生食淡水鱼行为传播华支睾吸虫病的效应分析

doi:10.12140/j.issn.1000-7423.2019.03.010

中国寄生虫学与寄生虫病杂志 ›› 2019, Vol. 37 ›› Issue (3): 296-301.doi: 10.12140/j.issn.1000-7423.2019.03.010

生食淡水鱼行为传播华支睾吸虫病的效应分析

钱门宝¹(), 蒋智华², 葛涛³, 王心⁴, 邓卓晖⁵, 周长海¹, 朱慧慧¹, 陈颖丹¹, 周晓农^1,^*()

1 中国疾病预防控制中心寄生虫病预防控制所,国家热带病研究中心,世界卫生组织热带病合作中心,科技部国家级热带病国际联合研究中心,卫生部寄生虫病原与媒介生物学重点实验室,上海 200025
2 广西壮族自治区疾病预防控制中心,南宁 530021
3 黑龙江省疾病预防控制中心,哈尔滨 150030
4 吉林省疾病预防控制中心,长春 130062
5 广东省疾病预防控制中心,广州 511430

收稿日期:2019-04-26 出版日期:2019-06-30 发布日期:2019-07-10
通讯作者: 周晓农
作者简介:
作者简介：钱门宝（1983-）,男,硕士,副研究员,主要从事土源性和食源性寄生虫病的防治研究。E-mail: qianmb@nipd.chinacdc.cn
基金资助:
瑞银集团慈善基金会项目（No. 9051）;上海市第四轮公共卫生体系建设三年行动计划（2015-2017年）（No. GWTD2015S06）

Association of raw-freshwater fish-eating practice with the infection of Clonorchis sinensis

Men-bao QIAN¹(), Zhi-hua JIANG², Tao GE³, Xin WANG⁴, Zhuo-hui DENG⁵, Chang-hai ZHOU¹, Hui-hui ZHU¹, Ying-dan CHEN¹, Xiao-nong ZHOU^1,^*()

1 National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology; Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai 200025, China
2 Guangxi Center for Disease Control and Prevention, Nanning 530021, China
3 Heilongjiang Center for Disease Control and Prevention, Harbin 150030, China
4 Jilin Center for Disease Control and Prevention, Changchun 130062, China
5 Guangdong Center for Disease Control and Prevention, Guangzhou 511430, China

Received:2019-04-26 Online:2019-06-30 Published:2019-07-10
Contact: Xiao-nong ZHOU
Supported by:
Supported by the UBS Optimus Foundation (No. 9051) and the Fourth Round of the Three-Year Public Health Action Plan (2015-2017) in Shanghai (No. GWTD2015S06)

摘要/Abstract

摘要：

目的分析生食淡水鱼行为在华支睾吸虫病传播中的定量效应。方法在广西、广东、黑龙江和吉林等4省（自治区）调查16个县（市、区）,每县分别抽取5个行政村（社区）,每个行政村（社区）整群抽取约200名居民。收集居民的粪样,采用改良加藤厚涂片法（Kato-Katz法,一粪二检）检测华支睾吸虫感染状况;同时收集调查对象生食淡水鱼行为信息。比较各县（市、区）、性别与年龄组的生食淡水鱼者比例和华支睾吸虫感染率,分析其相关性,计算决定系数（R²）。分析生食淡水鱼者和未生食淡水鱼者的华支睾吸虫感染率,计算相对危险度（RR）及95%置信区间（95% CI）。同时计算华支睾吸虫感染的归因危险度（AR）、归因危险度百分比（ARP）、人群归因危险度（PAR）和人群归因危险度百分比（PARP）。结果 4省（自治区）16个县（市、区）共检测16 230人,生食淡水鱼者比例为26.5%（4 295/16 230）,华支睾吸虫感染率为10.8%（1 747/16 230）。各县（市、区）生食淡水鱼者比例和华支睾吸虫感染率呈正向的线性关系（R² = 0.44,P < 0.01）。男性和女性生食淡水鱼者比例分别为31.7%（2 687/8 478）、20.7%（1 608/7 752）,二者差异有统计学意义（P < 0.01）。男性和女性华支睾吸虫感染率分别为13.7%（1 161/8 478）、7.6%（586/7 752）,二者差异有统计学意义（P < 0.01）。男性≤14、15~29、30~44、45~59和≥60年龄组生食淡水鱼者比例和华支睾吸虫感染率分别为1.9%、 19.4%、40.2%、44.5%、36.3%和1.5%、 7.5%、 15.1%、 20.8%、 15.4%;呈正向的线性关系（R² = 0.96,P < 0.01）。女性≤14、15~29、30~44、45~59和≥60年龄组生食淡水鱼者比例和华支睾吸虫感染率分别为2.3%、13.9%、25.3%、29.2%、22.4%和1.2%、6.1%、9.0%、10.4%、8.0%;呈正向的线性关系（R² = 0.99,P < 0.01）。与未生食淡水鱼者相比,生食淡水鱼者感染华支睾吸虫的RR为12.9（95% CI：11.4~14.7）。男性和女性生食淡水鱼者与未生食淡水鱼者相比,感染华支睾吸虫的RR分别为11.8（95% CI：10.0~14.0）、13.4（95% CI：10.9~16.4）。与未生食淡水鱼者相比,各年龄组生食淡水鱼者感染华支睾吸虫的RR为8.2~16.1。生食淡水鱼感染华支睾吸虫的AR为30.9%、ARP为92.3%、PAR为8.2%、PARP为75.9%。男性生食淡水鱼感染华支睾吸虫的AR为33.5%、ARP为91.5%、PAR为10.6%、PARP为77.4%;女性生食淡水鱼感染华支睾吸虫的AR为26.2%、ARP为92.5%、PAR为5.4%、PARP为72.0%。各年龄组的AR为15.6%~34.0%、ARP为87.9%~93.8%、PAR为0.3%~12.7%、PARP为24.1%~79.7%。结论生食淡水鱼行为是华支睾吸虫病传播的关键因素,生食淡水鱼行为的差异决定了华支睾吸虫病的地区和人群分布差异。

关键词: 华支睾吸虫病, 生食淡水鱼行为, 效应

Abstract:

Objective To quantitatively evaluate the relationship between the raw-freshwater fish-eating practice and the infection of Clonorchis sinensis. Methods Total 16 counties were enrolled from 4 provinces highly endemic with clonorchiasis (Guangxi, Guangdong, Heilongjiang and Jilin), and 5 villages were selected from each investigated counties as survey sites. Total 200 residents from each site were recruited for the investigation. The fecal samples were collected from each participant and the eggs of C. sinensis in the feces were examined under microscope using Kato-Katz thick smear method, and the information on eating raw freshwater fish among the participants was collected. The linear relationship between the percentage of participants eating raw freshwater fish and the prevalence of C. sinensis infection was analyzed in people living in different counties, with different genders and age. The parameter of coefficient of determination (R²) was determined accordingly. The relative risk (RR) and 95% confidential intervals (95% CI) were calculated for those with raw-freshwater fish-eating practice compared to those without the practice. Subsequently, attributable risk (AR), attributable risk percent (ARP), population attributable risk (PAR) and population attributable risk percent (PARP) were analyzed. Results A total of 16 230 participants from 16 counties were enrolled in this survey. The percentage of participants with practice of eating raw freshwater fish was 26.5% (4 295/1 6230) and the overall prevalence of C. sinensis infection was 10.8% (1 747/1 6230) with a positive linear association between them in investigated counties (R² = 0.44, P < 0.01). The percentage of eating raw freshwater fish was 31.7% (2 687/8 478) in males and 20.7% (1 608/7 752) in females (P < 0.01), while the corresponding prevalence of C. sinensis infection was 13.7% (1 161/8 478) and 7.6% (586/7 752) (P < 0.01). The percentage of eating raw freshwater fish in males aged ≤14, 15-29, 30-44, 45-59 and ≥60 was 1.9%, 19.4%, 40.2%, 44.5% and 36.3%, respectively, positively correlating with the prevalence of C. sinensis infection of 1.5%, 7.5%, 15.1%, 20.8% and 15.4%, correspondingly (R² = 0.96, P < 0.01). The percentage of eating raw freshwater fish in females aged ≤14, 15-29, 30-44, 45-59 and ≥60 was 2.3%, 13.9%, 25.3%, 29.2% and 22.4%, correspondingly, with positive linear association with, the prevalence of C. sinensis infection of 1.2%, 6.1%, 9.0%, 10.4% and 8.0%, respectively(R² = 0.99, P < 0.01). Compared to those without the practice, RR of C. sinensis infection in those with the practice reached 12.9 (95% CI: 11.4-14.7). RR was 11.8 (95% CI: 10.0-14.0) in males and 13.4 (95% CI: 10.9-16.4) in females between eating raw freshwater fishes and the chance of getting infected. RR ranged from 8.2-16.1 in different age groups. Overall, AR for eating raw freshwater fishes and the infection of C. sinensis was 30.9%, ARP was 92.3%, PAR was 8.2%, and PARP was 75.9%. In males, AR was 33.5%, ARP was 91.5%, PAR was 10.6% and PARP was 77.4%, compared to those in female of 26.2%, 92.5%, 5.4% and 72.0%, respectively. AR ranged between 15.6% and 34.0%, ARP between 87.9% and 93.8%, PAR between 0.3% and 12.7%, and PARP between 24.1% and 79.7% in different age groups. Conclusion Raw-freshwater fish-eating practice is seriously associated with the infection of C. sinensis and the difference in raw-freshwater fish-eating practice determines the different distribution of C. sinensis infection in areas and population in these investigated endemic areas.

Key words: Clonorchiasis, Raw-freshwater fish-eating practice, Effect

中图分类号:

R532.23

钱门宝, 蒋智华, 葛涛, 王心, 邓卓晖, 周长海, 朱慧慧, 陈颖丹, 周晓农. 生食淡水鱼行为传播华支睾吸虫病的效应分析[J]. 中国寄生虫学与寄生虫病杂志, 2019, 37(3): 296-301.

Men-bao QIAN, Zhi-hua JIANG, Tao GE, Xin WANG, Zhuo-hui DENG, Chang-hai ZHOU, Hui-hui ZHU, Ying-dan CHEN, Xiao-nong ZHOU. Association of raw-freshwater fish-eating practice with the infection of Clonorchis sinensis[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2019, 37(3): 296-301.

图/表 2

表1

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调查点 Counties	调查人数 No. examined	生食淡水鱼者比例/% Eating raw freshwater fish/%	华支睾吸虫感染率/% Prevalence of C. sinensis infection/%	相对危险度RR(95% CI)	归因危险度AR/%	归因危险度百分比ARP/%	人群归因危险度PAR/%	人群归因危险度百分比PARP/%
广西Guangxi
宾阳Binyang	1 026	16.9	15.4	4.1(2.8~6.0)	31.5	75.8	5.3	34.5
横县Hengxian	1 000	40.8	7.4	4.9(2.8~8.5)	11.1	79.4	4.5	61.2
靖西Jingxi	1 020	0	0
灵山Lingshan	1 026	5.2	5.0	215.7(58.9~790.4)	88.3	99.5	4.6	91.7
钦南Qinnan	1 110	0	0.7
田阳Tianyang	1 048	36.6	9.8	11.0(6.2~19.6)	21.1	90.9	7.7	78.5
广东Guangdong
龙门Longmeng	955	0.5	0.3	380.0(26.7~5403.4)	39.9	99.7	0.2	66.5
翁源Wengyuan	1 037	1.3	0.8	26.3(4.8~144.7)	14.8	96.2	0.2	24.0
新会Xinhui	1 005	17.9	15.5	2.8(1.9~4.1)	21.0	64.1	3.8	24.3
黑龙江Heilongjiang
桦川Huachuan	1 000	61.4	16.5	103.1(14.4~739.8)	26.5	99.0	16.2	98.4
五常Wuchang	1 000	0	0
依兰Yilan	1 000	11.9	0.2	7.4(0.5~119.2)	0.7	86.5	0.1	43.2
肇源Zhaoyuan	1 003	54.3	7.9	15.8(5.7~43.4)	12.9	93.7	7.0	88.9
吉林Jilin
大安Daan	1 000	52.6	53.7	23.3(10.5~51.7)	94.1	95.7	49.5	92.1
宁江Ningjiang	1 000	48.4	13.1	2.1(1.4~3.1)	9.4	52.6	4.6	34.9
镇赉Zhenlai	1 000	79.1	27.2	11.7(5.1~26.7)	30.8	91.5	24.3	89.4
合计Total	16 230	26.5	10.8	12.9(11.4~14.7)	30.9	92.3	8.2	75.9

性别 Gender	年龄组 Age groups	调查人数 No. examined	生食淡水鱼者比例/% Eating raw freshwater fish/%	华支睾吸虫感染率 /% Prevalence of C. sinensis infection/%	相对危险度RR (95% CI)	归因危险度AR/%	归因危险度百分比ARP/%	人群归因危险度PAR/%	人群归因危险度百分比PARP/%
女 Female	≤14	1 295	2.3	1.2	21.1 (6.7~66.2)	15.9	95.3	0.4	31.8
	15~29	791	13.9	6.1	15.0 (7.7~29.3)	28.9	93.3	4.0	66.1
	30~44	1 583	25.3	9.0	7.3 (4.9~10.7)	21.7	86.2	5.5	61.3
	45~59	2 241	29.2	10.4	13.3 (9.2~19.3)	28.0	92.5	8.2	78.3
	≥60	1 842	22.4	8.0	14.1 (9.2~21.5)	26.5	92.9	6.0	74.6
	小计Subtotal	7 752	20.7	7.6	13.4 (10.9~16.4)	26.2	92.5	5.4	72.0
男 Male	≤14	1 570	1.9	1.5	13.5 (4.7~39.0)	15.4	92.6	0.3	19.3
	15~29	756	19.4	7.5	11.6 (6.2~21.7)	26.1	91.4	5.1	67.3
	30~44	1 713	40.2	15.1	8.6 (6.0~12.4)	28.3	88.4	11.4	75.4
	45~59	2 582	44.5	20.8	9.5 (7.2~12.6)	37.0	89.5	16.4	79.2
	≥60	1 857	36.3	15.4	9.4 (6.7~13.2)	32.0	89.4	11.6	75.3
	小计Subtotal	8 478	31.7	13.7	11.8(10.0~14.0)	33.5	91.5	10.6	77.4
合计 Total	≤14	2 865	2.1	1.4	16.1 (7.5~34.9)	15.6	93.8	0.3	24.1
	15~29	1 547	16.6	6.8	13.2(8.3~20.7)	27.3	92.4	4.5	66.9
	30~44	3 296	33.0	12.1	8.2 (6.4~10.7)	25.9	87.9	8.6	70.5
	45~59	4 823	37.4	16.0	11.5 (9.2~14.4)	34.0	91.3	12.7	79.7
	≥60	3 699	29.4	11.7	11.7 (9.0~15.2)	30.2	91.4	8.9	75.8
	合计Total	16 230	26.5	10.8	12.9 (11.4~14.7)	30.9	92.3	8.2	75.9

生食淡水鱼行为传播华支睾吸虫病的效应分析

Association of raw-freshwater fish-eating practice with the infection of Clonorchis sinensis

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