西藏自治区乡镇尺度的包虫病传播风险研究

Echinococcosis is a zoonotic parasitic disease caused by the larval stages (metacestodes) of cestodes belonging to the genus Echinococcus. In western China, echinococcosis, both cystic and alveolar, which impairs the health of people and development of social economy. CE and AE’s disease burden were respectively accounted for 43% and 91% of the world, So China is the most serious epidemic area in the world, furthermore, Tibet is the most serious area in china. The results of the sampling survey in 2016 showed that all 74 counties in Tibet were the epidemic areas, the prevalence rate of the population was about 1.66%, the infection rate of livestock was about 13.21%, and the infection rate of dog was about 7.30%, Communist Party of China and the government paid high attention to hydatid disease prevention and control work. The CPC Central Committee and the State Council and the MOH had issued a series of important documents, clear requirements to strengthen the work of disease prevention and treatment of echinococcosis. So to increase and accelerate the Tibet autonomous region hydatid disease prevention and control work has become a pressing matter of the moment. The study combines with RS/GIS technology, logistic regression analysis and discriminant analysis, PCR detection technology and spatial statistical analysis techniques. Then it elucidates the epidemiological characteristics and the influence factors of hydatid disease in Tibet, and explores key epidemic area location, range and the risk, spatial interpolation predicting the township scale of transmission risk, and provides a reference for the Tibet autonomous region and the counties to determine the key control areas to carry out efficient hydatid disease prevention and control work. It has great practical significance for hydatid disease prevention and control in Tibet autonomous region.

包虫病严重危害我国流行区人民群众身体健康和生命安全。我国囊型、泡型包虫病的疾病负担分别占全球的43%和91%，而西藏又是我国包虫病流行的重中之重。2016年抽样调查结果表明西藏全区74个县均存在包虫病流行，人群患病率为1.66%，家畜感染率为13.21%，犬感染率7.30%，为全球流行程度最重的区域。党和政府高度关注包虫病防治工作，中共中央、国务院做出重要指示，国家卫计委联合其他部委下发了重要文件，明确要求加强包虫病防治工作。那么加大、加快西藏自治区包虫病防治工作已成为当务之急。本研究结合RS/GIS技术、logistic回归分析和判别分析、PCR检测技术及空间统计分析技术，阐明西藏包虫病的流行特征及影响因素、探索西藏重点流行区域范围及风险、空间插值预测乡镇尺度的流行程度，为西藏自治区及各县确定优先防治重点区域，高效开展棘球蚴病的防治工作提供参考依据，对西藏包虫病防治具有重要的现实意义。

包虫病是我国目前重大公共卫生问题，而西藏的包虫病防治工作是我国包虫病防治的重中之重。加快西藏包虫病防治进度、掌握流行特征规律、明确重点防治区域，在乡镇尺度上评估传播风险是高效开展防治亟待解决的内在需求。本课题通过收集乡镇尺度的防治数据、畜牧业生产数据、环境相关数据，下载提取各乡镇地理信息、高程、LST和NDVI等数据，进行整合链接，构建了西藏自治区乡镇尺度包虫病防治综合信息数据库。综合运用GIS /RS/GPS技术、多元统计分析、空间自相关分析、空间趋势分析和空间聚集性分析等技术，明晰了西藏自治区乡镇尺度包虫病流行特征，掌握了空间分布规律，定量与定性结合评估了692个乡镇的包虫病传播风险，并进行了流行程度分类，结果如下：I类流行乡镇：患病率大于等于1%的乡镇有127个（占18.4%）；II类流行乡镇：患病率大于等于0.1%且小于1%的乡镇有453个（占65.5%）；III类流行乡镇：患病率大于0且小于0.1%的乡镇有75个（占10.8%）；IV类流行乡镇：存在传播循环条件但患病率为0的乡镇有37个（占5.3%）。分析了影响流行的主要因素，有高程，户均养犬数量、户均家养牲畜数量、不洁饮用水饮用比例、LST和夏季平均NDVI等，并量化了作用方向和作用大小。探索了西藏包虫病的空间分布特征，发现人群包虫病患病情况呈现西北偏中的区域高发的趋势。利用SaTScan软件进行空间聚集性扫描发现了一个包虫病的高风险聚集区域和2个点状高发区域；进一步分型进行扫描，确定了囊型包虫病和泡型包虫病的高风险聚集区域，并给出了每个聚集区域的位置、范围和风险大小，结合聚集区特征提出了相应的防治建议。制作了西藏全域乡镇尺度流行风险地图，将主要结果进行了可视化展示。为西藏相关部门制定包虫病的防治策略提供了科学依据，为下一布细化流行区分类，因地制宜开展分类指导、进行精准防控提供了有力支撑和技术保障。