我国疟疾输入再传播风险评估指标的定量分析研究

Quantitative analysis of risk assessment indicators for re⁃introduction of im⁃ported malaria in China

目的 定量分析我国疟疾输入再传播风险指标及其权重系数,以探讨我国现有疟疾输入再传播风险评估体系纳入的风险指标对疟疾输入再传播风险评估贡献程度的差异。方法 在PubMed、Web of Science、中国知网(CNKI)、万方数据库、中文科技期刊数据库(维普)等国内外数据库中,分别以“malaria”、“re-introduction/re-transmission/re-establishment”、“risk assessment/risk evaluation/risk prediction”和“疟疾”、“再传播/再流行/重新流行/再建”、“风险评估/风险预测”等为检索词,检索截至2023年8月3日收录的明确报告了我国疟疾输入再传播风险评估体系风险指标及其权重系数的研究文献。同时检索“Google Scholar”搜索引擎以确保检索全面性。2名研究者按照预先建立的信息提取表提取研究文献基本信息及疟疾输入再传播风险指标相关数据并交叉核对。采用R 4.2.1软件绘制南丁格尔玫瑰图,以展示我国疟疾输入再传播风险评估体系纳入的风险指标及其权重系数。以风险指标被评估体系纳入的频次和指标权重系数排序分析风险指标的重要程度;计算不同赋权方法所得指标权重系数的最大值与最小值的比值,比较不同赋权方法筛选指标的能力。结果 共检索到2 138篇文献,经去重、筛选后,最终纳入8篇文献进行分析。8篇文献累计报告了8项疟疾输入再传播风险评估体系和52项疟疾输入再传播风险指标,其中输入性疟疾病例数量、当地传疟蚊媒种类被纳入疟疾输入再传播风险评估体系的频次较高,均为8次;输入性疟原虫种类和当地传疟媒介种群密度均被纳入6次。将各风险评估体系纳入的风险指标权重系数排序发现,当地传疟蚊媒种类、输入性疟疾病例数量和输入性疟疾病例类型等3项指标的权重系数分别为6、5次和4次,在风险评估体系中排前3位。8篇文献报告的疟疾输入再传播风险指标赋权方法包括专家评分法、专家评分法和层次分析法组合赋权及专家评分法和熵权法组合赋权,其中专家评分法所得的风险指标权重最大值与最小值的比值为1.143~2.241;专家评分法和层次分析法组合赋权所得的风险指标权重最大值与最小值的比值为34.970~162.000。结论 我国现有疟疾输入再传播风险评估体系中,当地输入性疟疾病例数量、输入性疟原虫种类、当地传疟媒介种类和当地传疟媒介种群密度是疟疾输入再传播风险评估体系核心指标。专家评分法和层次分析法组合赋权较单独采用专家评分法在风险指标赋权方面效果更好。

Objective To quantitatively analyze the risk indicators of re⁃introduction of imported malaria in China and their weighting coefficients,so as to investigate the difference in the contribution of risk indicators included in the current risk assess⁃ment framework for re⁃introduction of imported malaria in China to the risk assessment of re⁃introduction of imported malaria.Methods Publications pertaining to the risk assessment framework for re⁃introduction of imported malaria in China that reported the risk indicators and their weighting coefficients were retrieved in PubMed,Web of Science,CNKI,Wanfang Data,and VIP with terms of“malaria”,“re⁃introduction/re⁃transmission/re⁃establishment”,“risk assessment/risk evaluation/risk prediction”from the inception of the database through 3 August 2023,and literature search was performed in Google Scholar to ensure the comprehensiveness of the retrieval.Basic characteristics of included studies were extracted using pre⁃designed information ex⁃traction forms by two investigators,and data pertaining to risk indicators of re⁃introduction of imported malaria were cross⁃checked by these two investigators.The risk indicators included in the risk assessment framework for re⁃introduction of imported malaria in China and their weighting coefficients were visualized with the Nightingale’s rose diagrams using the software R 4.2.1,and the importance of risk indictors was evaluated with the frequency of risk indicators included in the risk assessment frame⁃work and the ranking of weighting coefficients of risk indicators.In addition,the capability of risk indicators screened by differ⁃ent weighting methods was compared by calculating the ratio of the maximum to the minimum of the weighting coefficients of the risk indicators screened by different weighting methods.Results A total of 2138 publications were retrieved,and following re⁃moval of duplications and screening,a total of 8 publications were included in the final analysis.In these 8 studies,8 risk assess⁃ment frameworks for re⁃introduction of imported malaria in China and 52 risk indicators of re⁃introduction of imported malaria were reported,in which number of imported malaria cases(n=8)and species of malaria vectors were more frequently included in the risk assessment frameworks(n=8),followed by species of imported malaria parasites(n=6)and population density of local malaria vectors(n=6),and species of local malaria vectors(n=6),number of imported malaria cases(n=5)and species of im⁃ported malaria parasites had the three highest weighting coefficients(n=4).The weighting methods included expert scoring meth⁃od,combination of expert scoring method and analytic hierarchy process,and combination of expert scoring method and entropy weight method in these 8 studies,and the ratios of the maximum to the minimum of the weighting coefficients of the risk indica⁃tors screened by the expert scoring method were 1.143 to 2.241,while the ratios of the maximum to the minimum of the weighting coefficients of the risk indicators screened by combination of the expert scoring method and analytic hierarchy process were 34.970 to 162.000.Conclusions Number of imported malaria cases,species of imported malaria parasites,species of local ma⁃laria vectors and population density of local malaria vectors are core indicators in the current risk assessment framework for re⁃in⁃troduction of imported malaria in China.Combination of the expert scoring method and analytic hierarchy process is superior to the expert scoring method alone for weighting the risk indicators.