云南省大理州棘球蚴病流行病学调查和病例回顾性分析

doi:10.12140/j.issn.1000-7423.2023.05.008

中国寄生虫学与寄生虫病杂志 ›› 2023, Vol. 41 ›› Issue (5): 573-578.doi: 10.12140/j.issn.1000-7423.2023.05.008

云南省大理州棘球蚴病流行病学调查和病例回顾性分析

李奔福¹(), 杨敬², 杨金玉³, 罗瑞娟⁴, 朱斌林⁵, 陈泰林⁶, 张丽娟⁷, 李雪瑶⁸, 严信留¹, 字金荣¹, 彭佳¹, 王正青¹, 李健雄¹, 蔡璇¹, 徐倩¹, 吴方伟¹, 杨亚明¹^,^*()

1 云南省寄生虫病防治所，云南公共卫生与疾病防控协同创新中心，大理学大学病原与媒介生物研究所（普洱分部），云南普洱 665000
2 大理州血吸虫病防治研究所，云南大理 671000
3 洱源县疾病预防控制中心，云南洱源 671200
4 剑川县疾病预防控制中心，云南剑川 671300
5 鹤庆县疾病预防控制中心，云南鹤庆 671500
6 宾川县疾病预防控制中心，云南宾川 671600
7 漾濞县疾病预防控制中心，云南漾濞 672500
8 云龙县疾病预防控制中心，云南云龙 672700

收稿日期:2023-03-28 修回日期:2023-07-21 出版日期:2023-10-30 发布日期:2023-11-06
通讯作者: *杨亚明（1965-），硕士，教授，从事重点寄生虫病防治与研究工作。E-mail：yangymsm@126.com
作者简介:李奔福（1979-），男，本科，主管技师，从事重点寄生虫病防治与研究工作。E-mail：libefu@163.com

Epidemiological investigation and case retrospective analysis of echinococcosis in Dali Prefecture, Yunnan Province

LI Benfu¹(), YANG Jing², YANG Jinyu³, LUO Ruijuan⁴, ZHU Binlin⁵, CHEN Tailin⁶, ZHANG Lijuan⁷, LI Xueyao⁸, YAN Xinliu¹, ZI Jinrong¹, PENG Jia¹, WANG Zhengqing¹, LI Jianxiong¹, CAI Xuan¹, XU Qian¹, WU Fangwei¹, YANG Yaming¹^,^*()

1 Yunnan Provincial Collaborative Innovation Center for Public Health and Yunnan Provincial Key Laboratory of Vector-borne Infectious Diseases Control and Research, Yunnan Institute of Parasitic Diseases, Pu’er 665000, Yunnan, China
2 Dali Prefectural Institute of Schistosomiasis Control, Dali 671000, Yunnan, China
3 Eryuan County Center for Disease Control and Prevention, Eryuan 671200, Yunnan, China
4 Jianchuan County Center for Disease Control and Prevention, Jianchuan 671300, Yunnan, China
5 Heqing County Center for Disease Control and Prevention, Heqing 671500, Yunnan, China
6 Binchuan County Center for Disease Control and Prevention, Binchuan 671600, Yunnan, China
7 Yangbi County Center for Disease Control and Prevention, Yangbi 672500, Yunnan, China
8 Yunlong County Center for Disease Control and Prevention, Yunlong 672700, Yunnan, China

Received:2023-03-28 Revised:2023-07-21 Online:2023-10-30 Published:2023-11-06
Contact: *E-mail: yangymsm@126.com

摘要/Abstract

摘要：

目的了解云南省大理白族自治州（简称大理州）2016—2022年棘球蚴病流行状况，为全省棘球蚴病防治提供参考依据。方法 2016—2022年，按照《云南省包虫病防治技术方案》，对大理州第一人民医院、大理大学第一附属医院、大理市第一人民医院，洱源县、剑川县、鹤庆县、宾川县、漾濞县和云龙县第一人民医院及疾病预防控防控制中心，以及国家传染病报告信息管理系统中能追溯到的既往棘球蚴病病例进行回顾性调查。2016—2022年采取整群随机样方法，选择洱源县、剑川县、鹤庆县、宾川县、漾濞县和云龙县等6个县，每个县每年抽取3个乡（镇），每个乡（镇）抽取不少于3个村，对调查村不少于500名3岁以上常住居民进行腹部超声检查。每个调查村抽取50名6岁以上常住居民进行防治知识知晓情况调查。每个调查村随机抽取养犬户，每户采集1份犬粪样，ELISA检测犬粪棘球绦虫抗原。每个调查县随机抽取当地饲养、宰杀的牛、羊和猪，采用内脏剖解法检查家畜棘球蚴感染情况。数据采用SPSS 17.0软件进行统计学分析。结果 2016—2022年大理州共12个县（市）发现病例161例。其中，回顾性调查发现病例95例（占50.01%），现场调查发现病例66例（占40.99%）；确诊病例127例（占78.89%），临床病例34例（占21.12%）。男性、女性病例数分别为65例（占40.37%）、96例（占59.63%），差异无统计学意义（χ² = 3.851，P > 0.05）。年龄分布中，40~49岁年龄组病例数最多（36例），各年龄组之间差异有统计学意义（χ² = 188.520，P < 0.05）。病例职业以农民（87.58%，141/161）和学生（6.83%，11/161）为主，病例的民族以白族（63.35%，102/161）和汉族（22.36%，36/161）为主；各职业、各民族间差异有统计学意义（χ² = 286.898、101.030，均P < 0.05）。2016—2022年共超声筛查6个县（市）543村265 983人，发现棘球蚴病66例，人群棘球蚴病检出率为24.81/10万。其中，洱源县人群棘球蚴病检出率最高，为39.03/10万（23/51 248），云龙县最低，为5.23/10万（2/38 243）。犬粪棘球绦虫抗原阳性率为1.48%（218/14 766），其中云龙县阳性率最高，为2.40%（44/1 837），宾川县最低，为0.73%（18/2 470）。2017年人群棘球蚴病检出率最高（149.03/10万），2021年最低（11.41/10万），从2017年开始呈下降趋势。共检查家畜脏器18 416份，棘球蚴感染率为0.09%（16/18 416），其中洱源县和漾濞县的家畜棘球蚴感染率分别为0.45%（15/3 349）和0.03%（1/3 202），其他县未检出感染家畜；2017、2018和2019年家畜感染率分别为0.06%（3/5 369）、0.15%（7/4 771）、0.22%（6/2 769），其他年份未检出感染家畜；牛和猪感染率分别为0.02%（1/4 715）和0.13%（15/11 427），羊未发现感染。人群棘球蚴病防治知识合格率为72.71%（4 494/6 181），其中云龙县最高，为88.76%（1 137/1 281），剑川县最低，为40.23%（286/711），不同地区的合格率差异有统计学意义（χ² = 109.991，P < 0.05）。结论云南省大理州棘球蚴病呈中度流行，需加强对女性、40~49岁年龄组、农民和白族等重点人群的健康教育。

关键词: 棘球蚴病, 流行病学, 回顾性分析, 大理

Abstract:

Objective To understand the endemic status of echinococcosis in Dali Bai Autonomous Prefecture, Yunnan Province (hereafter Dali) to provide reference basis for prevention and control of the disease in the province. Methods According to the Technical Scheme for Hydatid Disease Control in Yunnan Province, a retrospective survey was performed on all retraceable echinococcosis cases recorded in Dali Prefecture First people’s Hospital, the First Affiliated Hospital of Dali University, Dali City First People’s Hospital, The first People’s Hospitals and Centers for Disease Control and Prevention of counties Eryuan, Jianchuan, Heqing, Binchuang, Yangbi and Yunlong, as well as in the National Infectious Disease Reporting Information Management System from 2016 to 2022. In addition, sampling survey was conducted in 2016—2022. Using cluster random sampling method, 6 counties (Er Yuan, Jian Chuan, He Qing, Bin Chuan, Yang Bi and Yun Long) were selected, from each of which 3 townships were seleted annually, and then no less than 3 villages were selected from each township. From the selected villages, no less than 500 permanent residents at the age over 3 years were examined by abdominal ultrasonography. Hydatid disease was diagnosed based on ultrasonic imaging combined with epidemiological history and clinical manifestation. Serological tests were performed for those suspected cases. A questionnaire was carried out in enrolled participants with age over 6 year old for the awareness of infection and prevention of hydatid disease. A dog was selected from each household in each village to detect the coproantigen of Echinococccus by ELISA. In each county (city), visceral organs were collected from locally raised sheep, pigs and cattle for examining hydatid cysts by necropsy. All data were statistically analyzed using SPSS 17.0 software. Results A total of 161 cases were found in 12 counties through retrospective investigation. Among them, the number of cases found in hospitals accounted for 50.01% (95/161), and the number of cases found in surveys accounted for (40.99%, 66/161). The confirmed cases accounted for (78.89%, 127/161), the clinical cases accounted for (21.12%, 34/161). The accounted for cystic echinococcosis in males and females were 40.37% (65/161) and 59.63% (96/161), without statistically significant difference between gender (χ² = 3.851，P < 0.05). The accounted for increased with age (χ² = 188.520, P < 0.05), the group of 40-49 years old (22.36%, 36/161) was highest other group, with a statistically significant difference between age groups (χ² = 188.520，P < 0.05). Most echinococcosis cases were found in farmers (87.58%, 141/161) and students (6.83%, 11/161). The ethnic groups with cases are mainly Bai (63.35%, 102/161) and Han (22.36%, 36/161). There are statistically significant differences among professions and ethnic groups (χ² = 286.898, 101.030; both P < 0.05). A total of 543 villages were investigated in 6 counties from 2016 to 2022. A total of 265 983 residents were examined by ultrasound, of whom 66 (24.81/100 000) were detected with hydatid disease, all infected with Echinococcus granulosus. Eryuan County has the highest prevalence rate (39.03/100 000, 23/51 248), and Yunlong County has the lowest prevalence rate (5.23/100 000, 2/38 243). The detection rate of echinococcosis in the population was the highest in 2017 (149.03/100 000), and the lowest in 2021 (11.41/100 000), showing a downward trend since 2017. The overall dog coproantigen positive rate was 1.48% (218/14 766), with the highest positive rate (2.40%, 44/1 837) in Yunlong County, and the lowest positive rate (0.73%, 18/2 470) in Binchuan County. The overall hydatid detection rate in livestock (sheep, cattle and pigs) was 0.09% (16/18 416), and the infection rates of Echinococcus in livestock in Eryuan County and Yangbi County were 0.45% (15/3 349) and 0.03% (1/3 202), respectively. No infected livestock were found in other counties, with 0.06% (3/5 369) in 2017, 0.15% (7/4 771) in 2018 and 0.22% (6/2 769), respectively. The infection rates of cattle and pigs were 0.02% (1/4 715) and 0.13% (15/11 427), respectively, and no infection was found in sheep. The overall awareness rate for echinococcosis among the investigated population was 72.71% (4 494/6 181), The awareness rate of Yunlong County, Yangbi County, Heqing County, Jianchuan County, Eryuan County and Binchuan County was 88.76% (1 137/1 281), 79.31% (594/749), 77.66% (918/1 182), 74.49% (800/1 074), 64.10% (759/1 184) and 40.23% (286/711), respectively (χ² = 109.991, P < 0.05). Conclusion Echinococcosis in Dali showed a moderate prevalence. It is imperative to strengthen health education for key population including women, aged 40-49 group, farmers, and the Bai ethnic group.

Key words: Echinococcosis, Epidemiology analysis, Retrospective analysis, Dali

中图分类号:

R532.32

李奔福, 杨敬, 杨金玉, 罗瑞娟, 朱斌林, 陈泰林, 张丽娟, 李雪瑶, 严信留, 字金荣, 彭佳, 王正青, 李健雄, 蔡璇, 徐倩, 吴方伟, 杨亚明. 云南省大理州棘球蚴病流行病学调查和病例回顾性分析[J]. 中国寄生虫学与寄生虫病杂志, 2023, 41(5): 573-578.

LI Benfu, YANG Jing, YANG Jinyu, LUO Ruijuan, ZHU Binlin, CHEN Tailin, ZHANG Lijuan, LI Xueyao, YAN Xinliu, ZI Jinrong, PENG Jia, WANG Zhengqing, LI Jianxiong, CAI Xuan, XU Qian, WU Fangwei, YANG Yaming. Epidemiological investigation and case retrospective analysis of echinococcosis in Dali Prefecture, Yunnan Province[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2023, 41(5): 573-578.

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特征 Feature	病例数 No. case	占比% Percent/%
性别 Gender
男 Male	65	40.37
女 Female	96	59.63
年龄组/岁 Age group/year
< 10	4	2.48
10~19	9	5.59
20~29	23	14.29
30~39	20	12.42
40~49	36	22.36
50~59	24	14.91
60~69	29	18.01
≥ 70	16	9.94
职业Occupation
农民 Farmer	141	87.58
学生 Student	11	6.83
干部 Staff	4	2.48
儿童 Child	3	1.86
其他 Others	2	1.24
民族 Ethnic group
白族 Bai	102	63.35
汉族 Han	36	22.36
彝族 Yi	14	8.70
其他 Other	9	5.59

云南省大理州棘球蚴病流行病学调查和病例回顾性分析

Epidemiological investigation and case retrospective analysis of echinococcosis in Dali Prefecture, Yunnan Province

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