云南腾冲人类免疫缺陷病毒携带者人芽囊原虫感染的流行病学特征及影响因素分析

中国寄生虫学与寄生虫病杂志 ›› 2018, Vol. 36 ›› Issue (2): 129-134.

云南腾冲人类免疫缺陷病毒携带者人芽囊原虫感染的流行病学特征及影响因素分析

滕雪娇, 储言红, 翟铖铖, 俞英昉, 蔡玉春, 陈韶红, 艾琳, 田利光, 陈家旭^*()

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中心,卫生部寄生虫病原与媒介生物学重点实验室,上海 200025

收稿日期:2017-07-21 出版日期:2018-04-28 发布日期:2018-04-24
通讯作者: 陈家旭
基金资助:
国家自然科学基金（No. 81473022）;上海市卫计委科研课题（No. 291440499）;国家重点研发计划（No.2016YFC1202700,2016YFC1202701）

The epidemiological characteristics and influencing factors for Blastocystis hominis infection among human immunodeficiency virus seropositive individuals in Tengchong of Yunnan Province

Xue-jiao TENG, Yan-hong CHU, Cheng-cheng ZHAI, Ying-fang YU, Yu-chun CAI, Shao-hong CHEN, Lin AI, Li-guang TIAN, Jia-xu CHEN^*()

National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention;WHO Collaborating 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

Received:2017-07-21 Online:2018-04-28 Published:2018-04-24
Contact: Jia-xu CHEN
Supported by:
Supported by the National Natural Science Foundation of China(No. 81473022), the Scientific Research Subject of Shanghai Municipal Commission of Health and Family Planning(No. 291440499), and the National Key Research and Development Program(No. 2016YFC1202700, 2016YFC1202701)

摘要/Abstract

摘要：

目的了解云南腾冲市人类免疫缺陷病毒（HIV）携带者人芽囊原虫感染的流行病学特征、基因型分布及影响因素。方法采用横断面调查的方法在云南省腾冲市某二级甲等医院收集HIV携带者的粪样,提取粪样人芽囊原虫DNA,PCR扩增人芽囊原虫小亚基核糖体RNA（SSU-RNA）基因,对PCR阳性者测序确认,并构建进化树进行基因分型。采用调查问卷收集研究对象基本信息,采用单因素和logistic回归分析HIV携带者人芽囊原虫感染的影响因素。结果共收集HIV携带者粪样324份。PCR结果显示,12份粪样扩增出人芽囊原虫SSU-RNA基因的目的条带,大小约1 100 bp,人芽囊原虫检出率为3.7%。进化树基因分型结果显示,ST1型、ST3型、ST4型、ST7型、ST12型人芽囊原虫感染者分别为3、2、3、3、1例。单因素分析结果显示,与HIV携带者人芽囊原虫感染有关的影响因素为日常饮用水类型（χ² = 4.398,P < 0.05）、家中饲养家畜（χ² = 7.448,P < 0.05）、经常性接触动物（χ² = 6.276,P < 0.05）、CD4⁺细胞计数（χ² = 4.414,P < 0.05）和HIV-RNA病毒载量（χ² = 11.829,P < 0.05）。Logistic回归分析结果显示,日常直接饮用自来水（χ² = 6.595,P < 0.05）、家中饲养家畜（χ² = 6.740,P < 0.05）、CD4⁺细胞计数 ≤ 500个/μl（χ² = 3.864,P < 0.05）、HIV-RNA病毒载量 > 50 copies/ml（χ² = 9.561,P < 0.05）是HIV携带者感染人芽囊原虫的危险因素。结论云南腾冲市HIV携带者人芽囊原虫感染率为3.7%,其基因分型有5型,日常直接饮用自来水、家中饲养家畜和免疫功能低下是HIV携带者感染人芽囊原虫的主要影响因素。

关键词: HIV/AIDS, 人芽囊原虫, 基因型, 混合感染, 影响因素

Abstract:

Objective To investigate the epidemiological characteristics, genotype distribution and influencing factors for Blastocystis hominis infection among human immunodeficiency virus （HIV） seropositive individuals in Tengchong of Yunnan Province, China. Methods In the cross-sectional survey, stool specimens from HIV-seropositive individuals were collected in a hospital in Tengchong City, and the small-subunit ribosomal RNA (SSU-RNA) of B. hominis was examined by PCR. The positive results were further verified by sequencing. The evolutionary tree was constructed to analyze genotype distribution. A structured questionnaire was applied to collect basic information. The influencing factors for co-infection with HIV and Blastocystis hominis were analyzed with the single-factor analysis and logistic regression analysis. Results A total of 324 stool specimens were collected. PCR results showed that 12 samples had a specific band of SSU-RNA for B. hominis at 1 100 bp, with a positive rate of 3.7% (12/324). The evolutionary tree showed that the B. hominis subtypes ST1 (n = 3, 25%), ST3 (n = 2, 16.7%), ST4 (n = 3, 25%), ST7 (n = 3, 25%), and ST12 (n = 1, 8.3%) were the main subtypes in the HIV-infected individuals. Single-factor analysis revealed that the type of tap water (χ² = 4.398, P < 0.05), livestock-raising (χ² = 7.448, P < 0.05), frequent contact with animals (χ² = 6.276, P < 0.05), CD4⁺ cell count (χ² = 4.414, P < 0.05), and HIV-RNA viral load (χ² = 11.829, P < 0.05) were influencing factors for B. hominis infection among HIV-seropositive individuals. Logistic regression model showed that drinking unboiled tap water (χ² = 6.595, P < 0.05), livestock-raising (χ² = 6.740, P < 0.059), CD4⁺ cell count ≤ 500 cells/μl (χ² = 3.864, P < 0.05), and an HIV-RNA viral load > 50 copies/ml(χ² = 9.561, P < 0.05) were the influencing factors for B. hominis infection among HIV-seropositive individuals. Conclusion The prevalence of B. hominis infection among HIV-seropositive individuals is 3.7% in Tengchong of Yunnan Province. The B. hominis mainly has five genotypes. The main influencing factors for B. hominis infection among HIV-seropositive individuals include drinking unboiled tap water, raising of livestock and low immune function.

Key words: HIV/AIDS, Blastocystis hominis, Genotype, Co-infection, Influence factor

中图分类号:

R382.9

滕雪娇, 储言红, 翟铖铖, 俞英昉, 蔡玉春, 陈韶红, 艾琳, 田利光, 陈家旭. 云南腾冲人类免疫缺陷病毒携带者人芽囊原虫感染的流行病学特征及影响因素分析[J]. 中国寄生虫学与寄生虫病杂志, 2018, 36(2): 129-134.

Xue-jiao TENG, Yan-hong CHU, Cheng-cheng ZHAI, Ying-fang YU, Yu-chun CAI, Shao-hong CHEN, Lin AI, Li-guang TIAN, Jia-xu CHEN. The epidemiological characteristics and influencing factors for Blastocystis hominis infection among human immunodeficiency virus seropositive individuals in Tengchong of Yunnan Province[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2018, 36(2): 129-134.

图/表 4

图1

图2

表1 腾冲市HIV携带者人芽囊原虫感染影响因素单因素分析结果">

表1

表2

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因素 Factor		检查人数 No. exam′d	感染率/% Infection rate/%	OR (95%CI)	χ²值 χ² value	P值 P value
性别Gender	男 Male	157	1.9	0.342(0.091, 1.287)	2.745	0.098
性别Gender	女 Female	167	5.4	0.342(0.091, 1.287)
年龄Age	≤ 40	181	4.4	0.622(0.184, 2.110)	0.590	0.443
年龄Age	> 40	143	2.8	0.622(0.184, 2.110)
家庭总人口数 No. of family members	≤ 5	273	4.0	0.507(0.064, 4.018)	0.059	0.808
家庭总人口数 No. of family members	> 5	48	2.1	0.507(0.064, 4.018)
厕所类型 Type of toilets	旱厕Dry toilet	74	6.8	N/A	2.764	0.430
厕所类型 Type of toilets	粪池Spetic tank	112	3.6
	水冲厕Water flushing toilet	135	0
	公共厕所Public toilet	3	3.7
日常饮用水 Daily drinking water	开水Boiled water	303	3.0	0.184(0.046, 0.738)	4.398	0.036
日常饮用水 Daily drinking water	直接饮用自来水 Drinking-directly tap water	21	14.3	0.184(0.046, 0.738)
	水井水Well water	0	0
	桶装水Bottled water	0	0
饲养宠物 Keeping pets	是 Yes	81	4.9	1.526(0.447, 5.208)	0.434	0.510
饲养宠物 Keeping pets	否 No	243	3.3	1.526(0.447, 5.208)
饲养家畜 Raising livestock	是 Yes	172	6.4	10.317(1.316, 80.874)	7.448	0.006
饲养家畜 Raising livestock	否 No	152	0.7	10.317(1.316, 80.874)
经常接触动物 Having regular contactswith animals	是 Yes	183	6.0	8.953(1.142, 70.195)	6.276	0.012
经常接触动物 Having regular contactswith animals	否 No	141	0.7	8.953(1.142, 70.195)
CD4⁺ 细胞计数 CD4⁺ cell count	≤ 500	141	6.8	4.091(1.087, 15.403)	5.025	0.025
CD4⁺ 细胞计数 CD4⁺ cell count	> 500	181	1.6	4.091(1.087, 15.403)
贫血Anemia	是 Yes	9	11.1	3.455(0.397, 30.079)	0.957	0.328
贫血Anemia	否 No	315	3.5	3.455(0.397, 30.079)
HIV-RNA病毒载量 HIV-RNA viral load	≤ 50	294	2.4	8.200(2.425, 27.726)	11.829	0.001
HIV-RNA病毒载量 HIV-RNA viral load	> 50	30	16.7	8.200(2.425, 27.726)

因素Factor	回归系数b	标准误S.E	卡方值Wald	P值P value	OR	95%置信区间95%CI
日常饮用水 Daily drinking water	2.237	0.871	6.595	0.010	9.362	(1.698, 50.612)
饲养家畜 Raising livestock	2.830	1.090	6.740	0.009	16.944	(2.001, 143.498)
CD4⁺细胞计数 CD4⁺ cell count	1.431	0.728	3.863	0.049	4.181	(1.004, 17.413)
HIV-RNA病毒载量 HIV-RNA viral load	2.251	0.728	9.561	0.002	9.493	(2.280, 39.535)