西藏自治区棘球蚴病病例分析

摘要/Abstract

摘要：

目的了解西藏自治区棘球蚴病病例构成、地区分布及病灶分布情况。方法于2016年8-10月,采用分层整群抽样的方法,抽取西藏自治区7个地（市）70个县的364个行政村进行棘球蚴病流行情况调查,对居民进行B超检查,疑似病例辅以血清学检查,临床及疑似病例进行个案调查,影像学专家结合影像学和血清学检测结果及病例基本情况对病例进行确诊。采用SPSS 20.0统计学软件对数据进行统计分析。结果共B超检查77 049人,检出棘球蚴病病例1 230例,检出率为1.60%（1 230/77 049）,其中细粒棘球蚴病占87.64%（1 078/1 230）,多房棘球蚴病占11.06%（136/1 230）,未分型病例占1.30%（16/1 230）;全区7个地（市）均有细粒棘球蚴病和多房棘球蚴病病例检出,且不同地（市）、性别、年龄、民族、职业、文化程度、居住地生产类型等病例构成也均以细粒棘球蚴病为主。病例的文化程度以文盲为主,占71.95%（875/1 214）,随着年龄的增长细粒棘球蚴病有明显的病例堆积现象;不同职业病例构成中,牧民细粒棘球蚴病病例百分比（91.02%）高于半农半牧民（87.78%）（χ² = 10.710,P < 0.05）,不同生产类型病例构成中,牧区细粒棘球蚴病病例百分比（91.38%）高于农区（83.54%）（χ² = 9.008,P < 0.05）。棘球蚴病病例的病灶分布多在右肝,79%以上的病例仅有1个病灶。结论西藏自治区棘球蚴病病例以细粒棘球蚴病为主,牧区的牧民是防治的重点人群。

关键词: 西藏自治区, 细粒棘球蚴病, 多房棘球蚴病, 病例分析

Abstract:

Objective To understand case composition, regional distribution and lesion distribution of hydatid disease in Tibet Autonomous Region. Methods A stratified cluster sampling method was used to select 364 villages from 70 counties of 7 prefectures(cities) in Tibet Autonomous Region to perform an epidemiological survey on hydatid disease from August to October, 2016. B ultrasound was conducted on residents, accompanied by serological examination for suspected cases. Clinical and suspected cases were investigated individually. All the cases were finally identified by an imaging expert based on a combination of imaging and serological results. Negative cases were excluded. Data were analyzed by SPSS 20.0 software. Results A total of 77 049 residents received B ultrasound examination, and 1 230 were detected with hydatid disease(1.60%, 1 230/77 049), comprising 1 078 cystic echinococcosis (CE) (87.64%), 136 alveolar echinococcosis(AE) (11.06%), and 16 unclassified cases (1.30%). The 7 prefectures(cities) were all found with CE and AE cases, of which CE dominated the case composition with regard to city, gender, age, ethnicity, occupation, educational level, and type of production in place of residence. The cases were dominated by those uneducated 71.95% (875/1 214). There was a significant CE case accumulation with the increase of age. Among different occupations, the CE case composition of herdsmen (91.02%) was higher than that of farmer-and-herdsmen (87.78%) (χ² = 10.710, P < 0.05). Lesions distributed mainly in the right liver, with > 79% cases having only one focal lesion. Conclusion There is a wide prevalence of hydatid disease in Tibet Autonomous Region, and herdsmen are the major target population for control.

Key words: Tibet Region, Cystic echinococcosis, Alveolar echinococcosis, Case analysis

中图分类号:

R532.32

陈伟奇, 张雅兰, 贡桑曲珍, 伍卫平, 韩帅, 薛垂召, 郑灿军, 艾佳佳. 西藏自治区棘球蚴病病例分析[J]. 中国寄生虫学与寄生虫病杂志, 2018, 36(1): 43-47.

Wei-qi CHEN, Ya-lan ZHANG, Qu-zhen GONGSANG, Wei-ping WU, Shuai HAN, Chui-zhao XUE, Can-jun ZHENG, Jia-jia AI. Analysis of hydatid disease cases in Tibet Autonomous Region[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2018, 36(1): 43-47.

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地区（市） Prefecture(City)	细粒棘球蚴病Cystic echinococcosis		多房棘球蚴病Alveolar echinococcosis		未分型病例Unclassified cases		合计Total
地区（市） Prefecture(City)	病例数 No. patients	百分比/% Case constitution/%	病例数 No. patients	百分比/% Case constitution/%	病例数 No. patients	百分比/% Case constitution/%	合计Total
拉萨市Lhasa	124	82.12	27	17.88	0	0	151
日喀则市Shigatse	249	90.55	24	8.73	2	0.73	275
昌都市Changdu	167	81.07	39	18.93	0	0	206
阿里地区Ali	94	84.68	13	11.71	4	3.6	111
林芝市Nyingchi	42	89.36	5	10.64	0	0	47
山南地区Shannan	100	97.09	3	2.91	0	0	103
那曲地区Nagqu	302	89.61	25	7.42	10	2.97	337
合计Total	1 078	87.64	136	11.06	16	1.3	1 230

年龄组/岁 Age group/year	细粒棘球蚴病Cystic echinococcosis		多房棘球蚴病Alveolar echinococcosis		合计 Total
年龄组/岁 Age group/year	病例数 No. patients	百分比/% Case constitution/%	病例数 No. patients	百分比/% Case constitution/%	合计 Total
1~	32	86.49	5	13.51	37
11~	61	88.41	8	11.59	69
21~	148	90.24	16	9.76	164
31~	195	90.28	21	9.72	216
41~	195	87.44	28	12.56	223
51~	219	89.75	25	10.25	244
61~	155	86.59	24	13.41	179
71~	73	89.02	9	10.98	82
合计Total	1 078	88.80	136	11.20	1 214

生活环境和习惯 living environment and habit	细粒棘球蚴病Cystic echinococcosis		多房棘球蚴病Alveolar echinococcosis		合计 Total
生活环境和习惯 living environment and habit	病例数 No. patients	百分比/% Case constitution/%	病例数 No. patients	百分比/% Case constitution/%	合计 Total
无电器No electrical equipment	10	13.16	66	86.84	76
有电器Have electrical equipment	126	11.07	1 012	88.93	1 138
非集中屠宰No centralized slaughter	121	11.15	964	88.85	1 085
集中屠宰Centralized slaughter	15	11.63	114	88.37	129
非家庭私宰No private slaughter	36	12.37	255	87.63	291
家庭私宰Private slaughter	100	10.83	823	89.17	923
住地周围有野犬Wild dogs around residential quarters	106	11.00	858	89.00	964
住地周围无野犬No wild dogs around residential quarters	30	12.66	207	87.34	237
不知道Unknown	0	0	13	100	13
邻居未养狗 Neighborhood without dog	48	10.88	393	89.12	441
邻居养狗Neighborhood with dog(s)	88	11.38	685	88.62	773
家中无狐皮No fox fur at home	96	10.84	790	89.16	886
家中有狐皮Have fox fur at home	40	12.20	288	87.80	328