目的 了解云南省棘球蚴病流行状况,为制定棘球蚴病防治对策提供参考依据。方法 于2012-2017年按照《全国包虫病流行病学调查方案》要求,2012-2015年调查德钦县、洱源县、维西县和香格里拉等4个县。2016-2017年调查宾川县、大关县、大姚县、德钦县、洱源县、福贡县、贡山县、古城区、鹤庆县、会泽县、剑川县、兰坪县、隆阳区、泸水县、牟定县、石林县、腾冲市、维西县、香格里拉、宣威市、漾濞县、玉龙县、云龙县、昭阳区等24个县（市、区）。采取整群随机抽样方法,每个县抽取3个乡（镇）,每个乡（镇）抽取4个村。2012、2016和2017年对1岁以上常住居民进行腹部B超检查,结合流行病学史、临床表现和影像学特征对调查对象予以诊断,疑似病例辅助血清学检查。2013-2015年在调查点抽取1岁以上常住居民,每个县再随机抽取1所完全小学12岁以下的学生,ELISA检测血清抗棘球蚴IgG抗体,对血清学阳性者进行腹部B超检查。同时对调查者进行防治知识知晓率调查。每村随机抽取20个养犬户,每户仅采集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繁育、宰杀的羊（猪）100只或牛500头,采用内脏剖解法检查家畜棘球蚴感染情况。所有数据采用SPSS 17.0软件进行统计学分析。结果 2012-2015年共调查4个县192个村,2016-2017年共调查24个县576个村,合计768个村。2012、2016和2017年B超共调查105 555人,检出棘球蚴病病例67例,总患病检出率为0.06%,均为细粒棘球蚴病。2012、2016和2017年的患病检出率分别为0.05%（4/7 512）、0.05%（32/61 110）、0.08%（31/36 933）,2013-2015年未发现病例。患病检出率> 0.10%的县有鹤庆县（0.19%,7/3 779）、石林县（0.17%,8/4 799）、昭阳区（0.16%,4/2 520）、大姚县（0.12%,4/3 378）、洱源县（0.11%,11/9 738）、云龙县（0.11%,5/4 465）和剑川县（0.11%,5/4 595）。男性和女性的患病检出率分别为0.05%（23/46 179）和0.07%（44/59 376）（P > 0.05）。各年龄组均有病例检出,60~79岁年龄组患病检出率最高,为0.12%（26/21 227）,其次为≥ 80岁年龄组（0.08%,2/2 414）,患病检出率随着年龄的增长而升高（P < 0.05）。农牧民患病检出率（0.08%,64/82 978）高于其他职业人群（P < 0.05）。文盲人群患病检出率（0.11%,26/22 724）高于其他文化人群（P < 0.05）。犬粪棘球绦虫抗原总阳性率为4.87%（965/19 812）,阳性率> 5.00%以上的有隆阳区（8.41%,28/333）、香格里拉市（8.13%,263/3 234）、泸水县（7.21%,22/305）、洱源县（7.15%,263/3 677）、福贡县（6.54%,20/306）和牟定县（5.18%,16/309）,各县之间犬粪棘球绦虫抗原阳性率差异有统计学意义（P < 0.05）,2012-2017年犬粪抗原阳性率分别为1.24%（16/1 293）、13.41%（483/3 601）、5.10%（95/1 862）、3.01%（72/2 389）、1.56%（103/6 588）和4.81%（196/4 079）。家畜棘球蚴感染检出率为0.12%（32/27 502）,2015-2017年家畜感染检出率分别为1.49%（2/134）、0.21%（8/3 871）和0.10%（22/21 125）。人群棘球蚴病防治知识平均知晓率为52.39%（9 974/19 039）,2012-2017年分别为47.72%（607/1 272）、51.77%（789/1 524）、61.00%（549/900）、77.20%（772/1 000）、43.50%（5 075/11 668）和81.57%（2 182/2 675）。结论 云南省棘球蚴病呈中低度流行,均为细粒棘球蚴病。牧民、年龄60岁以上、文化水平较低者患病检出率较高。

Objective To understand the endemic status of echinococcosis in Yunnan province so as to provide evidence basis for the better prevention and control of the disease. Methods Based on the National Hydatid Disease Epidemiological Investigation Program, epidemiological investigation of echinococcosis was performed in Deqin, Eryuan, Weixi and Shangri-La counties from 2012 to 2015, and in other 24 counties (Binchuan, Daguan, Dayao, Deqin, Eryuan, Fugong, Gongshan, Gucheng, Heqing, Huize, Jianchuan, Lanping, Longyang, Lushui, Mouding, Shilin, Tengchong, Weixi, Shangri-La, Xuanwei, Yangbi, Yulong, Yunlong and Zhaoyang) from 2016 to 2017. Three townships from each county and 4 villages from each township were selected as investigation sites based on cluster random sampling method. Residents with age over 1 year old were examined by abdominal ultrasonography in 2012, 2016 and 2017. The diagnosis of hydatid disease was made based on the ultrasonic imaging combining with epidemiological history, clinical manifestations and serological test for those suspected. During the investigation from 2013 to 2015, residents with age over 1 year old and all students from one primary school in each county were chosen for testing anti-Echinococcosus IgG antibody in their sera. Those with antibody positive were further examined by abdomanal ultrasonography to confirm the diagnosis. A questionnaire investigation was carried out in enrolled participants for the awareness of infection and prevention of hydatid disease. Each dog was selected from 20 households in each village for detecting the coproantigen of Echinococcus by ELISA. In each county (city), visceral organs were collected from locally raised sheep/pigs (100) or cattle (500) for examining hydatid cysts by necropsy. All data were statistically analyzed using SPSS 17.0 software. Results A total of 768 villages were investigated including 192 villages in 4 counties from 2012 to 2015 and 576 villages in 24 counties from 2016 to 2017. A total of 105 555 residents were examined by ultrasound, of whom 67 (0.06%) were detected with hydatid disease, all infected with Echinococcus granulosus. The prevalence of cystic echinococcosis in the investigated population in 2012, 2016 and 2017 were 0.05% (4/7 512), 0.05% (32/61 110) and 0.08% (31/36 933), respectively. Among the different investigated countries, the prevalence > 0.10% was distributed in Heqing (0.19%, 7/3 779), Shilin (0.17%, 8/4 799), Zhaoyang (0.16%, 4/2 520), Dayao (0.12%, 4/3 378), Eryuan (0.11%, 11/9 738), Yunlong (0.11%, 5/4 465) and Jianchuan (0.11%, 5/4 595). The prevalence of cystic echinococcosis in males and females were 0.05% (23/46 179) and 0.07% (44/59 376), respectively (P > 0.05). The prevalence increased with age (χ² = 21.414, P < 0.05), with highest in group of 60-79 years old (0.12%, 26/22 724) followed by people with age over 80s (0.08%, 2/2 414). There was a significant difference in prevalence among the different occupations (χ² = 11.581, P < 0.05), with highest prevalence in farmers and herdsmen (0.08%, 64/82 978). As to the education level, the prevalence was highest in the people with illiteracy (0.11%, 26/22 724) with significant difference compared to people with higher educational levels (χ² = 16.307, P < 0.05). The overall dog coproantigen positive rate was 4.87% (965/19 812), The dog positive rate > 5% was located in Longyang District (8.41%), Shangri-La City (8.13%), Lushui County (7.21%), Eryuan County (7.50%), Fugong County (6.54%) and Muding County (5.18%), with statistical difference among different counties(χ² = 69.287, P < 0.05). From 2012-2017, the average dog coproantigen positive rates in these investigated sites was 1.24% (16/1 293), 13.41% (483/3 601), 5.10% (95/1 862), 3.01% (72/2 389), 1.56% (103/6 588) and 4.81% (196/4 079), respectively. The overall hydatid detection rate in livestock (sheep, cattle and pigs) was 0.12% （32/27 502）, with 1.49% (2/134) in 2015, 0.21% (8/3871) in 2016 and 0.10% (22/21 125) in 2017. The overall awareness rate for echinococcosis among the investigated population was 52.39% (9 974/19 039), 47.72% (607/1 272), 51.77% (789/1 524), 61.00% (549/900), 77.20% (772/1 000), 43.50% (5 075/11 668) and 81.57% (2 182/2 675) from 2012 to 2017, respectively. Conclusion Echinococcosis in Yunnan Province showed a low and medium prevalence, all of which were infected with E. granulosus. Farmers and herdsmen over 40 years old with low educational level had the highest infection rate.