目的 了解拉萨地区人群棘球蚴病患病现状和流行特征。 方法 于2017年在拉萨地区采取普查的方式进行人群筛查,采用便携式B超仪对调查对象进行腹部B超检查,依据《包虫病诊断标准》（WS 257-2006）,结合流行病学史及临床表现予以诊断。对疑似病例辅以血清学检测,ELISA检测血清中棘球蚴IgG抗体。采用SPSS 20.0统计学软件进行数据的统计分析。 结果 2017年拉萨地区人群棘球蚴病总检出率为0.24%（935/392 592）。男、女性棘球蚴病检出率分别为0.20%（402/198 921）、0.28%（533/193 671）。各年龄组均有棘球蚴病检出,≥ 70岁组的人群棘球蚴病检出率最高（0.90%,106/11 769）,< 10岁组人群的检出率最低（0.09%,48/54 181）,50~59岁、60~69岁、≥ 70岁人群中,女性棘球蚴病检出率分别为0.51%（111/21 812）、0.93%（92/9 924）、1.06%（70/6 629）,均高于男性的0.35%（73/20 853）、0.57%（51/8 988）、0.70%（36/5 140）（P < 0.05）。不同文化程度中,文盲及半文盲人群的棘球蚴病检出率最高（0.45%,369/82 206）,大学及以上人群的检出率最低（0.14%,26/18 124）,文盲及半文盲、小学人群中,女性棘球蚴病检出率分别为0.54%（232/43 171）、0.36%（148/40 655）,均高于男性的0.35%（137/39 035）、0.28%（118/41 786）（P < 0.05）。不同职业中,半农半牧民棘球蚴病检出率最高（1.20%,59/4 923）,学生的检出率最低（0.12%,79/64 398）,牧民和其他职业组人群女性的棘球蚴病检出率分别为0.96%（93/9 675）、0.26%（201/77 235）,高于男性的0.52%（53/10 139）、0.14%（113/79 483）（P < 0.05）。不同居住方式中,冬季定居夏季游牧人群棘球蚴病检出率最高（1.70%,26/1 529）,冬季定居夏季游牧和定居的女性棘球蚴病检出率分别为2.65%（21/792）、0.28%（431/153 203）,高于男性的0.68%（5/737）、0.20%（309/156 215）（P < 0.05）。不同生产类型中,牧业人群棘球蚴病检出率最高（0.57%,128/22 351）,农业人群的检出率最低（0.20%,266/130 298）,除半农半牧以外,城镇、牧业、农业人群中,女性棘球蚴病检出率分别为0.24%（246/104 250）、0.73%（82/11 162）、0.24%（149/62 149）,均高于男性的0.19%（195/103 092）、0.41%（46/11 189）、0.17%（117/68 149）（P < 0.05）;各县（区）人群棘球蚴病检出率为0.18%~0.41%,其中当雄县的最高（0.41%,102/24 588）,尼木县的最低（0.18%,48/26 768）。林周县（0.28%,135/48 848）、当雄县、墨竹工卡县（0.28%,117/41 689）人群棘球蚴病检出率均高于拉萨市城关区（市区）（0.21%,378/180 594）（P < 0.05）。 结论 女性、年龄≥70岁、职业为半农半牧、居住方式为冬季定居夏季游牧、文盲及半文盲、生产方式为牧业的人群是棘球蚴病的重点感染人群。
Objective To understand the prevalence and characteristics of human echinococcosis in Lhasa City. Methods Population based screening for echinococcosis was performed in 2017 by abdominal ultrasound scanning using a portable ultrasound scanner. Diagnosis was made according to the Diagnostic Criteria for Echinococcosis (WS 257-2006), combined with epidemiological history and clinical manifestations. Suspected cases further received a serological test with ELISA to detect serum IgG antibody against Echinococcus antigen. Data were analyzed using the SPSS 20.0 statistical software. Results The overall detection rate of human echinococcosis in Lhasa City was 0.24% (935/392 592) in 2017. The detection rate in females (0.28%, 533/193 671) was significantly higher than that in males (0.20%, 402/198 921) (P < 0.05). Echinococcosis was found in all age groups, with the highest prevalence in the group of ≥ 70 years (0.90%, 106/11 769) and the lowest in the group < 10 years (0.09%, 48/54 181). In the age groups of 50-59, 60-69, and ≥ 70 years, the prevalence in females(0.51%, 111/21 812; 0.93%, 92/9 924; 1.06%, 70/6 629, respectively) was significantly higher than those in males (0.35%, 73/20 853; 0.57%, 51/8 988; 0.70%, 36/5 140, respectively) (P < 0.05). Among the groups of different educational levels, the illiteracy and semi-illiteracy group had the highest detection rate of echinococcosis (0.45%, 369/82 206), while the college and higher group had the lowest(0.14%, 26/18 124). In the illiteracy and semi-illiteracy and the primary school group, the detection rates in females (0.54%, 232/43 171; 0.36%, 148/40 655) were both significantly higher than those in males (0.35%, 137/39 035; 0.28%, 118/41 786) (P < 0.05). The occupation distribution of echinococcosis showed that the prevalence was found the highest in the herdsman-farmer group (1.20%, 59/4 923) and the lowest in students (0.12%, 79/64 398). The prevalence in females of herdsman group and the group of other occupations was 0.96% (93/9 675) and 0.26% (201/77 235), respectively, being significantly higher than those in males(0.52%, 53/10 139 and 0.14%, 113/79 483, respectively) (P < 0.05). The lifestyle distribution indicated that the prevalence was the highest in those settled in winter and nomadic in summer(1.70%, 26/1 529), among them the females showed the prevalence (2.65%, 21/792; 0.28%, 431/153 203) significantly higher than those in males(0.68%, 5/737; 0.20%, 309/156 215, respectively)(P < 0.05). Among the groups engaging in different types of production, the prevalence was found the highest in the group of livestock farming (0.57%, 128/22 351), and the lowest in the agriculture group (0.20%, 266/130 298). In all production type groups, except the herding-farming group, higher prevalence was found in females of all other groups including town residents (0.24%, 246/104 250), livestock farming group (0.73%, 82/11 162), and agriculture group (0.24%, 149/62 149) respectively, which were significantly higher than those in males (0.19%, 195/103 092; 0.41%, 46/11 189 and 0.17%, 117/68 149, respectively) (P < 0.05). Furthermore, the prevalence varied in different counties (districts), ranging at 0.18%-0.41%, with the highest in Damshung County(0.41%, 102/24 588) and lowest in Nyemo County (0.18%, 48/26 768). The prevalence was higher in the counties of Lhundup (0.28%, 135/48 848), Damshung (0.41%, 102/24 588) and Medro Gongkar (0.28%, 117/41 689), compared with Chengguan District (urban area of Lhasa) (0.21%, 378/180 594) (P < 0.05). Conclusion The survey indicates that females, people at age ≥ 70, in the occupation of herding-farming, with living style being settled in winter and nomadic in summer, illiterate and semi-illiterate, and engaging in livestock farming are at higher risk of contracting echinococcosis in Lhasa area.
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