目的 了解湖北省并殖吸虫病流行状况,为制订防治对策提供依据。 方法 2018—2020年在湖北省13个县（市、区）设立监测点,每年8—10月,在每个监测点选择1个行政村或沿水系分布的若干自然村,按整群抽样的方法对6岁以上全部常住居民进行调查,人数不少于300人。采集监测点居民血样,采用ELISA检测血清抗并殖吸虫抗体水平。血清抗体阳性者再采集痰液用浓集消化法检测并殖吸虫虫卵,并进行个案调查。对采集血样的居民进行问卷调查,包括姓名、年龄、文化程度等一般情况和相关行为。选择监测点内的山坑、溪流环境采集第二中间宿主溪蟹,采用捣碎沉淀法检测并殖吸虫囊蚴感染情况。 结果 3年共调查3 947人,人群血清抗并殖吸虫抗体总阳性率为9.5%（376/3 947）。血清抗体阳性者痰液经浓集消化法检测均未查到虫卵。不同地区以兴山县人群血清抗体阳性率最高,为72.5%（158/218）;地区间人群血清抗体阳性率的差异有统计学意义（χ² = 1 169.9,P < 0.01）。男性和女性血清抗体阳率分别为9.2%（172/1 875）、9.9%（204/2 072）,差异无统计学意义（χ² = 0.516,P > 0.05）。各年龄段血清抗体阳性率以6~9岁和≥ 60岁较高,分别为11.1%（9/81）和12.9%（251/1 951）;各年龄段血清抗体阳性率差异有统计学意义（χ² = 56.148,P < 0.01）。不同文化程度人群血清抗体阳性率以小学和大学及以上人群较高,分别为12.4%（277/2 228）和2/14;不同文化程度血清抗体阳性率差异有统计学意义（χ² = 70.606,P < 0.01）。问卷调查分析结果显示：饮用自来水人群的血清抗体阳性率最高,为11.3%（285/2 529）;各种饮用水类型的人群血清抗体阳性率差异有统计学意义（χ² = 28.834,P < 0.01）。食用过溪蟹者的血清抗体阳性率为11.5%（36/313）,未食用者的血清抗体阳性率为9.4%（340/3 634）（χ² = 1.539,P > 0.05）。有饮生水行为者的血清抗体阳性率为5.9%（77/1 315）,无饮生水行为者的血清抗体阳性率为11.4%（299/2 632）,两者差异有统计学意义（χ² = 30.829,P < 0.01）。共采集溪蟹558只,并殖吸虫囊蚴感染率为10.4%（58/558）,平均感染度为7.6个囊蚴/只;13个监测点中溪蟹感染率最高的为兴山县,达81.6%（31/38）;利川市、丹江口市、建始县、夷陵区、通山县、宣恩县、英山县等7个监测点未查到囊蚴感染溪蟹;不同地区间溪蟹感染率差异有统计学意义（χ² = 195.514,P < 0.01）。 结论 湖北省人群血清抗并殖吸虫抗体阳性率仍较高,以兴山县、≥ 60岁年龄段、小学文化程度人群为重点人群;第二中间宿主溪蟹的囊蚴感染率较高,传播风险依然存在。

Objective To understand current prevalence of paragonimiasis in Hubei Province, to provide basis for formulating control strategy. Methods Surveillance sites were established in 13 counties (city, district) in Hubei Province from 2018 to 2020. One administrative village or several natural villages along water ways were selected from each surveillance site in August to October every year. All permanent residents over 6 years of age were investigated through cluster sampling, with the resident number no less than 300. Blood samples were collected from the residents at surveillance sites, and examined for antibodies against Paragonimus by ELISA. Sputum was collected from antibody-positives, and examined for Paragonimus eggs by concentrated digestion method, and the examinees were further investigated individually. For the residents who provided blood samples, questionnaire survey was conducted on general information including name, age, education level, and related behaviors as well. Stream crabs, the second intermediate host of Paragonimus, were collected in mountain pits and streams in the surveillance sites, and Paragonimus metacercaria were detected using mashing-precipitation method. Results A total of 3 947 people were investigated in 3 years, and the overall positive rate of serum antibody was 9.5% (376/3 947), while no worm egg was found in the sputum of seropositive participants. The highest seropositive rate, 72.5% (158/218), was found in Xingshan County. The seropositive rates in residents between different regions were significantly different (χ ² = 1 169.86, P < 0.01). The seropositive rate was 9.2% in males and 9.9% in females, with no statistically significant difference(χ ² = 0.516, P > 0.05). The seropositive rate were found higher among residents of age group 6-9 years old and ≥ 60 years old, being 11.1% (9/81) and 12.9% (251/1 951), respectively. The differences in seropositive rates between age groups were statistically significant (χ ² = 56.148, P < 0.01). The serum positive rates were higher in people with educational levels of college and above and primary school, being 2/14 and 12.4% (277/228), respectively. A significant difference was observed among educational levels (χ ² = 70.606, P < 0.01). The questionnaire results indicated that the serum antibody positive rate in residents drinking tap water was the highest, at 11.3% (285/2 529). Significant difference was observed among the residents groups drinking different types of water (χ ² = 28.834, P < 0.01). The seropositives found in 313 people who consume fresh crab was 11.5% (36/313); the seropositive rate in 3 643 people who had not eaten fresh crabs was 9.4% (340/3 634); with no significant difference between two groups (χ ² = 1.539, P > 0.05). The positive rate of serum antibody was 5.9% (77/1 315) in people who drank unboiled water and 11.4% (299/2 632) in those who did not drink unboiled water; the difference was statistically significant (χ ² = 30.829, P < 0.01). A total of 558 stream crabs were collected, and the positive rate of Paragonimus metacercariae was 10.4% (58/558). The intensity of infection was 7.6 metacercariae per crab. Among the 13 surveillance sites, the highest infection rate of Paragonimus metacercariae in stream crabs was found in Xingshan County, which reached 81.6% (31/38). No positive stream crabs were found in seven surveillance sites: Lichuan City, Danjiangkou City, Jianshi County, Yiling District, Tongshan County, Xuan’en County and Yingshan County. Significant difference in the infection rates of stream crabs were found between different regions (χ ² = 195.514, P < 0.01). Conclusion The positive rate of serum antibodies against Paragonimus in Hubei Province remain considerably high, especially in Xingshan County, in people ≥ 60 years of age and people with primary school education; the infection rate of metacercaria in stream crabs is comparatively high, indicative of the transmission risk remaining.