoft Excel 2019整理与清洗后，采用R 4.1.1进行统计分析。分类变量以n(%)表示，并使用卡方检验或Fisher确切概率法进行比较。显示正态分布的连续变量表示为均数±标准差，显示非正态分布的变量表示为中位数（四分位间距），即M(P25, P75)，并使用Mann-Whitney U检验进行比较。以是否发生重症为因变量，采用多因素logistic回归分析评估重症相关的危险因素。自变量包括性别、年龄、地区、职业、慢性病史、季节、受伤部位、受伤到治疗时间、伤后是否自行处理等。先进行单因素logistic回归分析，将有统计学意义的变量纳入多因素logistic回归模型。检验水准为α=0.05。
非新生儿破伤风发病率计算公式：发病率（1/10万）＝观察时段内苏州市各级医疗机构登记的非新生儿破伤风病例数/同期苏州市常住人口数×10万。
2　结果
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2.1　非新生儿破伤风病例的人口统计学分析
2.1.1　不同年份和不同季节的非新生儿破伤风患者住院情况
2013—2025年苏州市共收治非新生儿破伤风住院患者72例，其中重症38例（52.8%），非重症34例（47.2%）。2013—2025年苏州市非新生儿破伤风年均发病率为0.047/10万，年发病率范围为0.009/10万~0.070/10万，见图1。不同季节中，入院患者比例最高的是夏季（6—8月），为36.1%，最低的是冬季（12—2月），为11.1%，季节分布差异具有统计学意义（χ2=10.222，P=0.017）。见表2。重症与非重症病例在不同季节中的分布差异无统计学意义。
2.1.2　非新生儿破伤风患者的基本特征
患者的中位年龄为59.0(48.0, 73.0)岁。三组年龄组间重症比例的差异有统计学意义（P=0.011）。Mann-Whitney U检验显示，重症组与非重症组年龄分布差异亦具有统计学意义（Z=2.69，P=0.003）。不同地区、性别及职业分布在两组间差异均无统计学意义（P>0.05）。有慢性基础疾病者31例（43.1%），重症组中比例高于非重症组，差异有统计学意义（P=0.048）。见表2。
2.2　非新生儿破伤风患者的临床特征和疾病负担
2.2.1　非新生儿破伤风患者的治疗情况
患者的住院时长中位数为22.5(6.0, 35.8)天，受伤到治疗时间中位数为15.0(10.0，15.0)天。中位潜伏期为10.0(7.0, 13.8)天，其中重症组为8.0(6.0, 13.0)天，非重症组为11.0(8.0, 14.0)天，两组差异具有统计学意义（P=0.023）。20例（27.8%）患者在入院前曾自行处理伤口。两组受伤部位构成差异无统计学意义（P=0.095）。见表3。
使用破伤风抗毒素（tetanus antitoxin，TAT）治疗36例（50.0%），使用破伤风人免疫球蛋白（human tetanus immunoglobulin，HTIG）48例（66.7%），同时使用TAT和HTIG 25例（34.7%），两者均未使用13例（18.1%）。两组在使用HTIG的差异具有统计学意义（P=0.010）。31例（43.1%）患者使用机械通气，其中重症23例（74.2%），非重症8例（25.8%），差异具有统计学意义（P=0.003）。治疗结局：治愈60例（83.3%），未愈6例（8.3%），死亡6例（8.3%），差异无统计学意义（P=0.895）。见表3。
2.2.2　非新生儿破伤风患者的医疗费用
表4说明了非新生儿破伤风患者的直接医疗费用情况。患者总费用中位数为53 209.2(11 548.9, 167 943.7)元，最高为456 156.22元。其中，药物类费用（西药费用、中药费用）占比最高，中位数为22 436.9(4 910.9, 87 189.4)元；其次为诊断类费用（病理检查、实验室检查、影像学检查等），中位数为10 731.8 (3 222.7, 25 925.0)元；综合类服务费用（一般医疗服务、一般治疗操作、护理等）的中位数为9 159.9 (2 846.5, 38 422.5)元；耗材类费用中位数为1 643.9 (97.0, 7 384.0)元；治疗类费用中位数为492.0(0.0, 930.5)元，其他费用中位数为0.0(0.0, 51.8)元。
重症组患者的中位总费用为非重症组的5.42倍（P=0.007），综合医疗服务费用为非重症组的5.07倍（P=0.006），诊断费用为非重症组的3.60倍（P=0.002），治疗费用为非重症组的6.64倍（P=0.049），药物费用为非重症组的4.69倍（P=0.041），耗材费用达非重症组的15.56倍（P=0.001）。
2.3　非新生儿破伤风患者重症相关危险因素分析
在单因素分析中，年龄≥65岁和慢性病史这两个变量具有统计学意义，将其纳入多因素logistic回归分析。多因素分析结果显示，年龄≥65岁是破伤风的独立危险因素。年龄≥65岁的破伤风患者发展为重症的风险是年龄<65岁的3.10倍（95%CI：1.05~9.65，P=0.044）。详见表5。该分析提示，临床需重点关注老年（≥65岁）破伤风患者的重症预防与管理，可通过加强监测、早期干预等措施降低重症发生风险。
3　讨论
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本研究对2013—2025年苏州市非新生儿破伤风发病情况开展回顾性分析，共纳入非新生儿破伤风病例72例，其中重症组38例，非重症组34例，样本量较小，可能对统计效能产生一定影响。结果显示，患者以男性为主（65.3%），与Lanuza等［9］的研究结果一致。这可能与男性更多参与户外体力劳动、伤后防护意识较薄弱有关。苏州地区非新生儿破伤风全年均有发病，夏季高发（36.1%），与广西的一项研究结果一致［10］。LaForce［11］等发现64%的病例发生在5月至10月，本研究同期入院患者比例为63.89%，验证了这一趋势。非新生儿破伤风夏季高发可能与衣着减少导致皮肤损伤风险增高，以及高温高湿环境易诱发伤口感染、促进破伤风梭菌繁殖有关［12］。
患者的中位潜伏期为10.0(7.0，13.8)天，受伤到治疗时间中位数为15.0(10.0, 15.0)天，提示多数患者未及时就医。重症组中位潜伏期（8.0天）短于非重症组（11.0天）（P=0.023），6例死亡病例中位潜伏期为7.5天。研究表明，潜伏期愈短，病情进展愈快，预后也愈差［13］。出现牙关紧闭、肌肉强直等症状的个体，应尽早就医［14］。本研究发现14例（19.4%）患者未发现明显伤口，与既往研究发现约30%的患者无明显外伤史的结论一致，提示“不存在安全的伤口”［15-16］。
重症患者的治疗费用可达数万元，给家庭和社会带来了沉重负担［17］。本研究中重症组患者的总费用、综合医疗服务费用、诊断费用、药物费用和耗材类费用均显著高于非重症组，其中重症组的耗材费用中位数是非重症组的15.56倍（P=0.001），可能与重症组患者的病情更严重、治疗更复杂有关。重症患者常因喉痉挛导致缺氧窒息，继发自主神经功能紊乱及呼吸功能衰竭，早期实施气管插管/切开并行机械通气是抢救的关键［2］，这类操作会增加耗材类费用。本研究也显示两组患者机械通气使用率的差异具有统计学意义（P=0.003），支持这一推断。苏州市非新生儿破伤风患者的医疗费用为53 209.2元，高于中国广西省(20 200元)［10］和越南(3 710元)［18］，是《2023年中国统计年鉴》中国人均卫生总支出（5 952.32元）的8.94倍。此外，2013—2025年苏州市非新生儿破伤风年均发病率为0.047/10万，低于2014—2018年南京市的0.17/10万［6］，但高于发达国家的0.01/10万［7］。苏州市非新生儿破伤风发病率较低，可能与苏州市近年来持续推进外伤后破伤风预防处置规范化建设有关。《非新生儿破伤风诊疗规范》明确了外伤后伤口处置、破伤风风险评估、免疫制剂使用标准等关键环节，为规范化预防提供了制度和技术依据，有助于降低发病风险［1］。此外，南京市作为区域性医疗中心，承担了部分周边地市患者的诊疗任务，可能影响破伤风病例数及发病率水平。2013—2025年苏州市非新生儿破伤风的病死率为8.3%，高于福建省（5.26%）［19］和广州市（0%）［20］，但低于广西省（11.2%）［10］。这些研究结果凸显了非新生儿破伤风的严重性和沉重的经济负担。
孟加拉国一项多中心前瞻性研究表明，年龄是影响破伤风预后的重要因素，老年患者不良结局的风险显著增高［21］。本研究中65岁及以上患者的重症比例为72.4%，高于0~40岁（22.2%）与41~64岁（44.1%）组别，与该结论一致。多因素logistic回归分析确认年龄≥65是重症破伤风的独立危险因素（OR=3.10，95%CI：1.05~9.65）。提示需重点关注老年（≥65岁）破伤风患者的重症预防与管理，可通过加强监测、早期干预等措施降低重症的发生风险。Hirai［22］等发现慢性病是影响破伤风进展的危险因素，但本研究中，慢性病史在单因素分析中与重症破伤风相关（P＝0.029），在多因素logistic回归分析中未达到统计学显著性（OR＝1.94，95%CI：0.65~5.74，P＝0.229）。该结果提示，在控制混杂因素后，慢性病史对疾病严重程度的影响尚不稳定，可能与本研究的样本量较小、统计效能不足有关。此外，本研究中慢性病史主要来源于患者自我报告，存在信息偏倚，亦可能影响多因素分析的稳健性［23］。后续研究将扩大样本量，进一步探讨慢性病史对非新生儿破伤风严重程度的影响。
本研究存在一定局限性。首先，回顾性设计可能带来信息偏倚与选择偏倚，病历记录不完整及未就诊、误诊患者的缺失可能影响数据的全面性与代表性。其次，苏州医疗条件较好、病例数较少，结论外推至其他地区时需审慎。后续将扩大研究范围以解决上述局限。尽管如此，鉴于国内尚缺乏同类区域性研究，本成果仍可为苏州及类似地区的防控工作提供流行病学参考。
综上所述，年龄≥65岁是重症破伤风的独立危险因素，且重症患者经济负担更重。接种疫苗是预防非新生儿破伤风的最有效措施。建议将老年人作为防控重点，加强健康教育与免疫接种，以降低其重症及死亡风险。同时，应积极推进《非新生儿破伤风诊疗规范》的临床应用，并开展医务人员专项培训，提升其早期识别、规范诊疗与免疫预防能力。
基金
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  • 外伤后破伤风预防处置门诊规范建设试点项目(202308)
  • 扩大破伤风医防协同一体化建设试点项目(KJFWBPSF202505)
  • 苏州市政府姑苏卫生人才培养项目(GSWS2023065)
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参考文献 引证文献
排序方式：
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2026年第53卷第16期
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doi: 10.20043/j.cnki.MPM.202511372
  • 接收时间：2025-11-24
  • 首发时间：2026-09-28
  • 出版时间：2026-08-25
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  • 收稿日期：2025-11-24
基金
外伤后破伤风预防处置门诊规范建设试点项目(202308)
扩大破伤风医防协同一体化建设试点项目(KJFWBPSF202505)
苏州市政府姑苏卫生人才培养项目(GSWS2023065)
作者信息
    1.南京医科大学公共卫生学院，江苏 南京 211166
    2.苏州市疾病预防控制中心
    3.杭州市富阳区疾病预防控制中心
    4.苏州市卫生健康信息中心

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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