西藏自治区儿童棘球蚴病患病情况及影响因素分析

中国寄生虫学与寄生虫病杂志 ›› 2018, Vol. 36 ›› Issue (1): 20-25.

西藏自治区儿童棘球蚴病患病情况及影响因素分析

薛垂召¹, 伍卫平^1,^*(), 韩帅¹, 郑灿军², 王莹¹, 王立英¹, 余晴¹, 张山山¹, 周晓农¹, 肖宁¹, 曹建平¹, 贡桑曲珍³, 曹淳力¹, 田添¹, 陈伟奇⁴, 严信留⁵

1 中国疾病预防控制中心寄生虫病预防控制所,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 中国疾病预防控制中心,北京 102206
3 西藏自治区疾病预防控制中心,拉萨850000
4 河南省疾病预防控制中心,郑州 450016
5 云南省寄生虫病防治所,普洱 665000

收稿日期:2017-12-29 出版日期:2018-02-28 发布日期:2018-03-14
通讯作者: 伍卫平

Prevalence and influencing factors of hydatid disease among children in Tibet Autonomous Region

Chui-zhao XUE¹, Wei-ping WU^1,^*(), Shuai HAN¹, Can-jun ZHENG², Ying WANG¹, Li-ying WANG¹, Qing YU¹, Shan-shan ZHANG¹, Xiao-nong ZHOU¹, Ning XIAO¹, Jian-ping CAO¹, Qu-zhen GONGSANG³, Chun-li CAO¹, Tian TIAN¹, Wei-qi CHEN⁴, Xin-liu YAN⁵

1 National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; WHO Collaborative 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 Chinese Center for Disease Control and Prevention, Beijing 102206, China
3 Tibet Center for Disease Control and Prevention, Lhasa 850000, China
4 Henan Center for Disease Control and Prevention, Zhengzhou 450016, China
5 Yunnan Institute of Parasitic Diseases, Puer 665000, China

Received:2017-12-29 Online:2018-02-28 Published:2018-03-14
Contact: Wei-ping WU

摘要/Abstract

摘要：

目的掌握西藏自治区儿童棘球蚴病患病情况,分析其影响因素,为西藏自治区棘球蚴病防治策略的制定提供资料。方法 2016年8-10月,采用分层整群抽样的方法,在西藏自治区70个县（区）选择调查村,每个村随机抽查200人进行腹部B超筛查,对疑似病例辅以血清学检查。采用随机数字表法,每个村抽取20名当地村民;每个县抽取1所县完全小学4~6年级学生,每个年级不少于50名学生,采用一对一问答式进行防治知识和行为调查。每村采用随机数字表法抽取20户养犬户,每户仅采集1条犬的粪样（1~3 g）,ELISA检测犬粪棘球绦虫抗原。对所调查对象中的儿童采用SPSS 21.0统计学软件进行统计分析。结果共调查儿童13 651人,棘球蚴病检出率为0.40%（55/13 651）;在调查的70个县（区）中,仅25个县发现有儿童棘球蚴病患者,其中23个县发现细粒棘球蚴病病例;5个县发现多房棘球蚴病病例。儿童患病检出率排名前5位的依次为昌都市左贡县（11.84%,9/76）、阿里地区措勤县（1.84%,4/218）、日喀则市仲巴县（1.59%,3/189）、山南市浪卡子县（1.50%,2/133）、阿里地区改则县（1.37%,4/293）。检查女童6 660人,检出棘球蚴病患者32例,检出率为0.48%;男童6 991人,检出棘球蚴病患者23例,检出率为0.33%。< 6岁儿童6 770人,检出棘球蚴病患者13人,检出率为0.19%（13/6 770）;7~12岁儿童6 881人,检出棘球蚴病患者42人,检出率为0.61%（42/6 881）,两年龄段的检出率差异有统计学意义（χ² = 13.86,P < 0.05）。以3岁为一个年龄段进行分组,各年龄组均有病例分布,棘球蚴病检出率随着年龄的增长而升高（χ² = 17.69,P < 0.05）。对影响因素的分析表明,犬粪棘球绦虫抗原阳性率为首要危险因素（OR = 3250.2,P < 0.05）,然后依次为年龄和养犬率,问卷合格率则为保护因素。结论儿童棘球蚴病检出率较低,与年龄、养犬和生活习惯有关。

关键词: 棘球蚴病, 西藏自治区, 儿童, 影响因素

Abstract:

Objective To understand the prevalence of hydatid disease in children in Tibet Autonomous Region and analyze the influencing factors of the disease. Methods A stratified cluster sampling method was used to select 364 villages in 70 counties (distict) from August to October, 2016. In each village, 200 residents including children were randomly selected for B ultrasound examination, accompanied by a serological test for those suspected. In each village, 20 local residents were selected using a random number table method, and in each county, a primary school was selected, from which 50 students of grades 4-6 were selected. Their knowledge and behaviors on hydatid disease control were surveyed by face-to-face Q & A. In each village, 20 dog-raising households were selected randomly and in each household, fecal sample (1-3 g) was collected from only one dog. Statistical analysis was carried out using SPSS 19.0 statistical software. Results A total of 13 651 children were examined, with a prevalence of 0.40% (55/13 651) for hydatid disease. In the 70 counties (district) surveyed, child cases were found in only 25 counties(district), of which 23 had children with cystic hydatid disease and 5 had children with alveolar hydatid disease. The top 5 counties with regard to the prevalence were Zuogong County in Changdu City (11.84%, 9/76), Cuoqin County in Ali Prefecture (1.84%, 4/218), Zhongba County in Shigatse City (1.59%, 3/189), Langkazi County in Shannan City (1.50%, 2/133), and Gaize County in Ali Prefecture (1.37%). Among 6 660 girls examined, 32 were detected with hydatid disease (0.48%), and among 6 991 boys examined, 23 were detected with hydatid disease (0.33%). Among 6 770 children under 6 years, 13 were found with hydatid disease (0.19%)(13/6 770), and among 6 881 children aged 7-12 years, 42 were found with hydatid disease (0.61%)(42/6 881)(χ² = 13.86, P < 0.05). By setting 3 years as an age subgroup, each subgroup had cases of hydatid disease, and the prevalence showed a trend of increase with age (χ² = 17.69, P < 0.05). The antigen positive rate of dog feces was a leading risk factor （OR = 3250.2,P < 0.05）, followed by age and the rate of dog-raising, and the qualified rate of questionnairing was the protective factor. Conclusion Hydatid disease in children is related to age, dog-raising and daily hygienic habits.

Key words: Hydatid disease, Tibet Autonomous Region, Children, Influencing factors

中图分类号:

R532.32

薛垂召, 伍卫平, 韩帅, 郑灿军, 王莹, 王立英, 余晴, 张山山, 周晓农, 肖宁, 曹建平, 贡桑曲珍, 曹淳力, 田添, 陈伟奇, 严信留. 西藏自治区儿童棘球蚴病患病情况及影响因素分析[J]. 中国寄生虫学与寄生虫病杂志, 2018, 36(1): 20-25.

Chui-zhao XUE, Wei-ping WU, Shuai HAN, Can-jun ZHENG, Ying WANG, Li-ying WANG, Qing YU, Shan-shan ZHANG, Xiao-nong ZHOU, Ning XIAO, Jian-ping CAO, Qu-zhen GONGSANG, Chun-li CAO, Tian TIAN, Wei-qi CHEN, Xin-liu YAN. Prevalence and influencing factors of hydatid disease among children in Tibet Autonomous Region[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2018, 36(1): 20-25.

图/表 4

表1

2016年西藏自治区70个县（区）儿童棘球蚴病患病情况

地（市） City（Prefecture)	县（区） County(District)	检查人数 No. exam′d	多房棘球蚴病 Alveolar hydatid disease		细粒棘球蚴病 Cystic hydatid disease		合计Total
地（市） City（Prefecture)	县（区） County(District)	检查人数 No. exam′d	检出患病人数 No. patients	检出率/%Prevalence/%	检出患病人数 No. patients	检出率/%Prevalence/%	检出患病人数 No. patients	检出率/%Prevalence/%
拉萨市 Lhasa	当雄县Dangxiong	204	1	0.49	0	0	1	0.49
拉萨市 Lhasa	曲水县Qushui	294	0	0	1	0.34	1	0.34
	其他几个县Others	840	0	0	0	0	0	0
	小计Subtotal	1 338	1	0.07	1	0.07	2	0.15
昌都市 Changdu	左贡县Zuogong	76	1	1.32	8	10.53	9	11.84
昌都市 Changdu	丁青县Dingqing	411	1	0.24	1	0.24	2	0.49
	芒康县Mangkang	305	0	0	2	0.66	2	0.66
	其他几个县Others	1 744	0	0	0	0	0	0
	小计Subtotal	2 536	2	0.08	11	0.43	13	0.51
山南市 Shannan	浪卡子县Langkazi	133	0	0	2	1.50	2	1.50
山南市 Shannan	其他几个县Others	1 048	0	0	0	0	0	0
	小计Subtotal	1 181	0	0	2	0.17	2	0.17
日喀则市 Shigatse	仲巴县Zhongba	189	0	0	3	1.59	3	1.59
日喀则市 Shigatse	吉隆县Jilong	276	0	0	3	1.09	3	1.09
	定结县Dingjie	147	0	0	1	0.68	1	0.68
	定日县Dingri	505	0	0	2	0.40	2	0.40
	萨迦县Sajia	172	0	0	1	0.58	1	0.58
	昂仁县Angren	488	0	0	2	0.41	2	0.41
	南木林县Nanmulin	498	0	0	2	0.40	2	0.40
	桑珠孜区Sangzhuzi	737	0	0	2	0.27	2	0.27
	江孜县Jiangzi	393	1	0.25	0	0	1	0.25
	其他几个县Others	1 099	0	0	0	0	0	0
	小计Subtotal	4 504	1	0.02	16	0.36	17	0.38
那曲地区 Nagqu	申扎县Shenzha	158	0	0	2	1.27	2	1.27
那曲地区 Nagqu	那曲县Naqu	596	0	0	4	0.67	4	0.67
	比如县Biru	401	0	0	1	0.25	1	0.25
	其他几个县Others	889	0	0	0	0	0	0
	小计Subtotal	2 044	0	0	7	0.34	7	0.34
阿里地区Ali	措勤县Cuoqin	218	2	0.92	2	0.92	4	1.83
	改则县Gaize	293	0	0	4	1.37	4	1.37
	普兰县Pulan	77	0	0	1	1.30	1	1.30
	日土县Ritu	95	0	0	1	1.05	1	1.05
	噶尔县Gaer	203	0	0	2	0.99	2	0.99
	革吉县Geji	177	0	0	1	0.56	1	0.56
	其他几个县Others	95	0	0	0	0	0	0
	小计Subtotal	1 158	2	0.17	11	0.95	13	1.12
林芝市Nyingchi	工布江达县 Gongbujiangda	108	0	0	1	0.93	1	0.93
其他几个县Others	工布江达县 Gongbujiangda	108	0	0	1	0.93	1	0.93	782	0	0	0	0	0	0
	小计Subtotal	890	0	0	1	0.11	1	0.11
合计Total		13 651	6	0.04	49	0.36	55	0.40

表1

表2

表3

表4

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地（市） City (Prefecture)	调查县数/个 No. counties surveyed	患病率分级（县数）/个 Grading statistics of the hydatid disease detection rate (No. counties)
地（市） City (Prefecture)	调查县数/个 No. counties surveyed	< 0.1%	0.1%~	1.0%~	≥ 2.0%	总计Total
拉萨市Lhasa	8	6	2	0	0	8
昌都市Changdu	11	8	2	0	1	11
山南市Shannan	11	10	0	1	0	11
日喀则市Shigatse	17	8	7	2	0	17
那曲地区Nagqu	10	7	2	1	0	10
阿里地区Ali	7	1	2	4	0	7
林芝市Nyingchi	6	5	1	0	0	6
总计Total	70	45	16	8	1	70

指标Index	系数 B	标准误 S.E.	wald卡方值 Wals	P值 P value	比值比 EXP(B)	95%可信区间 95% Confidence interval
年龄Age	0.202	0.049	16.80	0.000	1.224	(1.111, 1.349)
养犬率Dog raising rate	0.010	0.004	5.03	0.025	1.010	(1.001, 1.019)
犬粪抗原阳性率Antigen positive rate in dog feces	8.086	0.992	66.39	0.000	3 250.177	(464.657, 22 734.293)
问卷合格率Qualified rate of questionnairing	-1.670	0.797	4.39	0.036	0.188	(0.039, 0.898)
常数Constant	-8.372	0.609	188.81	0.000	0.000