苏州市晚期血吸虫病患者流行病学特征分析

Epidemiological characteristics of current advanced schistosomiasis cases in Suzhou

目的掌握苏州市晚期血吸虫病(晚血)患者现状,为科学管理、优化救助、改善患者生活质量提供依据。方法对全市所有晚血患者进行问卷调查、体格检查和B超检查,根据《血吸虫病防治手册》进行确诊分型,并对其进行流行病学特征分析。结果苏州市晚血患者2420人,其分布与各市(区)历史累计有螺面积和历史累计查出血吸虫病患者数呈高度相关(r=0.949、0.946,P均<0.001)。所有患者中男性845人(34.92%),女性1575人(65.08%),不同市(区)患者的性别分布差异有统计学意义(χ^(2)=26.591,P<0.001)。患者平均年龄(76.80±7.55)岁,女性患者平均年龄高于男性患者(F=72.01,P<0.001)。晚血类型以巨脾型(2165人,89.42%)为主。所有患者病情分类中痊愈895人(36.98%),好转1337人(55.25%),未愈188人(7.77%),不同晚血类型的患者病情情况不同(χ^(2)=226.034,P<0.001),其中腹水型患者最差。所有患者中有1438例(59.42%)劳动能力减弱,540例(22.31%)丧失,仅442例(18.26%)正常。年龄增长(β=0.012,P<0.001)、临床分型为腹水型(β=0.346,P<0.001)和病情尚需治疗(β=0.298,P<0.001)为晚血患者劳动能力丧失的危险因素,病情稳定(β=-0.089,P=0.001)为保护因素。结论苏州市晚血救助工作当以历史重流行区为重点,加强老龄患者的护理关怀,重视腹水型患者的生存质量;此外亦要重视巨脾型患者的随访护理,以免转为腹水型。

Objective To understand the current situation of patients with advanced schistosomiasis in Suzhou,and to provide a basis for scientific management,medical assistance,and improvement of patients′quality of life.Methods Questionnaire survey,physical examination and B-ultrasound examination were performed on the registered patients with advanced schistosomiasis.The diagnosis and classification were carried out according to the"Schistosomiasis Control Manual".The epidemiological and clinical characteristics,disease classification,and medical and financial assistance of all existing patients were analyzed.Results There were 2420 cases of advanced schistosomiasis in Suzhou.Their distribution was highly correlated with the cumulative area of oncomelania snails and the cumulative number of schistosomiasis patients in each district(county)(r=0.949,P<0.01;r=0.946,P<0.01).There were 845 males and 1575 females.The highest proportion of male patients was found in Suzhou Industrial Park and the lowest in Kunshan(χ^(2)=26.591,P<0.001).The average age of patients was(76.80±7.55)years old,and the age of female patients were higher that of male patients(F=72.01,P<0.001).The splenomegaly type was the most common(2165),ascites type was the second(198),colonic proliferative type was the third(55),and pygmy type was the least(2).A total of 895 patients were cured and 1337 patients were improved,while 188 patients were not cured.The condition of advanced schistosomiasis patients with different clinical types was different(χ^(2)=226.034,P<0.001),and the condition of patients with ascites was the worst.1438 patients′labor level was reduced,and 540 patients lost their labor ability,while only 442 patients were normal.Age increase(β=0.012,P<0.001),clinical classification being ascites type(β=0.346,P<0.001)and need for treatment(β=0.298,P<0.001)were risk factors for the loss of labor ability in patients with late schistosomiasis.The stable condition of the disease(β=-0.089,P=0.001)was a protective factor.Conclusion There are a large number of advanced schistosomiasis cases in Suzhou,and the epidemiological characteristics of advanced schistosomiasis patients in different districts(cities)are different.The relief work of advanced schistosomiasis in Suzhou should focus on the historical heavy epidemic areas,strengthen the nursing care of the elderly patients,and pay attention to the quality of life of patients with ascites.It is also important to strengthen the follow-up nursing of patients with splenomegaly to avoid turning into ascites.All districts and counties should be guided by the characteristics of local patients and formulate targeted scientific management methods and rescue policies to improve the quality of life of patients.