青海省棘球蚴病影响因素的病例对照研究

doi:10.12140/j.issn.1000-7423.2023.02.009

摘要/Abstract

摘要： 目的探索青海省棘球蚴病的主要影响因素，为开展干预提供科学依据。方法在青海省棘球蚴病的重点流行区（果洛州、海北州、海南州、海西州、黄南州、玉树州）和非重点流行区（海东市、西宁市）对成年人棘球蚴病患者的感染因素开展病例对照研究。以居住地、年龄、性别、民族为匹配因素，按照1:2成组匹配对照，以是否患病为因变量进行单因素分析，构建logistic回归模型，分析居民患棘球蚴病的影响因素。使用SPSS 22.0统计学软件进行统计学分析。结果本研究符合纳入标准的病例组共1 447人，平均年龄为（38.7 ± 13.3)岁；男性58.3%（844/1 447)，女性41.7%（603/1 447)；藏族65.2%（944/1 447)，汉族22.9%（332/1 447)，回族6.6%（95/1 447)。对照组共2 894人，平均年龄为（38.5 ± 13.0）岁；男性58.3%（1 688/2 894)，女性41.7%（1 206/2 894)；藏族60.5%（1 751/2 894)，汉族26.4%（763/2 894)，回族6.0%（175/2 894)。单因素分析结果显示，养犬、养犬方式、犬的用途、犬经常接触饮水、犬粪未经处理、经常与犬接触、养家畜等25个因素在病例组和对照组间的差异有统计学意义（χ² = 143.53、46.88、40.26、80.63、38.77、107.16、117.27，均P < 0.01）。多因素logistic回归分析结果显示，养犬方式（OR = 1.37，95% CI：1.03~1.82）、犬的用途（OR = 1.59，95% CI：1.01~2.51）、犬接触饮用水（OR = 1.63，95% CI：1.19~2.24）、犬粪处理（OR = 2.51，95% CI：1.95~3.26）、近一年在家屠宰牲畜（OR = 1.44，95% CI：1.09~1.91）、家周围有屠宰场或肉店（OR = 1.67，95% CI：1.21~2.26）、犬喂食生的家畜脏器（OR = 1.53，95% CI：1.18~2.03）、家周围有野生动物（OR = 1.53，95% CI：1.19~1.95）、饮用未煮沸的水（OR = 1.42，95% CI：1.05~1.91）、饮用水储存方式（OR = 1.88，95% CI：1.37~2.59）、防治知识（OR = 1.75，95% CI：1.36~2.28）等11个因素是成年人棘球蚴病患病的主要危险因素。结论犬相关行为、卫生习惯、生产生活方式和防治知识知晓情况与青海省成年人患棘球蚴病高度相关，是青海流行区棘球蚴病干预的核心行为学因素。

关键词: 棘球蚴病, 病例对照研究, 危险因素

Abstract: Objective To study the main influencing factors to echinococcosis in Qinghai Province, to provide scientific basis for interventions. Methods A case-control study was conducted on the infection factors of adult echinococcosis cases in the significant endemic areas (Guoluo, Haibei, Hainan, Haixi, Huangnan and Yushu) and in the nonsignificant endemic areas (Haidong and Xining) of Qinghai Province. The study was carried out by setting the matching factors of age, sex and ethnicity, with the maching control ratio of patients against heathy people 1:2, defining whether or not the disease case as the dependent variable for univariate analysis using a logistic regression model constructed to analyze the factors influencing residents contracting echinococcosis. Statistical analysis was conducted using SPSS 22.0 statistical software. Results A total of 1 447 cases met the inclusion criteria was enrolled as the case group in this study, with a mean age of (38.7 ± 13.3) years, 58.3% male (844/1 447), 41.7% female (603/1 447), 65.2% Tibetan (944/1 447), 22.9% Han Chinese (332/1 447), 6.6% Hui (95/1 447); the control group consisted of 2 894 individuals with a mean age of (38.5 ± 13.0) years, 58.3% male (1 688/2 894), 41.7% female (1 206/2 894), 60.5% Tibetan (1 751/2 894), 26.4% Han (763/2 894), and 6.0% Hui (175/2 894). The results of univariate analysis showed that 25 factors, such as canine ownership, canine breeding method, canine use, frequent contact with drinking water, no disposal of canine feces, frequent contact with canine, and domestic animal ownership, were statistically significant between the case and control groups (χ² = 143.53, 46.88, 40.26, 80.63, 38.77, 107.16, 117.27; P < 0.01). Multivariate logistic regression analysis showed that the type of canine ownership (OR = 1.37, 95%CI: 1.03-1.82), use of canines (OR = 1.59, 95% CI: 1.01-2.51), canine contacted with drinking water (OR = 1.63, 95% CI: 1.19-2.24), disposal of canine feces (OR = 2.51, 95% CI: 1.95-3.26), slaughter of livestock at home in the last year (OR = 1.44, 95% CI: 1.09-1.91), slaughterhouse or butcher shop around home (OR = 1.67, 95% CI: 1.21-2.26), canine fed with raw livestock organs (OR = 1.53, 95% CI: 1.18-2.03), drinking unboiled water (OR = 1.42, 95% CI: 1.05-1.91), living with wild animals around home (OR = 1.53, 95% CI: 1.19-1.95), drinking water storage method (OR = 1.88, 95% CI: 1.37-2.59), as well as prevention knowledge (OR = 1.75, 95% CI: 1.36-2.28) were the main risk factors for echinococcosis prevalence in adults. Conclusion This study indicates that the factors of dog-related behavior, hygienic habits, lifestyle and the wareness on knowledge of disease prevention and control are highly associated with echinococcosis in adults in Qinghai Province and are the key behavioural factors in echinococcosis intervention in Qinghai endemic areas.

Key words: Echinococcosis, Case-control study, Risk factors

中图分类号:

R532.32

马冰村, 刘玉英, 张甜甜, 雷雯, 马霄, 刘寿. 青海省棘球蚴病影响因素的病例对照研究[J]. 中国寄生虫学与寄生虫病杂志, 2023, 41(2): 183-191.

MA Bingcun, LIU Yuying, ZHANG Tiantian, LEI Wen, MA Xiao, LIU Shou. A case-control study on the influencing factors of echinococcosis in Qinghai Province[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2023, 41(2): 183-191.

图/表 4

表1

影响棘球蚴病患病的多因素分析变量赋值

变量 Variable	赋值及含义 Assignment and meaning	变量 Variable	赋值及含义 Assignment and meaning
因变量 Dependent varible		饮水储存方式 Drinking water storage mode	0 = 加盖容器 0 = Capped container
棘球蚴病患病情况 Prevalence of echinococcosis	0 = 未患病 0 = Not sick		0 = 加盖容器 0 = Capped container
棘球蚴病患病情况 Prevalence of echinococcosis	1 = 患病 1 = Sick		1 = 无盖容器 1 = Uncapped container
自变量 Independent varible			1 = 无盖容器 1 = Uncapped container
养犬 Keep a canine	0 = 否 0 = No		2 = 其他 2 = Others
养犬方式 Canine keeping method	1 = 是 1 = Yes	近一年在家屠宰牲畜 Slaughtering livestock at home in the past year	0 = 否 0 = No
	0 = 拴养 0 = Tethering		1 = 是 1 = Yes
	1 = 放养 1 = Stocking
犬的用途 Use of canines	0 = 宠物 0 = Pets	家周围有屠宰场/肉店 Slaughterhouse/butcher’s shop around the house	0 = 否 0 = No
犬的用途 Use of canines	1 = 看家 1 = House keeping		1 = 是 1 = Yes
犬接触饮用水 Canines exposed to drinking water	2 = 放牧 2 = Graze		1 = 是 1 = Yes
	0 = 从不 0 = Never	犬喂食生的家畜脏器 Canines feed raw livestock viscera	0 = 从不 0 = Never
	1 = 偶尔 1 = Sometimes		1 = 偶尔 1 = Sometimes
	2 = 经常 2 = Often		2 = 经常 2 = Often
	0 = 无害化处理/做化肥 0 = Harmless treatment/as fertilizer	病变脏器喂犬Feeding canines with diseased organs	0 = 不会 0 = No
犬粪处理 Disposal of canine feces			0 = 不会 0 = No
犬粪处理 Disposal of canine feces			1 = 会 1 = Yes
	1 = 不处理 1 = No deal	家周围有流浪犬 With stray canines around the house	0 = 从不 0 = Never
与犬接触 Contact with canines	0 = 从不 0 = Never		1 = 偶尔 1 = Sometimes
与犬接触 Contact with canines	1 = 偶尔 1 = Sometimes		2 = 经常 2 = Often
	2 = 经常 2 = Often	家周围有野生动物 With wild animals around the house	0 = 从不 0 = Never
养家畜 Raising livestock	0 = 否 0 = No		1 = 偶尔 1 = Sometimes
	1 = 是 1 = Yes		2 = 经常 2 = Often
家畜与犬共用水 Livestock and canines share drinking water	0 = 否 0 = No	动物内脏处理 Disposal of animal visceral	0 = 无害化处理 0 = Harmless treatment
	1 = 是 1 = Yes		0 = 无害化处理 0 = Harmless treatment
			1 = 扔进公共垃圾区1 = Put into the public garbage area
生病家畜接受治疗 Sick livestock receiving treatment	0 = 经常 0 = Often		1 = 扔进公共垃圾区1 = Put into the public garbage area
	1 = 偶尔 1 = Sometimes		2 = 喂犬 2 = Feed a canine
	2 = 从不 2 = Never		3 = 煮食 3 = Boil to eat
近一年在野外游泳 Swimming in the wild for nearly a year	0 = 否 0 = No	放牧方式 Grazing mode	0 = 不放牧 0 = No grazing
近一年在野外游泳 Swimming in the wild for nearly a year	1 = 是 1 = Yes		1 = 放牧 1 = Graze
饭前洗手 Handwashing before eating	0 = 每次 0 = Every time	防治知识 Prevention and control knowledge	0 = 不合格 0 = Unqualified
	1 = 偶尔 1 = Sometimes	防治知识 Prevention and control knowledge	1 = 合格 1 = Qualified
	2 = 从不 2 = Never	参加相关宣教活动 Participate in relevant publicity and education activities	0 = 否 0 = No
接触动物后洗手 Wash hands after touching animals	0 = 不会 0 = No		1 = 是 1 = Yes
接触动物后洗手 Wash hands after touching animals	1 = 会 1 = Yes
饮用生水 Drinking raw water	0 = 从不 0 = Never	学习相关资料 Read relevant materials	0 = 否 0 = No
	1 = 偶尔 1 = Sometimes	学习相关资料 Read relevant materials	1 = 是 1 = Yes
	1 = 偶尔 1 = Sometimes	2 = 经常 2 = Often	1 = 是 1 = Yes

表1

表2

调查对象一般人口学信息

变量 Variables	病例组（n = 1 447） Case group (n = 1 447)				对照组（n = 2 894） Control group (n = 2 894)				χ²值 χ²value		P值 P value
变量 Variables	人数 No.		占比/% Proportion/%		人数 No.		占比/% Proportion/ %		χ²值 χ²value		P值 P value
婚姻状况 Marital status
未婚 Unmarried	310		21.4		591		20.4		4.92		> 0.05
已婚 Married	1 028		71.0		2 130		73.6
其他 Other	109		7.6		173		6.0
教育程度 Education level
小学及以下 Primary school and below	869		60.1		1 549		53.5		29.97		< 0.01
初高中（含中专） Junior/senior high school (including technical secondary school)	430		29.7		884		30.5
大专及以上 College and above	148		10.2		461		16.0
职业 Occupation
农民 Farmer	392		27.1		859		29.7		33.82		< 0.01
牧民 Herdsman	613		42.4		970		33.5
其他 Others	442		30.5		1 065		36.8
宗教信仰 Religious belief
无 No	466		32.2		956		33.0		13.37		< 0.01
有 Yes	981		67.8		1 938		67.0		13.37		< 0.01
家庭月收入/元 Monthly household income/yuan
≤ 1 000	345		23.8		675		23.3		53.56		< 0.01
1 001~3 000	644		44.5		1 143		39.5
3 001~5 000	364		25.2		674		23.3
> 5 000	94		6.5		402		13.9
居住方式 Living style
定居 Settledown	1 028		71.0		2 301		79.5		49.16		< 0.01
半游牧 Semi-nomadic	270		18.7		436		15.1
游牧 Nomadic	149		10.3		157		5.4
生产生活方式 Production and life style
近一年在家屠宰牲畜 Slaughtering livestock at home in the past year		636		44.0（636/1 447）		929		32.1（929/2 894）		58.78		< 0.01
家周围有屠宰场/肉店 Slaughter house/butcher’s shop around the house		418		28.9（418/1 447）		432		14.9（432/2 894）		119.40		< 0.01
犬喂食生的家畜脏器 Canines feed raw livestock viscera										128.09		< 0.01
从不 Never		694		48.0（694/1 447）		1 900		65.7（1 900/2 894）
偶尔 Sometimes		641		44.3（641/1 447）		871		30.1（871/2 894）
经常 Often		112		7.7（112/1 447）		123		4.2（123/2 894）
病变脏器喂犬 Feeding canines with diseased organs		566		39.1（566/1 447）		786		27.2（786/2 894）		64.35		< 0.01
家周围流浪犬 Stray canines around the house										9.60		< 0.01
从不 Never		507		35.0（507/1 447）		1 070		37.0（1 070/2 894）
偶尔 Sometimes		808		55.8（808/1 447）		1 636		56.5（1 636/2 894）
经常 Often		132		9.2（132/1 447）		188		6.5（188/2 894）
家周围有野生动物 With wild animals around the house										31.69		< 0.01
从不 Never		696		48.0（696/1 447）		1 652		57.1（1 652/2 894）
偶尔 Sometimes		629		43.5（629/1 447）		1 052		36.4（1 052/2 894）
经常 Often		122		8.4（122/1 447）		190		6.6（190/2 894）
动物内脏处理 Disposal of animal visceral										65.52		< 0.01
无害化处理 Harmless treatment		399		27.6（399/1 447）		1 015		35.1（1 015/2 894）
扔进公共垃圾区 Put it into the public garbage area		356		24.6（356/1 447）		752		26.0（752/2 894）
喂犬 Feed a canine		504		25.6（504/1 447）		683		23.6（683/2 894）
煮食 Boil to eat		188		22.2（188/1 447）		444		15.3（444/2 894）
放牧方式 Grazing mode										143.34		< 0.01
不放牧 No grazing		325		22.5（325/1 447）		1 181		40.8（1 181/2 894）
放牧 Graze		1 122		77.5（1 122/1 447）		1 713		59.2（1 713/1 447）
防控相关知识 Prevention and control related knowledge										114.19		< 0.01
防治知识 Prevention and control knowledge		835		57.7（835/1 447）		2 133		73.7（2 133/2 894）

表2

表3

青海省棘球蚴病病例组和对照组高危行为的单因素分析结果

行为分类 Behavior category	病例组（n = 1 447） Case group (n = 1 447)		对照组（n = 2 894） Control group (n = 2 894)		χ²值 χ² value	P值 P value
行为分类 Behavior category	人数 No.	占比/% Proportion/%	人数 No.	占比/% Proportion/%	χ²值 χ² value	P值 P value
犬相关行为 Canine related behavior
养犬 Keep a canine	743	51.3（743/1 447）	942	32.6（942/2 894）	143.53	< 0.01
养犬方式 Canine keeping method					46.88	< 0.01
拴养 Tethering	400	53.8（400/743）	660	70.1（660/942）
放养 Stocking	343	46.2（343/743）	282	29.9（282/942）
犬的用途 Use of canines					40.26	< 0.01
宠物 Pets	94	12.7（94/743）	77	8.2（77/942）
看家 House keeping	365	49.1（365/743）	607	64.4（607/942）
放牧 Graze	284	38.2（284/743）	258	27.4（258/942）
犬接触饮用水 Canines exposed to drinking water					80.63	< 0.01
从不 Never	335	45.1（335/743）	630	66.9（630/942）
偶尔 Sometimes	258	34.7（258/743）	199	21.1（199/942）
经常 Often	150	20.2（150/743）	113	12.0（113/942）
犬粪处理 Disposal of canine feces					38.77	< 0.01
无害化处理/做肥料 Harmless treatment/as fertilizer	224	30.1（224/743）	424	45.0（424/942）
不处理 No deal	519	69.9（519/743）	518	55.0（518/942）
给犬驱虫 Deworming for canines					5.54	> 0.05
定期 Regular	250	33.6（250/743）	299	31.7（299/942）
偶尔 Sometimes	347	46.7（347/743）	490	52.0（490/942）
从不 Never	146	19.7（146/743）	153	16.3（153/942）
与犬接触 Contact with canines					107.16	< 0.01
从不 Never	461	31.9（461/1 447）	1 377	47.6（1 377/2 894）
偶尔 Sometimes	710	49.1（710/1 447）	1 172	40.5（1 172/2 894）
经常 Often	276	19.0（276/1 447）	345	11.9（345/2 894）
家畜相关行为 Livestock related behaviors
养家畜 Raising livestock	819	56.6（819/1 447）	1 136	39.3（1 136/2 894）	117.27	< 0.01
家畜驱虫 Deworming for livestocks					4.21	> 0.05
定期 Regular	310	37.9（310/819）	379	33.4（379/1 136）
偶尔 Sometimes	366	44.7（366/819）	546	48.1（546/1 136）
从不 Never	143	17.4（143/819）	211	18.5（211/1 136）
家畜与犬共用饮水 Livestock and canines share drinking water	345	42.1（345/819）	414	36.4（414/1 136）	1.65	< 0.05
生病家畜接受治疗 Sick livestock receiving treatment					8.64	< 0.05
经常 Often	252	30.8（252/819）	335	29.5（335/1 136）
偶尔 Sometimes	417	50.9（417/819）	642	56.5（642/1 136）
从不 Never	150	18.3（150/819）	159	14.0（159/1 136）
卫生习惯 Hygienic habits
近一年在野外游泳 Swimming in the wild for nearly a year	375	25.9（375/1 447）	483	16.7（483/2 894）	51.78	< 0.01
饭前洗手 Handwashing before eating					34.94	< 0.01
每次 Every time	610	42.2（610/1 447）	1 492	51.6（1 492/2 894）
偶尔 Sometimes	708	48.9（708/1 447）	1 205	41.6（1 205/2 894）
从不 Never	129	8.9（129/1 447）	197	6.8（197/2 894）
接触动物后洗手 Wash hands after touching animals	922	63.7（922/1 447）	2 035	70.3（2 035/2 894）	19.36	< 0.01
饮用生水 Drinking raw water					36.83	< 0.01
从不 Never	632	43.7（632/1 447）	1 532	52.9（1 532/2 984）
偶尔 Sometimes	641	44.3（641/1 447）	1 023	35.3（1 023/2 894）
经常 Often	174	12.0（174/1 447）	339	11.8（339/2 894）
饮水储存方式 Drinking water storage mode					146.96	< 0.01
加盖容器 Capped container	524	36.2（524/1 447）	1 607	55.5（1 607/2 894）
无盖容器 Uncapped container	376	26.0（376/1 447）	480	16.6（480/2 894）
其他 Others	547	37.8（547/1 447）	807	27.9（807/2 894）

表3

表4

青海省棘球蚴病患病影响因素的logistic回归分析结果

变量分类Variables categories	β	Wald	P	OR	95% CI
养犬方式 Canine keeping method
拴养（对照）Tethering（ref）
放养 Stocking	0.30	44.06	< 0.05	1.37	（1.03~1.82）
犬的用途 Use of canines
看家（对照）House keeping（ref）
放牧 Graze	0.26	15.62	> 0.05	1.29	（0.99~1.70）
宠物 Pets	0.48	62.71	< 0.05	1.59	（1.01~2.51）
犬接触饮用水 Canines exposed to drinking water
从不（对照）Never（ref）
偶尔 Sometimes	0.67	156.67	< 0.01	1.89	（1.28~2.78）
经常 Often	0.50	134.39	< 0.01	1.63	（1.19~2.24）
犬粪处理 Disposal of canine feces
无害化处理/做化肥（对照）Harmless treatment/as fertilizer（ref）
不处理 Without treatment	0.97	184.88	< 0.01	2.51	（1.94~3.25）
近一年在家屠宰牲畜 Slaughtering livestock at home in the past year
否（对照）No（ref）
是 Yes	0.39	58.51	< 0.05	1.44	（1.09~1.91）
家周围有屠宰场/肉店 Slaughterhouse/butcher’s shop around the house
否（对照）No（ref）
是 Yes	0.51	134.47	< 0.01	1.67	（1.21~2.26）
犬喂食生的家畜脏器 Canines feed raw livestock viscera
从不（对照）Never（ref）
偶尔 Sometimes	0.43	20.82	> 0.05	1.52	（0.96~2.39）
经常 Often	0.46	123.28	< 0.01	1.53	（1.18~2.03）
饮用生水 Drinking raw water
从不（对照）Never（ref）
偶尔 Sometimes	0.07	3.63	> 0.05	1.07	（0.70~1.59）
经常 Often	0.36	58.11	< 0.05	1.42	（1.05~1.91）
家周围有野生动物 With wild animals around the house
从不（对照）Never（ref）
偶尔 Sometimes	0.42	119.90	< 0.01	1.42	（1.25~1.63）
经常 Often	0.46	123.27	< 0.01	1.53	（1.19~1.95）
饮水储存方式Drinking water storage mode
加盖容器(对照）Capped container（ref）
无盖容器 Uncapped container	0.22	10.58	> 0.05	1.23	（0.91~1.73）
其他 Other	0.62	156.58	< 0.01	1.88	（1.37~2.59）
防治知识 Prevention and control knowledge
合格（对照）Qualified（ref）
不合格 Unqualified	0.57	148.92	< 0.01	1.75	（1.36~2.28）

表4

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