2005-2014年西安市肾综合征出血热流行特征分析

Epidemic characteristics and tendency prediction of hemorrhagic fever with renal syndrome from 2005 to 2014 in Xi＆#39;an

目的 分析2005-2014年西安市肾综合征出血热（HFRS）流行特征及变化趋势,掌握其流行及发展规律,探讨有效防控措施.方法 收集2005-2014年西安市HFRS疫情的发病情况及人口年龄、性别、职业等基础资料,利用描述流行病学方法描述HFRS的三间分布;对资料进行统计分析,建立差分自回归移动平均模型（ARIMA）,进行2015年HFRS病例数的预测.结果 2005-2014年西安市共报告HFRS患者8 500例,年平均发病率为10.60/10万,发病率呈现先升高后降低的趋势,由2005年的9.06/10万上升到2010年的19.46/10万,之后下降到2014年的3.43/10万;每年发病均为双峰型,秋冬季高峰占全部病例的72.91％（6197/8 500）,春季高峰占全部病例的15.85％（1 347/8 500）;15～59岁为主要发病人群,发病率为11.36/10万,占全部病例的77.71％（6 605/8 500）,＜15、15～ 59和＞59岁组人群发病率比较差异无统计学意义（x2=15.63,P＞0.05）;男、女发病人数比为3.01：1.00,男性发病率为15.57/10万,女性发病率为5.41/10万,性别比较差异有统计学意义（x2=1 948.84,P＜0.05）;职业以农民为主,占总病例数的66.04％（5 613/8 500）;西安市长安区、周至县、户县、临潼区10年累计发病率均高于全市发病率,分别为31.07/10万、22.74/10万、21.09/10万、11.06/10万,属于西安市发病率最高的地区;利用ARIMA（1,1,0）×（0,1,1）12模型对2005-2014年西安市HFRS各月发病数进行拟合,预测西安市2015年发病数为235例,较2014年（295例）有所下降.结论 西安市HFRS疫情总体呈现持续平稳下降趋势,但下降缓慢,应采取积极有效的综合措施,加以干预,使HFRS发病维持在一个较低水平.

Objective To analyze the epidemiologic characteristics and tendency of hemorrhagic fever with renal syndrome （HFRS） in Xi＇an from 2005 to 2014,and to grasp the epidemic regularity and predict the trend of HFRS for establishing effective prevention and control measures.Methods The descriptive epidemiological method was used to analyze the epidemic situation of HFRS in Xi＇an from 2005 to 2014.The autoregressive integrated moving average （ARIMA） model was applied to analyze,fit and predict the epidemic data of 2015.Results There were 8 500 HFRS patients in Xi＇an from 2005 to 2014,the incidence rate was 10.60/100 000.The morbidity increased at first and then decreased from 2005 to 2014;the incidence rate was 9.06/100 000 in 2005 and up to 19.46/100 000 in 2010,then down to 3.43/100 000 in 2014.More cases were reported in spring （15.85%,1 347/8 500） and autumn-winter seasons （72.91%,6 197/8 500）.The high-risk age group of HFRS was between 15 to 59 years,accounting for 77.71% （6 605/8 500） of the overall incidence rate;there were no significant differences in 〈 15 years,15 to 59 years and 〉 59 years groups （x2 =15.63,P 〉 0.05）.The male to female ratio was 3.01 ∶ 1.00,male incidence was 15.57/100 000 and female incidence rate was 5.41/100 000,and the difference was statistically significant between gender （x2 =1 948.84,P 〈 0.05）.The main occupation was farmers,accounting for 66.04% （5 613/8 500） of the overall incidence rate.The top 4 districts were Chang＇an,Zhouzhi,Huxian and Lintong;the incidence rate was 31.07/100 000,22.74/100 000,21.09/100 000 and 11.06/100 000,respectively,and the 10 years cumulative incidence rate was higher than the total incidence.The monthly incidence was predicted with ARIMA （1,1,0） × （0,1,1）12 models in Xi＇an from 2005 to 2014,and the predicted number of cases was 235 in 2015 （lower than 2014）.Conclusions The overall trend of the epidemic has continued to fall but slowly.Positive and effective comprehensive measures should be taken to maintain the incidence of hemorrhagic fever at a lower level.