2005—2021年甘肃省陇南市内脏利什曼病流行特征

doi:10.12140/j.issn.1000-7423.2023.05.009

摘要/Abstract

摘要：

目的分析2005—2021年甘肃省陇南市内脏利什曼病的流行病学特征，为内脏利什曼病防控策略制定提供科学依据。方法收集国家传染病报告信息管理系统中2005—2021年报告的现住址在陇南市的内脏利什曼病病例信息，使用Microsoft Excel 2013建立数据库，运用描述性流行病学方法分析内脏利什曼病病例的三间分布特征，用Arc GIS10.2绘制报告病例分布图，采用SPSS 25.0软件进行统计学分析。结果 2005—2021年陇南市共报告内脏利什曼病病例1 109例，其中临床诊断病例577例、确诊病例532例，年均报告发病率为2.49/10万，呈低度流行状态；2005年发病率为2.76/10万，至2009年升高至4.53/10万，随后逐渐下降至2021年的0.46/10万，呈先升后降的趋势（χ² = 267.561，P < 0.01）。报告病例主要分布在武都区（606例）、文县（323例）、宕昌县（148例），占总报告病例数的97.11%（1 077/1 109）。内脏利什曼病流行县的部分乡（镇）呈现聚集性高发。男性、女性报告病例分别为633和476例，男女性别比为1.33∶1，男性、女性发病率分别为2.73/10万、2.23/10万（χ² = 2.699，P > 0.05）。0~4岁年龄组报告病例数占报告病例总数的50.50%（560/ 1 109），发病率最高，为19.62/10万；其次为5~9岁年龄组，报告病例数占报告病例总数的12.80%（142/1 109），发病率为4.84/10万；报告病例发病率随着年龄的增长呈下降趋势（χ² = 14.942，P < 0.01）。散居儿童报告病例数最多，占总报告病例数的41.12%（456/1 109），其次为农民，占24.71%（274/1 109）。结论甘肃省陇南市内脏利什曼病呈低度流行状态，报告病例以儿童居多，历史流行县疫情有复燃趋势。

关键词: 内脏利什曼病, 发病趋势, 流行特征

Abstract:

Objective To analyze the epidemiological characteristics of visceral leishmaniasis cases in Longnan City, Gansu Province from 2005 to 2021, to provide scientific basis for formulating prevention and control strategy for visceral leishmaniasis. Methods The information on the visceral leishmaniasis cases residing at the current address in Longnan City, reported by the National Infectious Disease Surveillance Reporting and Management System from 2005 to 2021, was collected. A database was established using Microsoft Excel 2013. Three-dimentional distribution characteristics of visceral leishmaniasis cases were analyzed with descriptive epidemiological method. The distribution map of reported cases was plotted by Arc GIS 10.2. Statistical analysis was performed using SPSS 25.0 software. Results From 2005 to 2021, a total of 1 109 cases of visceral leishmaniasis were reported in Longnan City,among them, 577 cases were of clinical diagnosis, and 532 confirmed cases. The annual average incidence rate was reported at 2.49/100 000, showing a low prevalence status. The incidence rate reached 2.76/100 000 in 2005, rose to 4.53/100 000 in 2009, and gradually dropped to 0.46/100 000 in 2021, indicating a trend of first increase and then decrease (χ² = 267.561, P < 0.01). The visceral leishmaniasis cases were mainly distributed in Wudu District (606 cases), Wenxian County (323 cases) and Tanchang County (148 cases), accounting for 97.11% of reported cases (1 077/1 109). In some villages/towns of endemic counties, a cluster of high incidence was found. There were 633 male cases and 476 female cases, and the sex ratio was 1.33∶1; the incidence rates in males and females were 2.73/100 000 and 2.23/100 000, respectively (χ² = 2.699, P > 0.05). The number of reported cases in the 0-4 age group accounted for 50.50% (560/1 109) of the total number of reported cases, with the highest incidence rate of 19.62/100 000. The second is the 5-9 age group, with the number of reported cases accounting for 12.80% (142/1 109) of the total number of reported cases, and the incidence rate is 4.84/100 000. It indicated that the incidence rate tends to decrease with age (χ² = 14.942, P < 0.01). The first incidence rate was occupied in children of scattered living, accounting for 41.12% (456/1 109), and the second in peasants, accounting for 24.71% (274/1 109). Conclusion In Longnan City of Gansu Province, visceral leishmaniasis remains at a low prevalent status. The reported cases are mainly of children. There is a recurgence trend in historically endemic counties.

Key words: Visceral leishmaniasis, Incidence trend, Epidemiological characteristics

中图分类号:

R531.6

王小军, 蔡玉成, 邹轩, 李辉, 童波波. 2005—2021年甘肃省陇南市内脏利什曼病流行特征[J]. 中国寄生虫学与寄生虫病杂志, 2023, 41(5): 579-585.

WANG Xiaojun, CAI Yucheng, ZOU Xuan, LI Hui, TONG Bobo. The epidemiological characteristics of visceral leishmaniasis in Longnan City from 2005 to 2021[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2023, 41(5): 579-585.

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参考文献 23

[1]	Zhang P, Shen ZY, Zhang YP, et al. Research progress of clinical epidemiology, prevention and treatment on visceral leishmaniasis[J]. Med J Natl Defending Forces Northwest Chin, 2019, 40(11): 703-708. (in Chinese)
	(张鹏, 沈兆媛, 张亚萍, 等. 我国内脏利什曼病临床流行病学特征与防治研究现状[J]. 西北国防医学杂志, 2019, 40(11): 703-708.)
[2]	Li RJ, Kang W, Lian JQ, et al. Epidemiological and clinical characteristics of patients with kala-azar admitted in Tangdu Hospital from 2010 to 2020[J]. J Air Force Med Univ, 2022, 43(8): 867-870. (in Chinese)
	(李瑞娟, 康文, 连建奇, 等. 唐都医院2010—2020年收治的黑热病患者流行病学及临床特征分析[J]. 空军军医大学学报, 2022, 43(8): 867-870.)
[3]	Zhou ZB, Li YY, Zhang Y, et al. Prevalence of visceral leishmaniasis in China in 2019[J]. Chin J Parasitol Parasit Dis, 2020, 38(5): 602-607. (in Chinese)
	(周正斌, 李元元, 张仪, 等. 2019年我国内脏利什曼病疫情分析[J]. 中国寄生虫学与寄生虫病杂志, 2020, 38(5): 602-607.)
[4]	Wang ZJ, Xiong GH, Guan LR. Epidemiology and control achievements of kala-azar in New China[J]. Chin J Epidemiol, 2000, 21(1): 51-54. (in Chinese) pmid: 15459981
	(王兆俊, 熊光华, 管立人. 新中国黑热病流行病学与防治成就[J]. 中华流行病学杂志, 2000, 21(1): 51-54.)
[5]	Zhou ZB, Li YY, Zhang Y, et al. Prevalence of visceral leishmaniasis in China during 2015—2018[J]. Chin J Parasitol Parasit Dis, 2020, 38(3): 339-345. (in Chinese)
	(周正斌, 李元元, 张仪, 等. 2015—2018年我国内脏利什曼病疫情分析[J]. 中国寄生虫学与寄生虫病杂志, 2020, 38(3): 339-345.)
[6]	Zhou ZB, Pan GQ, Li YY, et al. Prevalence of visceral leishmaniasis in China in 2021[J]. Chin J Parasitol Parasit Dis, 2023, 41(2): 149-155. (in Chinese)
	(周正斌, 潘改芹, 李元元, 等. 2021年我国内脏利什曼病疫情分析[J]. 中国寄生虫学与寄生虫病杂志, 2023, 41(2): 149-155.)
[7]	Bai XF. Study on epidemiological distribution and influencing factors of Leishmania infection in human population and domestic animals in Tanchang County, Gansu Province[D]. Beijing: Chinese Center for Disease Control and Prevention, 2016: 24-35). (in Chinese)
	(白雪飞. 甘肃宕昌县人群与家养动物利什曼原虫感染分布及其影响因素研究[D]. 北京: 中国疾病预防控制中心, 2016: 24-35.)
[8]	Guan LR, Wang J, Hu YD, et al. Epidemiology of kala-azarin China and its significance in the prevention and treatment of kala-azar[J]. J Control Res Epidem Dis, 1976, 3: 225-232. (in Chinese)
	(管立人, 王捷, 胡永德, 等. 我国黑热病流行病学的类型及其在防治上的意义[J]. 流行病防治研究, 1976, 3: 225-232.)
[9]	Guan LR, Shen WX. Recent advances in visceral leishmaniasis in China[J]. Southeast Asian J Trop Med Public Health, 1991, 22(3): 291-298.
[10]	Li DM, Chen Y, Wei LS, et al. Prevalence and control strategy of kala-azar in Longnan area of Gansu Province[J]. Endem Dis Bull, 2004, 19(3): 95-96. (in Chinese)
	(李德明, 陈云, 魏露生, 等. 甘肃省陇南地区黑热病流行及防治策略[J]. 地方病通报, 2004, 19(3): 95-96.)
[11]	Li F, Chen SB, Feng Y, et al. Analysis on epidemic factors of kala-azar in Gansu Province from 2005 to 2007[J]. Endem Dis Bull, 2009, 24(5): 37-38. (in Chinese)
	(李凡, 陈生邦, 冯宇, 等. 2005—2007年甘肃省黑热病流行因素分析[J]. 地方病通报, 2009, 24(5): 37-38.)
[12]	Luo Y, Abulimiti SNWR. Epidemiological characteristics of kala-azar in Kashgar from 2011 to 2020[J]. Bull Dis Control Prev, 2022, 37(1): 46-49. (in Chinese)
	(罗英, 斯那瓦尔•阿布力米提. 2011—2020年喀什市黑热病流行特征分析[J]. 疾病预防控制通报, 2022, 37(1): 46-49.)
[13]	Liu LL, Guan ZP, Li F, et al. Retrospective analysis of epidemic feature of visceral leishmaniasis in Wen County of Gansu Province from 2009 to 2017[J]. Bull Dis Control Prev Chin, 2019, 34(1): 29-31, 57. (in Chinese)
	(刘林林, 关真平, 李凡, 等. 2009—2017年甘肃省文县内脏利什曼病流行特征回顾分析[J]. 疾病预防控制通报, 2019, 34(1): 29-31, 57.)
[14]	Yu DW, Li F, Feng Y, et al. Risk factors analysis of canines infected Leishmania in Wenxian and Diebu counties of Gansu[J]. Chin Trop Med, 2022, 22(1): 5-8, 13. (in Chinese)
	(余大为, 李凡, 冯宇, 等. 甘肃省文县、迭部县家犬感染利什曼原虫危险因素研究[J]. 中国热带医学, 2022, 22(1): 5-8, 13.) doi: 10.13604/j.cnki.46-1064/r.2022.01.02
[15]	Wang JY, Feng Y, Gao CH, et al. Asymptomatic Leishmania infection in human population of Wenxian County, Gansu Province[J]. Chin J Parasitol Parasit Dis, 2007, 25(1): 62-64. (in Chinese)
	(汪俊云, 冯宇, 高春花, 等. 甘肃省文县流行区人群婴儿利什曼原虫无症状感染现状[J]. 中国寄生虫学与寄生虫病杂志, 2007, 25(1): 62-64.)
[16]	Lu ZL, Liang HM, Fu XM, et al. Epidemiology of visceral leishmaniasis before and after the Wenchuan earthquake in Longnan City, China, 2005—2013[J]. Chin J Zoonoses, 2014, 30(10): 1039-1044. (in Chinese)
	(逯召莲, 梁红梅, 付喜梅, 等. 2005—2013年陇南市汶川地震前后黑热病流行特点研究(英文)[J]. 中国人兽共患病学报, 2014, 30(10): 1039-1044.)
[17]	Dai PF, Tian XD, Zhao JY, et al. Epidemiological characteristics of visceral leishmaniasis in Shanxi Province, China, 2020[J]. Chin J Vector Biol Control, 2022, 33(3): 405-408. (in Chinese)
	(代培芳, 田晓东, 赵俊英, 等. 山西省2020年黑热病流行特征分析[J]. 中国媒介生物学及控制杂志, 2022, 33(3): 405-408.) doi: 10.11853/j.issn.1003.8280.2022.03.017
[18]	Zhang PJ, Zhou ZB, Li YY, et al. Prevalence of mountain-zoonotic type visceral leishmaniasis in Yangquan City of Shanxi Province from 2015 to 2020[J]. Chin J Schisto Control, 2022, 34(5): 493-499. (in Chinese)
	(张佩君, 周正斌, 李元元, 等. 2015—2020年山西省阳泉市犬源型内脏利什曼病疫情调查[J]. 中国血吸虫病防治杂志, 2022, 34(5): 493-499.)
[19]	Luo ZW, Zhou ZB, Gong YF, et al. Current status and challenges of visceral leishmaniasis in China[J]. Chin J Parasitol Parasit Dis, 2022, 40(2): 146-152. (in Chinese)
	(罗卓韦, 周正斌, 公衍峰, 等. 我国内脏利什曼病的流行现状和防控挑战[J]. 中国寄生虫学与寄生虫病杂志, 2022, 40(2): 146-152.)
[20]	Zhou ZB, Lyu S, Zhang Y, et al. Visceral leishmaniasis- China, 2015—2019[J]. China CDC Wkly, 2020, 2(33): 625-628.
[21]	Yu DW, Ding GW, Ge PF, et al. A retrospective analysis on the prevalence of visceral leishmaniasis in Gansu Province during 2005—2014[J]. Chin J Parasitol Parasit Dis, 2015, 33(3): 208-211. (in Chinese)
	(余大为, 丁国武, 格鹏飞, 等. 2005—2014年甘肃省内脏利什曼病流行情况的回顾性分析[J]. 中国寄生虫学与寄生虫病杂志, 2015, 33(3): 208-211.)
[22]	Chen J, Wei ZY, Li H, et al. Epidemiological characteristics and spatio-temporal cluster analysis of kala-azar in Shanxi Province[J]. Chin Remedies Clin, 2021, 21(11): 1955-1956. (in Chinese)
	(陈靖, 魏志云, 李虹, 等. 山西省黑热病流行病学特征及时空聚类分析[J]. 中国药物与临床, 2021, 21(11): 1955-1956.)
[23]	Ling P, Wang XF, Zhao Y, et al. Epidemiological characteristics of kala-azar cases in Sichuan Province from 2015 to 2019[J]. J Prev Med Chin People’s Liberation Army, 2020, 38(4): 63-65. (in Chinese)
	(凌攀, 王晓凤, 赵仪, 等. 2015—2019年四川省疾控黑热病病例流行特征分析[J]. 解放军预防医学杂志, 2020, 38(4): 63-65.)

年龄组/岁 Age group/year	男性 Male			女性 Female			合计 Total
年龄组/岁 Age group/year	人口数 Population	病例数 No. case	发病率/100 000^-1 Incidence rate/ 100 000^-1	人口数 Population	病例数 No. case	发病率/100 000^-1 Incidence rate/ 100 000^-1	人口数 Population	病例数 No. case	发病率/100 000^-1 Incidence rate/ 100 000^-1
0~4	1 487 697	315	21.17	1 366 984	245	17.92	2 854 681	560	19.62
5~9	1 525 450	74	4.85	1 407 334	68	4.83	2 932 784	142	4.84
10~14	1 533 686	38	2.48	1 422 295	30	2.11	2 955 981	68	2.3
15~19	1 931 364	30	1.55	1 854 474	27	1.46	3 785 838	57	1.51
20~24	1 906 649	21	1.1	1 850 670	22	1.19	3 757 319	43	1.14
25~29	1 518 336	17	1.12	1 417 131	15	1.06	2 935 467	32	1.09
30~34	1 630 633	17	1.04	1 484 605	17	1.15	3 115 238	34	1.09
35~39	2 192 834	29	1.32	1 970 592	15	0.76	4 163 426	44	1.06
40~44	2 268 205	17	0.75	2 003 402	9	0.45	4 271 607	26	0.61
45~49	1 860 687	19	1.02	1 600 675	9	0.56	3 461 362	28	0.81
50~54	1 168 244	15	1.28	1 011 222	4	0.4	2 179 466	19	0.87
55~59	1 105 491	14	1.27	986 164	5	0.51	2 091 655	19	0.91
60~64	991 799	10	1.01	909 334	3	0.33	1 901 133	13	0.68
65~69	867 899	9	1.04	812 395	3	0.37	1 680 294	12	0.71
70~74	610 320	8	1.31	594 622	4	0.67	1 204 942	12	1
≥ 75	571 047	0	0	641 199	0	0	1 212 246	0	0
合计 Total	23 170 341	633	2.73	21 333 098	476	2.23	44 503 439	1 109	2.49

职业 Occupation	病例数 No. case	构成比/% Composition rate/%
散居儿童 Scattered child	456	41.12
农民 Farmer	274	24.71
学生 Student	209	18.85
幼托儿童 Child care	143	12.89
家务及待业 Housewife and unemployed	8	0.72
干部职员 Official	5	0.45
离退人员 Retired personnel	4	0.36
工人 Worker	3	0.27
教师 Teacher	2	0.18
牧民 Herdsman	2	0.18
商业服务 Business service	2	0.18
医务人员 Medical personnel	1	0.09
合计 Total	1 109	100