2016—2022年云南省土源性线虫感染监测结果分析

doi:10.12140/j.issn.1000-7423.2023.06.008

摘要/Abstract

摘要：

目的了解云南省人群土源性线虫感染现状及流行趋势，为制定土源性线虫病防治策略和措施提供科学依据。方法 2016—2022年，按照《全国肝吸虫病和土源性线虫病监测方案（试行）》要求，在云南省各州（市）至少抽取1个县（市、区）设立土源性线虫病监测点，各监测点根据地理方位划分为5个片区（东、西、南、北、中），每个片区随机抽取1个乡（镇）的1个行政村开展监测，以3周岁及以上本地常住居民为监测对象，每个行政村整群抽取监测对象不少于200人，每个监测点监测人数不少于1 000人。采集监测对象的粪样（约30 g），采用改良加藤厚涂片法（Kato-Katz法，一粪两检）检测土源性线虫（钩虫、蛔虫、鞭虫和蛲虫）虫卵，计算感染率和感染度。钩虫卵阳性者粪便采用试管滤纸培养法鉴别钩虫虫种，3~9岁儿童加做透明胶纸肛拭法检测蛲虫感染情况。感染率的比较采用卡方检验。结果 2016—2022年在云南省共设立71个监测点，监测108 221人，检出土源性线虫感染7 475例，总感染率为6.91%（7 475/108 221），其中钩虫、蛔虫、鞭虫和蛲虫的感染率分别为3.75%（4 056/108 221）、1.68%（1 817/108 221）、2.23%（2 408/108 221）和0.11%（121/108 221）。试管滤纸培养法培养出钩蚴1 288份，其中美洲钩虫感染1 199份，十二指肠钩虫感染79份，两者混合感染10份。2016—2022年，云南省各年度人群土源性线虫感染率分别为12.03%（1 606/13 350）、8.67%（1 317/15 195）、7.10%（1 095/15 425）、5.37%（897/16 693）、5.83%（969/16 617）、5.77%（922/15 967）和4.47%（669/14 974），各年份间土源性线虫感染率差异有统计学意义（χ² = 880.360，P < 0.01）。检测的16个州（市）中，土源性线虫感染率最高为西双版纳州（26.21%，1 312/5 006），最低为丽江市（0.15%，6/4 041），不同州（市）间土源性线虫感染率差异有统计学意义（χ² = 8 081.151，P < 0.01）。女性和男性的土源性线虫感染率分别为7.40%（4 276/57 812）和6.35%（3 199/50 409）（χ² = 46.198，P < 0.01）。不同人群的土源性线虫感染率中，年龄分布以10~19岁年龄组最高（8.56%，1 249/14 592），民族分布以布朗族最高（30.20%，778/2 576），职业分布以学生最高（7.96%，1 638/20 588），文化程度分布以文盲和半文盲人群最高（10.06%，1 078/10 719）；不同年龄、民族、职业和文化程度间人群土源性线虫感染率差异均有统计学意义（χ² = 139.432、8 546.389、324.218、833.291，均P < 0.01）。结论 2016—2022年云南省人群土源性线虫感染率呈下降趋势，但部分地区仍维持在较高水平，应继续加强对边境地区少数民族、农民、老年人等重点人群的土源性线虫病综合防治工作。

关键词: 土源性线虫, 感染率, 监测, 云南省

Abstract:

Objective To understand the prevalence and transmission of soil-transmitted helminth (STH) infection in Yunnan Province, providing scientific basis for formulating prevention and control strategies and measures. Methods The surveillance sites were selected in Yunnan Province according to the National Surveillance Program for Clonorchiasis and Soil-transmitted Nematodes (Pilot) from 2016 to 2022. From each district (city), at least one county (city, township) was selected as the surveillance site, which was further divided into 5 sectors (east, west, south, north and central) according to the geographic location. From each sector, one township (town) was selected randomly and an administrative village was selected from the township (town) to conduct the surveillance among permanent residents over 3 years old. No less than 200 residents were cluster sampled from each administrative village and no less than 1 000 residents from each surveillance site. Fecal samples (about 30 g) from the enrolled residents were collected and examined for STH eggs (hookworm, Ascaris lumbricoides, Truchuris trichiura and Enterobius vermicularis) by modified Kato-Katz thick smear method (two slide-reading for each sample). The infection rate and intensity of STH were calculated. The hookworm egg positive samples were further identified for species by tube-filter paper culture method. Children aged 3-9 were additionally examined for E. vermicularis eggs with transparent tape and anal swab method. Chi-square test was used to compare the infection rates. Results A total of 108 221 residents were enrolled in the surveillance from 71 surveillance sites in Yunnan Province and the total STH infection rate was 6.91% (7 475/108 221) from 2016 to 2022. The infection rates of hookworm, A. lumbricoides, T. trichiura and E. vermicularis were 3.75% (4 056/108 221), 1.68% (1 817/108 221), 2.23% (2 408/108 221) and 0.11% (121/108 221) respectively. A total of 1 288 cases of hookworm infection were identified by tube-filter paper culture method. 93.09% (1 199/1 288) of them were infected with Necator americanus, 6.13% (79/1 288) were infected with Ancylostoma duodenale and 0.78% (10/1 288) were co-infected. From 2016 to 2022, the annual infection rates of STH in Yunnan Province were 12.03% (1 606/13 350), 8.67% (1 317/15 195), 7.10% (1 095/15 425), 5.37% (897/16 693), 5.83% (969/16 617), 5.77% (922/15 967) and 4.47% (669/14 974) respectively. The differences between the infection rates among different years were statistically significant (χ² = 880.360, P < 0.01). Among the 16 prefectures (cities) surveyed, the highest STH infection rate was found in Xishuangbanna (26.21%, 1 312/5 006) and the lowest was found in Lijiang City (0.15%, 6/4 041). The differences between the infection rates among different prefectures (cities) were statistically significant (χ² = 8 081.151, P < 0.01). The STH infection rates in male and female were 6.35% (3 199/50 409) and 7.40% (4 276/57 812) respectively, with a significant difference (χ² = 46.198, P < 0.01). Among the different age-groups, nationalities, occupations and educational levels, the highest infection rates were found in the group of 10 to 19 year-old (8.56%, 1 249/14 592), Bulang ethnic group (30.20%, 778/2 576), students (7.96%, 1 638/20 588) and illiteracy or semi-illiteracy group (10.06%, 1 078/10 719), with the significant differences (χ² = 139.432, 8 546.389, 324.218, 833.291; all P < 0.01). Conclusion From 2016 to 2022, the STH infection rate in Yunnan Province showed a decreasing trend, but remained at a comparatively high level in some areas. It is imperative to continuously strengthen comprehensive control of STH for the key population including the ethnic groups near the border areas, farmers and the elderly.

Key words: Soil-transmitted helminth, Infection rate, Surveillance, Yunnan Province

中图分类号:

R532.1

吴方伟, 彭佳, 字金荣, 李奔福, 严信留, 蔡璇, 王正青, 徐倩, 李建雄, 杨亚明. 2016—2022年云南省土源性线虫感染监测结果分析[J]. 中国寄生虫学与寄生虫病杂志, 2023, 41(6): 718-724.

WU Fangwei, PENG Jia, ZI Jinrong, LI Benfu, YAN Xinliu, CAI Xuan, WANG Zhengqing, XU Qian, LI Jianxiong, YANG Yaming. Surveillance on soil-transmitted helminth infections in Yunnan Province from 2016 to 2022[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2023, 41(6): 718-724.

图/表 3

表1

表2

表3

2016—2022年云南省监测人群土源性线虫感染情况分布

特征 Feature	调查人数 No. investigated	总感染人数 Total no. infected	总感染率/% Total infection rate/%	钩虫 Hookworm		蛔虫 A. lumbricoides		鞭虫 T. trichiura		蛲虫 E. vermicularis
特征 Feature	调查人数 No. investigated	总感染人数 Total no. infected	总感染率/% Total infection rate/%	感染人数 No. infected	感染率/% Infection rate/%	感染人数 No. infected	感染率/% Infection rate/%	感染人数 No. infected	感染率/% Infection rate/%	感染人数 No. infected	感染率/% Infection rate/%
性别 Gender
男 Male	50 409	3 199	6.35	1 697	3.37	773	1.53	1 043	2.07	57	0.11
女 Female	57 812	4 276	7.40	2 359	4.08	1 044	1.81	1 365	2.36	64	0.11
年龄组/岁 Age group/Year
3~9	13 477	787	5.84	191	1.42	350	2.60	395	2.93	60	0.45
10~19	14 592	1 249	8.56	260	1.78	382	2.62	859	5.89	36	0.25
20~29	8 364	456	5.45	223	2.67	144	1.72	149	1.78	2	0.02
30~39	14 252	890	6.24	506	3.55	203	1.42	257	1.80	8	0.06
40~49	18 250	1 213	6.65	786	4.31	257	1.41	271	1.48	1	0.01
50~59	18 788	1 349	7.18	997	5.31	221	1.18	199	1.06	9	0.05
60~69	12 414	941	7.58	672	5.41	168	1.35	155	1.25	3	0.02
70~79	6 349	475	7.48	337	5.31	74	1.17	94	1.48	1	0.02
≥ 80	1 735	115	6.63	84	4.84	18	1.04	29	1.67	1	0.06
民族 Nationality
阿昌族 Achang	252	7	2.78	4	1.59	1	0.40	2	0.79	0	0.00
白族 Bai	8 888	39	0.44	15	0.17	9	0.10	17	0.19	0	0.00
崩龙族 Benglong	413	48	11.62	0	0.00	2	0.48	47	11.38	1	0.24
布朗族 Bulang	2 576	778	30.20	365	14.17	265	10.29	266	10.33	3	0.12
藏族 Zang	1 819	75	4.12	6	0.33	51	2.80	29	1.59	0	0.00
傣族 Dai	6 008	771	12.83	728	12.12	28	0.47	16	0.27	5	0.08
独龙族 Dulong	1 514	421	27.81	73	4.82	221	14.6	256	16.91	23	1.52
哈尼族 Hani	5 332	1 116	20.93	406	7.61	208	3.90	675	12.66	31	0.58
汉族 Han	50 946	1 768	3.47	1 053	2.07	426	0.84	363	0.71	13	0.03
回族 Hui	847	52	6.14	9	1.06	32	3.78	15	1.77	0	0.00
景颇族 Jingpo	209	1	0.48	1	0.48	0	0.00	0	0.00	0	0.00
拉祜族 Lahu	2 745	683	24.88	655	23.86	15	0.55	49	1.79	4	0.15
傈僳族 Lisu	4 938	387	7.84	101	2.05	206	4.17	215	4.35	5	0.10
苗族 Miao	1 213	113	9.32	31	2.56	52	4.29	49	4.04	1	0.08
纳西族 Naxi	2 398	31	1.29	0	0.00	29	1.21	1	0.04	1	0.04
怒族 Nu	1 293	139	10.75	24	1.86	68	5.26	72	5.57	2	0.15
佤族 Wa	2 459	301	12.24	147	5.98	71	2.89	126	5.12	0	0.00
瑶族 Yao	1 119	134	11.97	50	4.47	39	3.49	54	4.83	8	0.71
彝族 Yi	9 759	485	4.97	350	3.59	37	0.38	134	1.37	6	0.06
壮族 Zhuang	3 142	111	3.53	28	0.89	54	1.72	20	0.64	17	0.54
其他 Others	351	15	4.27	10	2.85	3	0.85	2	0.57	1	0.28
职业 Occupation
餐饮食品业 Food worker	124	0	0.00	0	0.00	0	0.00	0	0.00	0	0.00
干部职员 Cadre	287	2	0.70	0	0.00	0	0.00	2	0.70	0	0.00
工人 Worker	635	11	1.73	2	0.31	4	0.63	6	0.94	0	0.00
家务及待业 Housework and unemployment	651	5	0.77	0	0.00	1	0.15	4	0.61	0	0.00
教师 Teacher	407	1	0.25	0	0.00	0	0.00	1	0.25	0	0.00
离退人员 Retiree	205	2	0.98	2	0.98	0	0.00	0	0.00	0	0.00
民工 Migrant worker	857	20	2.33	13	1.52	1	0.12	7	0.82	0	0.00
农民 Farmer	75 860	5 409	7.13	3 600	4.75	1 079	1.42	1 141	1.50	26	0.03
散居儿童 Scattered children	1 820	126	6.92	43	2.36	72	3.96	53	2.91	10	0.55
商业服务 Business services	517	3	0.58	1	0.19	1	0.19	1	0.19	0	0.00
学生 Student	20 588	1 638	7.96	343	1.67	516	2.51	1 092	5.30	59	0.29
医务人员 Medical worker	618	3	0.49	1	0.16	2	0.32	0	0.00	0	0.00
幼托儿童 Nursery children	5 065	238	4.70	47	0.93	135	2.67	94	1.86	26	0.51
其他 Others	587	17	2.90	4	0.68	6	1.02	7	1.19	0	0.00
文化程度 Education levels
文盲或半文盲 Illiteracy or semi-illiteracy	10 719	1 078	10.06	620	5.78	282	2.63	327	3.05	5	0.05
学龄前儿童 Preschool child	7 363	362	4.92	90	1.22	207	2.81	145	1.97	36	0.49
小学 Primary school	55 760	4 573	8.20	2 686	4.82	889	1.59	1 383	2.48	58	0.10
初中 Junior high school	26 974	1 338	4.96	611	2.27	389	1.44	510	1.89	21	0.08
中专或中技 Technical secondary school	1 531	25	1.63	13	0.85	7	0.46	9	0.59	0	0.00
高中 Senior high school	3 444	74	2.15	30	0.87	29	0.84	26	0.75	1	0.03
大专 College	1 576	19	1.21	3	0.19	12	0.76	6	0.38	0	0.00
大学及以上 University and above	854	6	0.70	3	0.35	2	0.23	2	0.23	0	0.00

表3

参考文献 19

[1]	Chen YD, Zhu HH, Huang JL, et al. Status and working principals of soil-transmitted nematodiasis during new period in China[J]. Chin J Schisto Control, 2019, 31(1): 23-25. (in Chinese)
	(陈颖丹, 朱慧慧, 黄继磊, 等. 我国土源性线虫病流行现状及新时期防控原则[J]. 中国血吸虫病防治杂志, 2019, 31(1): 23-25.)
[2]	Wang LB, Wu FW, Du ZW, et al. Prevalence of infection with soil-transmitted nematodes in Yunnan Province[J]. J Pathog Biol, 2015, 10(7): 634-637, 658. (in Chinese)
	(汪丽波, 吴方伟, 杜尊伟, 等. 云南省人群土源性线虫感染现状调查[J]. 中国病原生物学杂志, 2015, 10(7): 634-637, 658.)
[3]	Wu FW, Wang LB, Li BF, et al. Prevalence of human soil-borne nematode infections in Yunnan Province: a cross-sectional study in 2015[J]. Chin J Schisto Control, 2021, 33(5): 513-517. (in Chinese)
	(吴方伟, 汪丽波, 李奔福, 等. 2015年云南省人体土源性线虫感染调查[J]. 中国血吸虫病防治杂志, 2021, 33(5): 513-517.)
[4]	National Health and Family Commission of the People’s Republic of China. Detection of intestinal helminths the Kato-Katz method: WS/T 570—2017[S]. Beijing: Standards Press of China, 2017. (in Chinese)
	(中华人民共和国国家卫生和计划生育委员会. WS/T 570—2017肠道蠕虫检测改良加藤厚涂片法[S]. 北京: 中国标准出版社, 2017.)
[5]	Brooker S. Estimating the global distribution and disease burden of intestinal nematode infections: adding up the numbers--a review[J]. Int J Parasitol, 2010, 40(10): 1137-1144. doi: 10.1016/j.ijpara.2010.04.004 pmid: 20430032
[6]	Wang LD. Report on the national survey of curent status of major human parasitic diseases in China[M]. Beijing: People’s Medical Publishing House, 2008: 156-161. (in Chinese)
	(王陇德. 全国人体重要寄生虫病现状调查[M]. 北京: 人民卫生出版社, 2008: 156-161.)
[7]	Zhu AY, Li Y, Li AM, et al. Analysis of soil-transmitted nematode infection in population at the national surveillance sites of Guizhou Province during 2016—2019[J]. Chin J Parasitol Parasit Dis, 2021, 39(5): 674-680, 686. (in Chinese)
	(朱爱娅, 李杨, 李安梅, 等. 2016—2019年贵州省国家监测点人群土源性线虫感染情况分析[J]. 中国寄生虫学与寄生虫病杂志, 2021, 39(5): 674-680, 686.)
[8]	Wan XL, Lyu GL, Jiang ZH, et al. Surveillance on soil-transmitted nematode infections in population in Guangxi Zhuang Autonomous Region during 2016—2020[J]. Chin J Parasitol Parasit Dis, 2021, 39(6): 800-807. (in Chinese)
	(万孝玲, 吕国丽, 蒋智华, 等. 2016—2020年广西壮族自治区人群土源性线虫感染监测结果[J]. 中国寄生虫学与寄生虫病杂志, 2021, 39(6): 800-807.)
[9]	Luo JW, Tian HC, Tie L, et al. Surveillance of soil-transmitted nematode infections in Sichuan Province from 2016 to 2021[J]. Chin J Parasitol Parasit Dis, 2023, 41(2): 192-197. (in Chinese)
	(罗静雯, 田洪春, 铁磊, 等. 2016—2021年四川省人群土源性线虫感染情况分析[J]. 中国寄生虫学与寄生虫病杂志, 2023, 41(2): 192-197.)
[10]	Cao ZG, Wang TP, Jin W, et al. Surveillance of human soil-transmitted nematode infection in Anhui Province during 2016—2022[J]. Chin J Parasitol Parasit Dis, 2023, 41(1): 44-51. (in Chinese)
	(操治国, 汪天平, 金伟, 等. “十三五”期间安徽省人群土源性线虫感染监测结果分析[J]. 中国寄生虫学与寄生虫病杂志, 2023, 41(1): 44-51.)
[11]	Chen Z, Jiang WS, Li D, et al. Analysis of soil-transmitted helminth infection in populations in national surveillance sites of Jiangxi Province during 2016—2019[J]. Chin J Parasitol Parasit Dis, 2020, 38(5): 534-541. (in Chinese)
	(陈喆, 姜唯声, 李东, 等. 2016—2019年江西省土源性线虫病国家监测点人群感染情况分析[J]. 中国寄生虫学与寄生虫病杂志, 2020, 38(5): 534-541.)
[12]	Mu CR, Peng J, Pu SW, et al. Investigation on infection of human soil-transmitted helminth infections in the part border areas between China and Vietnam[J]. J Pathog Biol, 2023, 18(5): 593-597. (in Chinese)
	(母昌汝, 彭佳, 普舒伟, 等. 中越部分边境地区人群土源性线虫感染调查[J]. 中国病原生物学杂志, 2023, 18(5): 593-597.)
[13]	Chen YD, Huang JL, Zhu HH, et al. China’s control process of soil-transmitted helminth infections from pandemic to low-endemic levels[J]. Chin J Parasitol Parasit Dis, 2019, 37(4): 395-398. (in Chinese)
	(陈颖丹, 黄继磊, 朱慧慧, 等. 我国土源性线虫从高感染到低感染水平的防治历程[J]. 中国寄生虫学与寄生虫病杂志, 2019, 37(4): 395-398.)
[14]	Zeng XJ, Jiang WS, Xie SY, et al. Trends of soil-transmitted nematode infections in Jiangxi Province[J]. Chin J Schisto Control, 2017, 29(6): 710-715. (in Chinese)
	(曾小军, 姜唯声, 谢曙英, 等. 江西省土源性线虫病流行趋势分析[J]. 中国血吸虫病防治杂志, 2017, 29(6): 710-715.)
[15]	Zhu AY, Yao DC, Li AM, et al. Prevalence of human soil-transmitted helminth infections in rural areas of Guizhou Province in 2015[J]. Chin J Parasitol Parasit Dis, 2019, 37(6): 670-675. (in Chinese)
	(朱爱娅, 姚丹成, 李安梅, 等. 2015年贵州省农村地区人体土源性线虫感染现状调查[J]. 中国寄生虫学与寄生虫病杂志, 2019, 37(6): 670-675.)
[16]	Chen YH, Xie HG, Xie XL, et al. Current status and control effect of soil-transmitted nematode infections in human population of Fujian Province from 2017 to 2019[J]. Chin J Parasitol Parasit Dis, 2022, 40(1): 84-87, 93. (in Chinese)
	(陈云虹, 谢汉国, 谢贤良, 等. 2017—2019年福建省人群土源性线虫感染现状及防治效果[J]. 中国寄生虫学与寄生虫病杂志, 2022, 40(1): 84-87, 93.)
[17]	Ni BX, Xu XZ, Jin XL, et al. Analysis of surveillance on soil-transmitted nematode infections in Jiangsu Province from 2017 to 2021[J]. Chin J Parasitol Parasit Dis, 2022, 40(6): 730-736. (in Chinese)
	(倪碧娴, 徐祥珍, 金小林, 等. 2017—2021年江苏省土源性线虫感染情况监测分析[J]. 中国寄生虫学与寄生虫病杂志, 2022, 40(6): 730-736.)
[18]	Yu WJ, Wang ZJ, Wang B, et al. Surveillance and trends of soil-transmitted helminth infections in Liaoning Province, 2016—2020[J]. Chin J Parasitol Parasit Dis, 2022, 40(2): 211-215, 222. (in Chinese)
	(于维君, 王子江, 王博, 等. 2016—2020年辽宁省土源性线虫感染现状及流行趋势[J]. 中国寄生虫学与寄生虫病杂志, 2022, 40(2): 211-215, 222.)
[19]	Zhou CH, Zhu HH, Zang W, et al. Monitoring of Enterobius vermicularis infection among children from 2006 to 2010 and SWOT analysis[J]. Chin J Schisto Control, 2014, 26(4): 370-375, 386. (in Chinese)
	(周长海, 朱慧慧, 臧炜, 等. 2006—2010年我国儿童蛲虫感染监测及SWOT分析[J]. 中国血吸虫病防治杂志, 2014, 26(4): 370-375, 386.)