甘肃省藏区人群棘球蚴病流行现状调查及分析

An epidemiological survey on hydatid disease in Tibetan autonomous areas of Gansu Province

目的了解甘肃省10个藏区县人群棘球蚴病流行情况。方法 2011年9月-2012年6月在甘肃省10个藏族自治州(县)进行分层随机抽样,每县共抽取16个行政村。采用B超扫描的方法,开展人群棘球蚴病流行情况调查。应用SPSS 20.0软件对调查结果进行描述和统计学分析,患病检出率比较采用χ~2检验。结果共抽样检查37 815人,所有调查点均发现棘球蚴病例;以县为单位的人群患病检出率为0.05%~1.59%,平均0.59%(224/37 815);患病检出率大于1%的县分别为夏河县1.59%(64/4 019)、玛曲县1.37%(44/3 206)、肃南县1.20%(60/5 000)。总人群男性患病检出率为0.53%(108/20 276)、女性患病检出率为0.66%(116/17 539),两者间差异无统计学意义(χ~2=2.647,P>0.05),但藏族女性(0.71%,93/13 146)和男性(0.46%,73/15 709)患病检出率间差异有统计学意义(χ~2=7.372,P<0.05)。不同年龄组间患病检出率差异有统计学意义(χ~2=109.346,P<0.05),其中20~岁组最低,为0.28%(19/6 687),80~岁组最高,为2.41%(4/166),患病检出率曲线随年龄增长呈现增高趋势。不同民族间患病检出率差异无统计学意义(χ~2=1.710,P>0.05),回族患病检出率最高,为0.92%(5/546)。不同职业人群间患病检出率差异有统计学意义(χ~2=33.345,P<0.05),其中商人患病检出率最高,为3.32%(2/62)。共发现细粒棘球蚴病223例,多房棘球蚴病1例,无混合感染病例。其中单脏器寄生占98.21%(220/224);累及肝脏占94.76%(217/229);单包囊占81.70%(183/224);60岁及以上年龄组中多包囊比例(28.57%,22/77)高于60岁以下组(12.93%,19/147),两者间差异有统计学意义(χ~2=8.273,P<0.05)。结论甘肃省10个藏区县存在不同程度的细粒棘球蚴病流行,其中夏河县、玛曲县、肃南县流行严重。藏族女性、60岁以上者、商人是该病的重点干预人群。

Objective To investigate the prevalence of echinococcosis in 10 Tibetan autonomous prefectures（counties） of Gansu Province. Methods Stratified random sampling was carried out from September 2011 to June 2012, 16 villages for each. The subjects were examined by B ultrasonography. Statistics were performed using the SPSS 20.0 software. Data of prevalence were analyzed with χ2 test. Results A total of 37 815 residents were examined, and echinococcosis was found in all the surveyed sites with an average county-level prevalence rate of 0.59%（224/37 815） （0.05%-1.59%）. The counties with prevalence of over 1% were Xiahe（1.59%, 64/4 019）, Maqu（1.37%, 44/3 206） and Sunan（1.20%, 60/5 000）. In the overall populations, the prevalence in males and females was 0.53%（108/2 0276） and 0.66%（116/17 539） respectively（χ2 = 2.647, P 〉 0.05）, while in the Tibetan ethnic population, the prevalence showed a considerable difference（0.71% in females versus 0.46% in males, P 〈 0.05）. There was also a significant difference by age（χ2 = 109.346, P 〈 0.05）, with the lowest prevalence in the group of 20-30 years old（0.28%, 19/6 687）, and highest in the group of 〉 80 years old（2.41%, 4/166）. Overall, the prevalence showed a trend of increase with ageing. There was no significant difference in prevalence among ethnicities（χ2 = 1.710, P 〉 0.05） though the Hui ethnicity seemed higher（0.92%, 5/546）. The prevalence varied significantly among residents with different occupations（χ2 = 33.345, P 〈 0.05）, with businessmen ranking first（3.32%, 2/62）. In this study, we identified 223 cystic echinococcosis cases and a case of alveolar echinococcosis. No mixed infection was found. Single-organ infection accounted for 98.21%, with a liver dominance（94.76%, 217/229）. The single cyst type accounted for 81.75% （183/224）. The proportion of multi-cyst type was higher in residents 〉 60 years old（28.57%, 22/77） than in those 〈 60 years old（12.93%, 19/147） （χ2 = 8.273, P〈 0.05）. Conclusions Cystic echinococcosis is present in all the counties surveyed, particularly in counties of Xiahe, Maqu and Sunan. Target populations are mainly females of Tibetan ethnicity, residents aged over 60 years, and merchants.