我国棘球蚴病疾病负担分析

Analysis on disease burden of hydatid disease in China

目的了解棘球蚴病的伤残权重,推算我国棘球蚴病的疾病负担。方法于2016年12月-2017年3月,在甘肃、青海、四川、新疆等4个省(自治区)各选取1家棘球蚴病定点医院,调查1个月内的所有棘球蚴病住院病例;每个省(自治区)抽取2个棘球蚴病流行县,每个县抽取25例棘球蚴病病例,共计200例。根据《国际功能、伤残健康分类》和健康调查简表SF-36,编制棘球蚴病患者生命质量调查表,对患者的生存质量进行调查。分析棘球蚴病患者的生存质量和伤残权重,根据我国棘球蚴病的患病率、现患人数、不同严重程度的伤残权重和人口学资料,计算棘球蚴病的疾病负担,采用SPSS19.0统计学软件对患者的生存质量、疾病严重程度进行参数检验和非参数检验。结果从甘肃、青海、四川、新疆等4个省(自治区)分别收到调查问卷76、95、79、89份,共339份;有效问卷分别为76、91、79、88份,共334份,问卷有效回收率为98.53%(334/339)。男性占46.4%,女性占53.6%,平均年龄45.15(4～79)岁。细粒棘球蚴病病例占73.65%(246/334),多房棘球蚴病病例占24.85%(83/334),未分型病例占0.15%(5/334)。无症状、轻症、中症、重症、死亡病例分别占40.58%、40.88%、10.80%、5.26%、2.49%。棘球蚴病患者的平均生存质量评分为0.716,其中细粒棘球蚴病患者为0.735,多房棘球蚴病患者为0.661,两者差异有统计学意义(t=5.464,P<0.01)。男性患者生存质量评分为0.739,女性患者的为0.696,两者差异有统计学意义(t=2.986,P<0.01)。无症状、轻症、中症、重症、死亡的伤残权重分别为0.257、0.280、0.359、0.363和1.000,棘球蚴病平均伤残权重为0.302。人均伤残损失寿命年为1.864,其中细粒棘球蚴病患者为1.64年,多房棘球蚴病患者为2.55年,两者差异有统计学意义(t=6.669,P<0.01)。估算我国棘球蚴病的伤残损失寿命年为29.36万人年、减寿年数为2.88万人年,疾病负担为32.24万人年。结论棘球蚴病在我国的流行范围广,疾病负担重,对当地居民的危害不可忽视,亟需加大对该病的防治力度。

Objective To define the disability weight and estimate disease burden of hydatid disease in China. Methods A hospital on hydatid disease was selected in each of the four provinces（Autonomous region） of Gansu, Qinghai, Sichuan, and Xinjiang, from December, 2016 to March, 2017. All inpatients admitted within 1 month were surveyed in each hospital. Two counties with hydatid disease prevalence were selected from each province, and in each county 25 cases of hydatid disease were selected to reach a total of 200 cases. A questionnaire was compiled based on International Classification of Functioning, Disability and Health and the MOS 36 item short form health survey, SF-36, to examine the life quality and analyze disability weights of patients. The disease burden was calculated based on the prevalence, number of patients, disability weights and demography data. Results In Gansu, Qinghai, Sichuan, and Xinjiang Province（Autonomous region） , 76, 95, 79 and 89 questionnaires were received, of which 76, 91, 79, and 88 were valid questionnaires, with a recovery efficiency of 98.53%. Of these questionnaires, 46.4% were from males, and 53.6% from females, with an average age of 45.15 （4-79）. Of these patients, 73.65% （246/334） were cases of cystic echinococcosis （CE）, 24.85% （83/334） were alveolar echinococcosis（AE）, and 0.15%（5/334） were unclassified. The morbidity level of the disease was devided into asymptomatic, mild, medium, severe, and death, which accounted for 40.58%, 40.88%, 10.80%, 5.26% and 2.49%, respectively. The average quality score of patients was 0.716, CE being 0.735 and AE being 0.661 （t = 5.464, P 〈 0.01 CE vs. AE）. The life quality score was 0.739 in male, and 0.696 in female （t = 2.986, P 〈 0.01）. The disability weights of those asymptomatic, mild, medium, severe, and death cases were 0.257, 0.280, 0.359, 0.363 and 1, respectively, with an average of 0.302. The years lived with disability（YLDs） were 1.864 per patient. It was 1.864 for CE patients, for AE patients（t = 6.669, P 〈 0.01）. It was estimated that the disease burden of hydatid disease in China added up to 322.4 thousand disability adjusted life year（DALYs）, 293.4 thousand YLDs, 28.8 thousand years of life lost（YLLs）. Conclusion Echinococcosis is widely prevalent with a heavy disease burden and an enormous threat to the people’s health in the country.