目的 分析血吸虫病传播控制后鄱阳湖区居民血清抗体水平现状,探索科学的血清抗体阳性者管理模式,为开展精准防治提供参考。 方法 于2016-2018年对江西省新建区2个重点流行乡南矶乡（向阳村、朝阳村、红卫村）和昌邑乡（昌北村、曹会村）6岁以上常住居民采用间接血凝试验法（IHA）开展血吸虫血清抗体水平检测。302名血吸虫抗体阳性者通过简单随机分组法分为联合组（吡喹酮化疗 + 健康教育）、化疗组（吡喹酮化疗）和健教组（健康教育）3组,连续3年观察不同组别间的血清抗体转阴率,并比较血清抗体平均滴度的差异。每年同步对各组进行1次问卷调查,比较血清抗体阳性者血防知识正确率和血防行为正确率的差异。 结果 调查对象以男性为主,年龄主要分布在40岁以上,文化程度以小学和初中为主,职业多为农民或渔船民。2017年联合组、化疗组和健教组的血清抗体转阴率分别为38.1%（37/97）、33.7%（32/95）、40.0%（38/95）,差异无统计学意义（P > 0.05）;2018年各组的血清抗体转阴率分别为47.9%（45/94）、45.3%（43/95）、51.7%（45/87）,差异无统计学意义（P > 0.05）。2017年联合组、化疗组和健教组的血清抗体平均滴度分别为1 : 22.5、1 : 26.6、1 : 29.9,差异有统计学意义（P < 0.05）;2018年各组的血清抗体平均滴度分别为1 : 24.0、1 : 18.7、1 : 25.6,差异有统计学意义（P < 0.05）。2016年联合组、化疗组和健教组的血防知识正确率分别为84.0%（79/94）、87.5%（84/96）、88.6%（78/88）,差异无统计学意义（P > 0.05）;2017年各组的血防知识正确率分别为85.9%（85/99）、90.7%（88/96）、90.2%（83/92）,差异无统计学意义（P > 0.05）;2018年各组的血防知识正确率均为100.0%。2016年联合组、化疗组和健教组的血防行为正确率分别为31.9%（30/94）、22.9%（22/96）、22.7%（20/88）,差异无统计学意义（P > 0.05）;2017年各组的血防行为正确率分别为42.4%（42/99）、44.8%（43/96）、45.7%（42/92）,差异无统计学意义（P > 0.05）;2018年各组的血防行为正确率分别为63.4%（64/101）、65.7%（65/99）、66.3%（65/98）,差异无统计学意义（P > 0.05）。 结论 血吸虫病传播控制地区宜采用健康教育方式,在提高居民血防知识及行为意识的同时,可减少药物用量,节约成本,有利于实现对血清抗体阳性者的个案管理,使血吸虫病防治更加精准。

Objective To determine the anti-Schistosoma antibody level in residents around endemic Poyang Lake after transmission of schistomosiasis has been controlled and the scientific management model for people with antibody-positive, so as to provide reference for precise prevention and control of schistosomiasis in areas with transmission controlled. Methods Two major schistosomiasis endemic townships: Nanji Township(including Xiangyang, Chaoyang and Hongwei Villages) and Changyi Township (including Changbei and Caohui Villages), were selected as the research sites. The sera were collected from residents in these villages with age over 6 years old and the indirect hemagglutination assay (IHA) was used to detect the anti-Schistosoma antibody in the sera. The identified 302 residents with antibody positive were randomly divided into three groups, praziquantel chemotherapy plus health education (joint intervention group), praziquantel chemotherapy only (chemotherapy group), health education only (education group). The antibody titers were examined annually for consecutive three years among these people from 2016 to 2018. Their knowledge, awareness and attitude towards schistosomiasis control was investigated by a questionnaire annually. Results The survey subjects were male, mainly over 40 years old, with primary and junior high school education, mostly farmers or fishermen. In 2017, there were 38.1% (37/97), 33.7% (32/95) and 40.0% (38/95) people with antibody converted to negative for joint intervention group, chemotherapy group and education group, respectively, without significant difference between groups (P > 0.05). The average titers of antibody in joint intervention group, chemotherapy group and education group in 2017 were 1 : 22.5, 1 : 26.6 and 1 : 29.9, respectively, with significant difference between the groups (P < 0.05). In 2018, the average titers of antibody in joint intervention group, chemotherapy group and education group were 1 : 24.0, 1 : 18.7 and 1 : 25.6, respectively, with significant difference between groups (P < 0.05), with 47.9% (45/94), 45.3% (43/95) and 51.7% (43/95) people with antibody converted to negative, respectively, without significant difference between groups (P > 0.05). The correct rate for the knowledge about schistosomiasis control in joint intervention group, chemotherapy group and education group increased year by year, from 84.0% (79/94), 87.5% (84/96), 88.6% (78/88) in 2016 to 85.9% (85/99), 90.7% (88/96), 90.2% (83/92) in 2017, and then all groups reached to 100%, respectively, without significant difference between groups in the same year (P > 0.05). The correct rate for schistosomiasis control behavior in joint intervention group, chemotherapy group and education group have increased from 31.9% (30/94), 22.9% (22/96), 22.7% (20/88) in 2016, to 42.4% (42/99), 44.8% (43/96), 45.7% (42/92) in 2017, and to 63.4% (64/101), 65.7% (65/99), 66.3% (65/98) in 2018, respectively, without significant between groups though (P > 0.05). Conclusion To better manage the antibody positive people in the endemic areas, the health education is important to improve the knowledge and behavior in people living in endemic areas to prevent the infection of S. japanicum, as a supplement for chemotherapy with praziquantel.