云南省宾川县片形吸虫病人群流行病学调查及危险因素分析

Epidemiological investigation on fascioliasis and its risk factors in population of Binchuan County,Yunnan Province

目的了解云南省宾川县人群片形吸虫感染情况及相关危险因素。方法 2014年2-3月,选择宾川县州城镇2个行政村的6个自然村作为调查点,对≥5岁的常住人口采用ELISA法进行血清抗体检测,采用Kato-Katz法和尼龙绢集卵孵化法对血检阳性者进行粪便虫卵检查。对筛检出的片形吸虫病病例进行个案调查,同时选择同村性别相同、年龄相近的血检阴性者作为对照,按1∶2进行匹配,开展病例对照研究,以探索片形吸虫感染的危险因素。结果共血检1207人,36人阳性,人群片形吸虫血清抗体总阳性率为2.98%;不同性别及年龄组人群血检阳性率差异均无统计学意义(χ2=1.686、7.106,P均>0.05);但不同行政村及自然村人群感染率差异均有统计学意义(χ2=4.103、13.181,P均<0.05)。血检阳性者中有2例粪检阳性,其中1例为新病例,粪检阳性率为6.45%(2/31)。病例对照研究表明,食用外购凉拌菜(4.30)、生薄荷(1.22)、生韭菜(4.30)和饮生水史(3.75)OR值较高,但均无统计学意义(χ2=0.524、0.046、0.524、1.571,P均>0.05)。结论宾川州城地区片形吸虫感染仍然存在,呈散发状态。进食被片形吸虫囊蚴污染的生蔬菜和生水可能是当地人群片形吸虫感染途径,寻找到确切入口途径是控制感染的关键。

Objective To understand the infection status of Fasciola and related risk factors in population of Binchuan County,Yunnan Province. Methods In February and March,2014,6 natural villages from 2 administrative villages in Zhoucheng Town were selected as investigated sites,and the permanent residents aged ≥ 5 years were examined by ELISA for the serum antibody detection,and then the positive ones were examined by Kato-Katz technique and the hatching method for Fasciola egg detection. Meanwhile,the fascioliasis cases that checked out by the above methods were further surveyed,and the residents who with the same gender,similar age and negative results in the blood examination were selected as the controls,then the risk factors were explored through a case control study. Results Totally 1 207 people were included in the blood examination,and 36 positives were found with a positive rate of 2.98%. Though the differences between the positive rates of the serum antibody in people with different genders and age were not statistically significant（ χ2 = 1.686,7.106,both P〉0.05）,those between the rates of people in different administrative villages and natural villages were statistically significant（ χ^2 = 4.103,13.181,both P〈0.05）. Two cases were determined as positives in fecal examinations with a positive rate of 6.45%（2/31）,among which,1 case was newly discovered. The case control study showed that OR values of eating out-purchased cold dish（4.30）,raw mint（1.22）,raw leek（4.30）and drinking unboiled water（3.75）were relatively higher,but all of them were not statistically significant（ χ^2 = 0.524,0.046,0.524,1.571,all P〈0.05）. Conclusions There is still sporadic Fasciola infection in Binchuan County. Eating raw vegetables and drinking unboiled water which are contaminated by Fasciola metacercariae may be the infection routes of local people,and to find out the exact entrance way is the key points for the infection control.