2012年青海省玉树藏族自治州棘球蚴病流行调查

An Epidemiological Survey on Echinococcosis in Yushu Prefecture of Qinghai Province

目的 了解2012年青海省玉树藏族自治州棘球蚴病的流行情况。 方法 2012年6-8月在青海省玉树藏族自治州称多县、囊谦县、曲麻莱县、玉树县、杂多县和治多县等6县各抽取2～3个镇，对1岁以上常住居民进行B超检查，调查人群患病情况。ELISA检测人血清棘球蚴抗体。内脏剖检法调查鼠类和牲畜的棘球蚴感染情况；现场随机采集无主犬犬粪，ELISA检测犬粪棘球蚴抗原。 结果 B超检查共7 025人，查出棘球蚴病患者319例，患病率为4.54%。ELISA检测共2 790人，血清棘球蚴抗体阳性率为16.38%（457/2 790）。其中，人群患病率以称多县最高，为7.41%（181/2 444），血清抗体阳性率以玉树县最高，为23.18%（127/548）。男性患病率和血清抗体阳性率分别为3.91%（118/3 018）和13.93%（172/1 235），女性分别为5.02%（201/4 007）和18.33%（285/1 555）。年龄分布以60～岁和40～岁人群的患病率较高，分别为8.39%（38/453）和6.61%（67/1 014），70岁以上人群的血清抗体阳性率最高，为33.93%（19/56）。不同职业中，牧民、半农半牧和宗教人士的患病率较高，分别为5.28%（252/4 777）、6.52%（24/368）和3.37%（11/326），血清抗体阳性率以儿童、宗教人士和牧民较高，分别为24%（6/25）、18.79%（31/165）和18.34%（328/1 788）。不同文化程度中，文盲人群的患病率和血清抗体阳性率均最高，分别为5.04%（241/4 779）和18.34%（359/1 958）。不同居住方式中，冬季定居夏季游牧人群的患病率和血清抗体阳性率均最高，分别为8.25%（227/2 753）和19.48%（158/811）。不同地区、性别、年龄、职业、文化程度、居住方式间的患病率和血清抗体阳性率差异均有统计学意义（P〈0.05或P〈0.01）。共检查鼠类872只，棘球蚴检出率为0.46%（4/872）。共检查牛、羊809只，棘球蚴检出率为10.14%（82/809）。采集无主犬犬粪共838份，棘球蚴粪抗原阳性率为10.74%（90/838）。 结论 玉树州人群棘球蚴病患病率和血清棘球蚴抗体阳性率较高，牛、羊棘球蚴检出率和无主犬棘球蚴粪抗原阳性率较高。

Objective To investigate the prevalence of echinococcosis in Yushu Prefecture of Qinghai Province in 2012. Methods Two to three towns were selected in each of Chengduo, Nangqian, Qu malai, Yushu, Zaduo and Zhiduo Counties from June to August in 2012. Ultrasound examination was conducted for residents aged over 1 year, and ELISA was performed to detect serum antibody against Echinococcus. Visceral dissection was performed to detect hydatid infection in rodents and livestock. ELISA was used to detect Echinococcus antigen in collected dog feces. Results A total of 7 025 residents received ultrasound examination, of whom 319 showed hydatid cysts with a morbidity rate of 4.54%. ELISA showed a serum antibody positive rate of 16.38% （457/2 790）. The mobidity of hydatid disease was highest in Chengduo County （7.41%, 181/2 444）, and the rate of serum antibody was highest in Yushu County （23.18%, 127/548）. The morbidity and serum antibody in males were 3.91% （118/3 018） and 13.93% （172/1 235） respectively, and those in females were 5.02% （201/4 007） and 18.33% （285/1 555）. In terms of age distribution, the morbidity was relatively higher in residents of 60- （8.39%, 38/453） and 40- years （6.61%, 67/1 014）; and the rate of serum antibody was highest in residents over 70 years （33.93%, 19/56）. In terms of occupation, the morbidity was relatively higher in herdsmen （5.28%, 252/4 777）, Herdsmen-peasants （6.52%, 24/368）, and religious workers（3.37%, 11/326）, while the rate of serum antibody was relatively higher in children（24%, 6/25）, religious workers （18.79%, 31/165） and herdsmen（18.34%, 328/1 788）. In terms of education level, the morbidity and the rate of serum antibody were both highest in the uneducated（5.04%, 41/4 779; 18.34%, 359/1 958, respectively）. In terms of residential pattern, the morbidity and the rate of serum antibody were both highest in those who were settled in winter and nomadic in summer （8.25%, 227/2 753; 19.48%, 158/811, respectively）. There were significant differences in the morbidity and the rate of serum antibody in aspects of residential region, sex, age, occupation, education level and residential pattern（P〈0.05 or P〈0.01）. In 872 rodents detected, the Echinococcus hydatid rate was 0.46% （4/872）, while in 809 cattle and sheep detected, the Echinococcus hydatid rate was 10.14% （82/809）. The fecal antigen positive rate in 838 samples of dog feces was 10.74%（90/838）. Conclusion It shows a high morbidity of hydatid diesease and serum antibody positive rate in residents, a high Echinococcus hydatid rate in cattle and sheep, and a high fecal antigen positive rate in dogs in Yushu Prefecture.