陕西省韩城市黑热病流行特征及高危因素分析

目的 了解韩城市黑热病流行病学特征及高危因素,为进一步开展流行病学调查奠定基础。方法 对韩城市历史数据进行描述,回访调查2012-2016年报告病例发病诊治经过,按照1∶4匹配的病例对照研究方法,对生活行为习惯和居住环境等因素进行问卷调查,数据用Excel 2007、R软件描述分析。结果 韩城市1953-2016年共报告病例599例,死亡9例,年平均发病率为14.61/10万,病死率为1.50%;2012年至2016年报告病例18例,死亡2例,发病高峰期是5-9月, 占报告病例数的72.22%;病例大部分分布在北部山区;农民发病较多,男性发病高于女性,成人多于儿童;病例主要症状体征为发热、脾大;利用COX回归分析患病因素,养犬OR值为4.618,95%CI为1.519~14.039,P<0.05,病例组与对照组间存在统计学差异,其余因素病例组与对照组不存在统计学差异。结论 韩城市为黑热病历史疫区, 2012年至2016年报告病例呈点状分布,家中养犬是患病的危险因素,综合分析韩城市可能为山丘型或人犬共患型黑热病流行区。

Characteristics and risk factors of the kala-azar in Hancheng City,Shaanxi Province,China

To investigate the epidemiological status of kala-azar in the city of Hancheng, the epidemiological features and high risk factors were studied in this paper. The initial data based on the reported cases of kala-azar in Hancheng from 2012 to 2016 were collected and described, and then questionnaire survey on the life habits and living environment of the reported patients was performed according to 1∶4 matched case-control study method. All the collected data were analyzed through the Excel 2007, R software. Results showed that there were 599 kala-azar cases reported in Hancheng from 1953 to 2016, and 9 of which died. Based on this result, the average annual incidence of kala-azar in Hancheng was 14.61/100 000, and fatality rate was 1.50%. In addition, there were 18 kala-azar cases reported in Hancheng from 2012 to 2016, and 2 of which died and 72.22% started to get sick during May to September. Most cases were distributed in the northern mountainous of Hancheng, and most patients were farmers. Men were more likely to have kala-azar than women, and adults outnumber children. The main symptoms of these patients with kala-azar included fever and splenomegaly. Using COX regression analysis of predisposing factors showed that keeping the dog in house increased the risk of kala-azar (OR=4.618, 95%CI=1.519-14.039, P<0.05), and other factors had no influence on the risk of kala-azar. Hancheng is an age-old area with regional kala-azar, and new reported cases from 2012 to 2016 showed point shape distribution feature. More importantly, raising the dog in the home is a high risk factor for kala-azar. All the data suggest that Hancheng maybe an epidemic area for hilly or human canine type of kala-azar.