拉萨市棘球蚴病流行现状分析

摘要/Abstract

摘要：

目的了解拉萨市棘球蚴病流行现状。方法于2016年8-12月,采取分层整群随机抽样法,在拉萨市当雄、林周、尼木、墨竹工卡、达孜、曲水、堆龙德庆、城关8个县（区）抽取调查村。根据生产类型,将各县划分成牧区、半农半牧区、农区和城镇,按比例随机抽取调查村数。以行政村（居委会）为单位,每村至少检查200人,人数不足时由邻近村补足,对居民进行腹部B超检查。每个行政村（居委会）随机抽取20名居民,每个县抽1所完全小学,4~6年级每个年级抽不少于50名学生,以问卷形式对居民和学生进行棘球蚴病防治知识与行为调查。每个行政村（居委会）抽取20个养犬户,每户采集1份犬粪,ELISA检测犬粪棘球绦虫抗原。每个行政村（居委会）抽取当地繁育、宰杀的羊（猪）10只或牛5头,检查肝、肺等脏器的包囊情况。利用χ²检验比较不同组间检出率的差异。结果 2016年拉萨市人群棘球蚴病检出率为1.38%（151/10 917）,分型以细粒棘球蚴病为主（82.12%,124/151）,不同县（区）间居民棘球蚴病检出率的差异无统计学意义（χ² = 13.322,P > 0.05）。男、女性棘球蚴病检出率分别为1.12%（48/4 267)和1.55%（103/6 650), 两者差异无统计学意义（χ² = 3.425,P > 0.05）。各年龄组均有棘球蚴病检出,检出率随年龄的增加呈上升趋势,≥ 70岁人群棘球蚴病检出率最高,为2.99%（19/635）,不同年龄组人群棘球蚴病检出率的差异有统计学意义（χ² = 39.544,P < 0.01）。牧民、半农半牧民和家务工作者的棘球蚴病检出率较高,依次为3.16%（38/1 263)、1.93%（15/777)和1.59%（8/504),不同职业类型人群棘球蚴病检出率的差异有统计学意义（χ² = 53.199,P < 0.01）。文盲人群的棘球蚴病检出率最高,为2.08%（99/4 755）,高中及以上文化程度人群的棘球蚴病检出率最低,为0.47%（3/638）,不同文化程度人群棘球蚴病检出率的差异有统计学意义（χ² = 34.138,P < 0.01）。非定居人群和定居人群棘球蚴病检出率分别为3.03%（8/264）和1.34%（143/10 653）,两者差异有统计学意义（χ² = 4.215,P < 0.05）。牧区人群棘球蚴病检出率最高,为2.63%（40/1 995）,城镇人群检出率最低,为0.84%（21/2 512）,不同生产类型地区人群棘球蚴病检出率的差异有统计学意义（χ² = 11.206,P < 0.05）。人群棘球蚴病防治知识认知合格率为40.20%（907/2 256）。犬粪棘球绦虫抗原阳性率为6.30%（66/1 047）,家畜（猪、牛、羊）棘球蚴感染检出率为15.68%（29/185）。结论拉萨市人群棘球蚴病检出率较高,牧区是棘球蚴病的重度流行区。

关键词: 棘球蚴病, 拉萨市, 流行

Abstract:

Objective To investigate the prevalence of echinococcosis in Lhasa. Methods A stratified cluster sampling method was used to select 8 counties (Damxung, Lhünzhub, Nyêmo, Maizhokunggar, Dagzê, Qüxü,Doilungdegen and Chengguan) in Lhasa City to investigate the prevalence of echinococcosis, and they were divided into pastoral area, semi-agricultural and semi-pastoral area, agricultural area and towns based on the type of production. Villages for investigation were assigned into the 8 counties with an appropriate proportion. In each village, at least 200 residents were examined by B ultrasound. When there were fewer than 200 people in a village, residents from its neighbor village would be enrolled. Twenty villagers were randomly selected in each village, and no less than 50 students were selected from each of grades 4-6 in primary schools(one primary school from each county) for survey on the knowledge of and behaviors in relation to echinococcosis prevention by questionnairing. Twenty dog-raising households were selected from each village, and Echinococcus antigen in dog feces was detected by ELISA. In each village, 10 sheep/pigs or 5 cattle were selected to examine internal organs including liver and lung. The number of cysts found were recorded. Difference in prevalence among groups was analyzed by χ² test. Results In 2016, the prevalence of echinococcosis in Lhasa was 1.38% (151/10 917), dominated by cystic echinococcosis (82.12%, 124/151). There was no significant difference in prevalence among the counties (χ² = 13.322, P > 0.05) and between males (1.12%, 48/4 267) and females (1.55%, 103/6 650) (χ² = 3.425, P > 0.05). All age groups were found with hydatid disease, with the ≥ 70 years group having the highest prevalence (2.99%, 19/635). The prevalence showed a trend of increase with age (χ² = 39.544, P < 0.01). The prevalence was higher in herdsmen (3.16%, 38/1 263), semi-farmer-and-herdsmen (1.93%, 15/777), and houseworkers (1.59%, 8/504) , with a significant difference among occupations (χ² = 53.199, P < 0.01). There was a significant difference in prevalence among educational levels (χ² = 34.138, P < 0.01), highest in the illiterates (2.08%, 99/4 755) and lowest in those with a high school level or above (0.47%, 3/638). There was also a significant difference in prevalence between the settled-down residents (3.03%, 8/264) and the nomadic population (1.34%, 143/10 653) (χ² = 4.215, P < 0.05). In addition, the prevalence was highest in pastoral area (2.63%, 40/1 995) and lowest in town (0.84%, 21/2 512) (χ² = 11.206, P < 0.05). The qualified rate on knowledge of echinococcosis prevention in selected residents was 40.20% (907/2 256). The positive rate of Echinococcus antigen in dog fecal samples was 6.30% (66/1 047). The prevalence of hydatid infection was 16.36% (29/185) in livestock. Conclusion There is a high prevalence of hydatid disease in Lhasa, especially in pastoral area.

Key words: Echinococcosis, Lhasa City, Prevalence

中图分类号:

R532.32

次仁拉姆, 严信留, 旦珍旺久, 龙章佑, 旦增曲珍, 艾佳佳, 王栋民, 李景中. 拉萨市棘球蚴病流行现状分析[J]. 中国寄生虫学与寄生虫病杂志, 2018, 36(1): 58-63.

La-mu CIREN, Xin-liu YAN, Wang-jiu DANZHEN, Zhang-you LONG, Qu-zhen DANZENG, Jia-jia AI, Dong-ming WANG, Jing-zhong LI. Epidemiological status of echinococcosis in Lhasa City[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2018, 36(1): 58-63.

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参考文献 21

[1]	李雍龙. 人体寄生虫学[M]. 7版. 北京: 人民卫生出版社, 2011: 144-150.
[2]	刘平, 李金花, 李印, 等. 包虫病病原在我国的流行现状及成因分析[J]. 中国动物检疫, 2016, 33(1): 48-51.
[3]	宋壮志, 郝慧霞, 姜晓峰, 等. 内蒙古自治区包虫病流行现况调查[J]. 首都公共卫生, 2017, 11(2): 53-55.
[4]	黎能金, 张霞, 邱海勇, 等. 2008年四川省阿坝藏族羌族自治州人与家畜棘球蚴病流行病学调查研究[J]. 中国循证医学杂志, 2010, 10(1): 26-29.
[5]	史映红, 陈正杨. 四川江油市包虫病流行病学调查[J]. 热带病与寄生虫学, 2016, 14(4): 198-200.
[6]	李焕军, 牛卫东. 甘肃省肃南县包虫病流行病学调查分析[J]. 疾病预防控制通报, 2012, 27(5): 24-25.
[7]	赫永虎, 强丽红. 甘肃省白银市2011年棘球蚴病流行情况调查[J]. 中国寄生虫学与寄生虫病杂志, 2014, 32(1): 78-79.
[8]	马霄, 王虎, 程时磊, 等. 青海省黄南藏族自治州棘球蚴病流行情况调查[J]. 中国寄生虫学与寄生虫病杂志, 2017, 35(5): 512-514.
[9]	赵建华, 吴向林, 马荣, 等. 宁夏2012年棘球蚴病流行现况调查分析[J]. 宁夏医学杂志, 2014, 36(4): 314-316.
[10]	吴向林, 买买提江·吾买尔. 2012年宁夏家畜包虫病感染现况调查[J]. 宁夏医学杂志, 2015, 37(3): 277-278.
[11]	买买提江·吾买尔, 伊斯拉音·乌斯曼, 阿迪力·司马义, 等. 新疆维吾尔自治区动物棘球绦虫感染调查分析[J]. 中国寄生虫学与寄生虫病杂志, 2017, 35(2): 145-149.
[12]	王乐, 冯晓辉, 段新宇, 等. 999例包虫病住院患者经济负担分析[J]. 中华流行病学杂志, 2010, 31(7): 835-836.
[13]	张梦媛, 伍卫平. 国内外包虫病疾病负担研究进展[J]. 中国病原生物学杂志, 2017, 12(5): 473-475.
[14]	朱曜宇, 伍卫平. 国内外包虫病防治和研究进展[J]. 中国病原生物学杂志, 2016, 11(3): 284-286.
[15]	冯运灵, 杨炬, 吴向林, 等. 1991-2006年宁夏包虫病住院病例回顾性调查分析[J]. 现代预防医学, 2009, 36(17): 3215-3217,3220.
[16]	王国强. 全国包虫病流行情况调查报告[M]. 上海: 上海科学技术出版社, 2016.
[17]	余大为. 甘肃省棘球蚴病流行因素分析[D]. 兰州: 兰州大学, 2015: 18, 26.
[18]	杨炳军, 郭淑霞, 彭心宇, 等. 包虫病流行病学调查现状[J]. 医学综述, 2009, 15(8): 1195-1198.
[19]	温浩, 初向东, 王桂芝, 等. 新疆和布克赛尔蒙古自治县囊型包虫病危险因素分析[J]. 中华流行病学杂志, 2010, 31(3): 297-299.
[20]	王虎. 青海省人体包虫病风险因素分析关[J]. 中国病原生物学杂志, 2004, 17(4): 214-216.
[21]	李丽, 闫立民, 冯运灵, 等. 宁夏包虫病危险因素病例对照研究[J]. 宁夏医学杂志, 2008, 30(2): 133-135.

县（区） County(District)	调查人数 No. exam′d	检出患病人数 No. patients	检出率/% Prevalence/%	细粒棘球蚴病 Cystic echinococosis		多房棘球蚴病 Alveolar echinococosis
县（区） County(District)	调查人数 No. exam′d	检出患病人数 No. patients	检出率/% Prevalence/%	检出患病人数 No. patients	百分率/% Proportion/%	检出患病人数 No. patients	百分率/% Proportion/%
当雄县Damxung	960	19	1.98	17	89.47	2	10.53
墨竹工卡县Maizhokunggar	820	16	1.95	12	75.00	4	25.00
林周县Lhünzhub	1 601	29	1.81	28	96.55	1	3.45
尼木县Nyêmo	853	14	1.64	7	50.00	7	50.00
达孜县Dagzê	834	13	1.56	8	61.54	5	38.46
城关区Chengguan	3 330	36	1.08	32	88.89	4	11.11
堆龙德庆区Doilungdegen	1 670	14	0.84	10	71.43	4	28.57
曲水县Qüxü	849	10	1.18	10	100.00	0	0
合计 Total	10 917	151	1.38	124	82.12	27	17.88

特征Features		调查人数 No. exam′d	检出患病人数 No. patients	检出率/%Prevalence/%
性别 Gender	男Male	4 267	48	1.12
性别 Gender	女Female	6 650	103	1.55
年龄组 Age Group	1~9	932	2	0.21
	10~19	735	3	0.41
	20~29	1 210	15	1.24
	30~39	1 963	20	1.02
	40~49	2 142	25	1.17
	50~59	2 163	43	1.99
	60~69	1 137	24	2.11
	≥ 70	635	19	2.99
职业 Occpuation	学龄前儿童 Preschool child	675	1	0.15
	学生Student	958	3	0.31
	职业人员Worker	655	4	0.61
	农民Farmer	5 836	81	1.39
	家务劳动者 House worker	504	8	1.59
	半农半牧民 Semi-agricultural herdsman	777	15	1.93
	牧民Herdsman	1 263	38	3.16
	其他Others	301	1	0.33
文化程度 Education	学龄前Preschool	614	1	0.16
文化程度 Education	文盲Illiteracy	4 755	99	2.08
	小学Primary school	4 123	38	0.92
	初中Junior high school	787	10	1.27
	高中及以上Senior high school and above	638	3	0.47
居住方式 Way of living	定居Settled	10 653	143	1.34
居住方式 Way of living	非定居Nomadic	264	8	3.03
生产类型 Type of production	牧区Pastoral area	1 995	40	2.01
生产类型 Type of production	半农半牧区 Semi-agricultural and semi-pastoral area	2 891	40	1.38
	农区Agricultural area	3 519	50	1.42
	城镇Town	2 512	21	0.84

县（区） County (District)	居民Resident			学生Student			合计Total
县（区） County (District)	调查人数 No. investigated	合格人数 No. qualified	合格率/% Qualified rate/%	调查人数 No. investigated	合格人数 No. qualified	合格率/% Qualified rate/%	调查人数 No. investigated	合格人数 No. qualified	合格率/% Qualified rate/%
当雄县Damxung	80	4	5.00	150	40	26.67	230	44	19.13
墨竹工卡县 Maizhokunggar	82	36	43.90	150	35	23.33	232	71	30.60
林周县Lhünzhub	310	106	34.19	-	-	-	310	106	34.19
尼木县Nyêmo	80	35	43.75	150	56	37.33	230	91	39.57
达孜县Dagzê	80	35	43.75	150	77	51.33	230	112	48.70
城关区Chengguan	476	217	45.59	-	-	-	476	217	45.59
堆龙德庆区 Doilungdegen	164	44	26.83	154	64	41.56	318	108	33.96
曲水县Qüxü	230	158	68.70	-	-	-	230	158	68.70
合计Total	1 502	635	42.28	754	272	36.07	2 256	907	40.20

县（区） County (District)	家畜（牛、猪、羊） Livestocks (cattle, pigs, sheep)			犬Dog
县（区） County (District)	检查数/头 No. exam′d	感染数/头 No. infection	感染检出率/% Infection rate/%	检查数/份 No. exam′d	粪抗原阳性数/份 No. positives	阳性率/% Positive rate/%
当雄县Damxung	40	9	22.50	80	6	7.50
墨竹工卡县Maizhokunggar	20	4	20.00	81	6	7.41
林周县Lhünzhub	40	0	0	159	15	9.43
尼木县Nyêmo	20	10	50.00	80	4	5.00
达孜县Dagzê	20	2	10.00	80	3	3.75
城关区Chengguan	25	2	8.00	324	29	8.95
堆龙德庆区Doilungdegen	-	-	-	163	1	0.61
曲水县Qüxü	20	2	10.00	80	2	2.50
合计 Total	185	29	15.68	1 047	66	6.30