山南市棘球蚴病流行现状调查

Prevalence of echinococcosis in Shannan City

目的了解西藏自治区山南市棘球蚴病流行现状。方法于2016年8-10月采用分层整群抽样方法,抽取山南市浪卡子、隆子、错那、扎囊、贡嘎、乃东、琼结、加查、桑日、曲松、洛扎等11个县(区)的调查村,每村抽取200名1岁以上常住居民进行B超检查,计算人群棘球蚴病检出率。采用内脏剖检法调查家畜棘球蚴感染情况。采集家犬粪样,ELISA检测犬粪棘球绦虫抗原情况。每个调查村随机抽取20名居民,每个县抽1所县小学的4～6年级学生(每个年级不少于50名),进行棘球蚴病防治知识调查。结果B超共调查10 287人,人群棘球蚴病检出率为1.00%(103/10 287),以细粒棘球蚴病为主(100例,占97.09%)。11个县(区)均有棘球蚴病流行,检出率较高的为浪卡子县、隆子县和错那县,分别为2.03%(17/836)、1.81%(15/830)、1.43%(12/839),最低的为洛扎县,为0.11%(1/931);不同县(区)棘球蚴病检出率差异有统计学意义(χ~2=34.08,P<0.05)。男性棘球蚴病检出率为0.84%(31/3 683),女性检出率为1.09%(72/6 604),两者差异无统计学意义(χ~2=1.47,P>0.05)。不同年龄组中,以≥60和45～59岁组人群棘球蚴病检出率较高,分别为1.76%(30/1 708)和1.32%(44/3 333);人群棘球蚴病检出率随着年龄的增长而升高(χ~2趋势=25.64,P<0.01)。不同职业人群中,以牧民、农民和半农半牧民的棘球蚴病检出率较高,分别为1.81%(17/937)、1.04%(64/6 155)和1.03%(18/1 740);不同职业人群棘球蚴病检出率间差异有统计学意义(χ~2=20.73,P<0.05)。不同文化程度人群中,以文盲人群的棘球蚴病检出率最高,为1.26%(63/5 009);人群棘球蚴病检出率随文化程度增高呈降低的趋势(χ~2趋势=7.63,P<0.05)。不同生产类型地区人群中,以牧区人群的棘球蚴病检出率最高,为1.19%(20/1 682);不同生产类型人群棘球蚴病检出率差异无统计学意义(χ~2=0.85,P>0.05)。本次共检查家畜307头,棘球蚴感染检出率为11.40%(35/307),其中曲松县的感染检出率最高,为85.00%(34/40);不同地区家畜的棘球蚴感染检出率差异有统计学意义(χ~2=175.409,P<0.01)。共采集犬粪932份,犬粪棘球绦虫抗原阳性率为6.87%(64/932)。其中,浪卡子县的犬粪棘球绦虫抗原阳性率最高,为27.50%(22/80),错那县和隆子县次之,分别为13.75%(11/80)和7.50%(6/80);不同县(区)犬粪抗原阳性率间差异有统计学意义(χ~2=61.41,P<0.01)。人群棘球蚴病防治知识和行为合格率为51.63%(1 343/2 601),不同县(区)人群棘球蚴病认知合格率以桑日县和曲松县较高,分别为97.83%(225/230)和91.34%(211/231);错那县和浪卡子县合格率较低,分别为10.24%(17/166)和18.55%(41/221);不同县(区)合格率差异有统计学意义(χ~2=605.52,P<0.05)。结论山南市浪卡子县、隆子县、错那县人群棘球蚴病检出率和犬粪棘球绦虫抗原阳性率较高、棘球蚴病防治知识认知合格率较低,应作为棘球蚴病重点防治地区。

Objective To investigate the prevalence of echinococcosis in Shannan City of Tibet Autonomous Region. Methods Villages were selected using stratified cluster sampling method from the counties of Langkazi, Longzi, Cuona, Zhanang, Gonggar, Qiongjie, Gacha, Sangri, Qusong, Luozha and Naidong District in Shannan City, from August to October, 2016. In each village, 200 residents aged 〉 1 year were selected for B ultrasound examination to calculate the prevalence of hydatid disease among the populations. Visceral necropsy was performed in livestock to investigate the status of hydatid infection. Feces from home-raised dogs were collected to examine Echinococcus antigen using ELISA method. Knowledge on echinococcosis control was surveyed in 20 randomly-selected residents in each village and no less than 50 students of each grade of grades 4-6 in a selected primary school in each county. Results Among the 10 287 persons receiving B ultrasound examination, 103 were detected to have hydatid cysts （1.00%）, dominated by Echinococcus granulosus （97.09%）. The 11 counties（districts） were all found with cases of hydatid disease, of which Langkazi County, Longzi County, and Cuona County had a high prevalence of 2.03% （17/836）, 1.81% （15/830）, and 1.43% （12/839）, respectively, while Luozha County had the lowest prevalence of 0.11% （1/931）. There was a significant difference in prevalence among the 11 counties/districts. There was no significant difference between males （0.84%, 31/3 683） and females （1.09%, 72/6 604） （χ2 = 1.47, P 〉 0.05）. The detection rate elevated with increased age （χ2trend = 25.64, P 〈 0.01）, being highest in the population groups of ≥ 60 years （1.76%, 30/1 708） and 45-59 years （1.32%, 44/3 333）, and was significantly different among occupations （χ2 = 20.73, P 〈 0.05）, being highest in herdsmen （1.81%, 17/937）, farmers （1.04%, 64/6 155）, and semi-herdsman-and-farmers （1.03%, 18/1 740）. The prevalence showed a trend of decrease with higher educational level （χ2trend = 7.63, P 〈 0.05）, being highest in those illiterates （1.26%, 63/5 009）. The prevalence of hydatid disease was highest in pastoral area （1.19%, 20/1 682）; there was no significant difference in the prevalence of hydatid disease among populations with different types of production （χ2 = 0.85, P 〉 0.05）. Among the 307 livestock examined, the prevalence of hydatid disease was 11.40% （35/307）. There was a significant difference in livestock prevalence among the 11 counties（districts） （χ2 = 175.409, P 〈 0.01）, with Qusong County having the highest prevalence. Among the 932 fecal samples collected, the positive rate of Echinococcus antigen was 6.87% （64/932）, with Langkazi County having the highest positive rate （27.50%, 22/80）, followed by Cuona County （13.75%, 11/80）and Longzi County （7.50%, 6/80）[χ2 = 61.41, P 〈 0.01, among the 11 counties（districts）]. The overall qualified rate on knowledge of echinococcosis control was 51.63% （1 343/2 601） in the residents. It was better in Sangri County （97.83%, 225/230） and Qusong County （91.34%, 211/231）, and poor in Cuona County （10.24%, 17/166） and Langkazi County （18.55%, 41/221） [χ2 = 605.52, P 〈 0.05, among the 11 counties（districts）]. Conclusion There is a high prevalence of hydatid disease in human populations, a high positive rate of Echinococcus antigen in dog feces, and poor knowledge on echinococcosis control in some counties of Shannan City, Tibet.