克孜勒河流域内脏利什曼病的流行特征及其相关因素研究

发布时间：2018-03-31 03:04

本文选题：内脏利什曼病　切入点：时间-空间聚集性　出处：《中国疾病预防控制中心》2013年博士论文

【摘要】：新疆维吾尔自治区是目前我国内脏利什曼病的主要流行区之一,其中克孜勒河流域的喀什、疏附、疏勒、伽师4县(市)为重流行区,有人源型和自然疫源型内脏利什曼病的流行。内脏利什曼病属于被忽视的传染病之一。既往工作主要围绕着媒介白蛉的分类鉴定、地域分布和生态学等方面开展,鲜见与该病流行规律、传播特征有关的研究,在白蛉分子生物学方面的研究也有限。近年来,随着空间统计学和分子生物学方法、技术的广泛应用,为从不同角度研究我国内脏利什曼病流行特征及白蛉群体遗传结构提供了新手段并具有重要现实意义。本研究收集了克孜勒河流域4县(市)逐乡(镇)、逐月的发病数据、人口数据、地理空间数据、环境因素数据以及部分乡(镇)的媒介白蛉数据。通过运用流行病学、空间统计学、分子生物学的方法对研究地区内脏利什曼病发病的时间-空间聚集性、发病热点的时空演变、疾病流行的环境因素、媒介白蛉的分子群体遗传结构进行了研究,获得以下主要结果：一、内脏利什曼病发病的时间-空间聚集性运用空间统计分析扫描统计量法对各乡(镇)逐年的空间聚集性进行扫描,获得16次内脏利什曼病发病的空间聚集(P均0.01),可归为2个一级聚集区和1个二级聚集区。对连续13年的数据进行时空聚集性扫描,获得2个内脏利什曼病发病的高危聚集区及其对应的高风险时段,2个聚集区内的内脏利什曼病发病风险分别是其他相同人口半径、相同时间间隔的扫描窗口发病风险的27.34倍和29.09倍(P均0.01) 二、内脏利什曼病发病热点的时空演变运用空间统计方法对研究地区内脏利什曼病的发病进行地理区域相关性分析,Global Moran's I=0.18, Z Score=3.89(P0.01)、General G=0.59, Z Score=4.11(P0.01),结果说明内脏利什曼病的发病具有空间自相关性,且为高值聚集。运用地统计分析模块建立发病预测图并进行热点分析,累计探测到80个发病热点,内脏利什曼病在局部区域呈现中度甚至重度的聚集性,发病热点随时间的推移变化明显,地理位置表现为热点从中部-东部-中部的转移趋势,该病类型表现出从人源型-自然疫源型-人源型的转移趋势。三、内脏利什曼病流行的环境因素研究运用多元线性回归筛选与年发病率(1/万)相关的环境变量,建立不同类型内脏利什曼病流行的疾病-环境模型,定量分析了环境相关因素对该病流行的影响。拟合的人源型和自然疫源型内脏利什曼病模型分别见①和②： ①√INCIDENCE=-8.64+0.35QTM6Z8+9.46QEM6Z8-0.06QRM1Z3 经过筛选,纳入模型的环境变量有3个,分别为：前一年6-8月平均地面温度、前一年6-8月平均EVI、前一年1-3月平均地面降水。模型的决定系数R2=0.61,F=12.67,P0.01。 ②√INCIDENCE=-16.05+0.29T6+0.82QTMYEAR-0.21QRM1Z3 经过筛选,纳入模型的环境变量有3个,分别为：当年6月平均地面温度、前一年全年平均地面温度、前一年1-3月平均地面降水。模型的决定素数R2=0.34,F=4.13,P0.05。四、媒介白蛉的分子群体遗传结构研究应用mtDNA-Cytb基因研究了吴氏白蛉和长管白蛉的群体遗传结构。结果显示FST的范围最小值在长管白蛉群体间,最大值在吴氏白蛉与长管白蛉群体间,吴氏白蛉群体间FST均为负值,提示群体间的遗传差异非常小。吴氏白蛉(R2=0.34,P0.05)与长管白蛉(R2=0.09,P0.05)基因流与地理距离均呈负相关,群体遗传结构格局符合距离隔离模型。结论：克孜勒河流域内脏利什曼病流行存在2个一级聚集区和1个二级聚集区。2个一级聚集区分别是以绿洲生态型为特征的人源型聚集区和以荒漠生态型为特征的自然疫源型聚集区。构建了该地区内脏利什曼病的流行的疾病-环境模型,该病的传播与特定时间的降水和温度呈相关关系。媒介白蛉的分子群体遗传结构研究揭示了该地区不同蛉种的种群遗传特征,为内脏利什曼病的疫情评估、监测预警提供了新的思路。
[Abstract]:The Xinjiang Uygur Autonomous Region is one of the major epidemic areas of visceral leishmaniasis in China at present, including Kashi, the Shufu River Basin, Shule, Jiashi 4 counties (city) for heavy epidemic areas, human and natural foci of type of visceral leishmaniasis epidemic. Visceral leishmaniasis belongs to one of the most infectious diseases were ignored. The previous work mainly around the classification and identification of vector sandfly, geographical distribution and ecological aspects, and the rare disease epidemic law, research on propagation characteristics of relevant research in the molecular biology of sandflies are limited. In recent years, with the spatial statistics and molecular biological methods, applications, and provides a new method for the study of visceral leishmaniasis in China the epidemic characteristics and sandfly population genetic structure from different angles and has important practical significance.
This study collected the river basin 4 counties (city) by the township (town), the monthly incidence data, population data, geographic data, environmental factor data and part of the township (town) in media data through the use of epidemiology, spatial statistics, time - the method of molecular biology on the incidence of visceral leishmaniasis in study area spatial clustering, spatial and temporal evolution of the incidence of hot spots, the environmental factors of epidemic diseases, molecular genetic structure of vector sandfly was studied. The main results are as follows:
Time spatial aggregation of visceral leishmaniasis
Using spatial statistics analysis method of scan statistics of each township (town) by spatial cluster scan, 16 times the incidence of visceral leishmaniasis spatial aggregation (P 0.01), can be divided into 2 first level gathering area and 1 two level gathering area. Time and space for 13 consecutive years of data gathering. Scanning, 2 high risk period of visceral leishmaniasis incidence of high-risk areas and the 2 accumulation of visceral leishmaniasis risk in the region are the same population radius, the risk of the same scan window of time interval of 27.34 times and 29.09 times (P 0.01)
Two, the temporal and spatial evolution of the hot spots of visceral leishmaniasis
The incidence of using spatial statistics method to study area of visceral leishmaniasis were analyzed between Global Moran's I=0.18 region, Z, Score=3.89 (P0.01), General G=0.59, Z Score=4.11 (P0.01), the result shows that the incidence of visceral leishmaniasis with spatial autocorrelation, and the high value aggregation. With the statistical analysis module is established to predict the incidence hot spots on the map and detect 80, the cumulative incidence of hot, visceral leishmaniasis in local area showed moderate or severe aggregation, change the incidence over time was hot, the geographical position of the central transfer trend from the Middle East hot - - the disease type appeared to spread from human - nature focus - human type.
Three, environmental factors for the epidemic of visceral leishmaniasis
Using multiple linear regression and screening the annual incidence rate (1/ million) related to environmental variables, setting different types of visceral leishmaniasis endemic disease model, quantitative analysis of the related factors that affect the environment of this epidemic. The people who see fitting source and natural foci of visceral leishmaniasis type Manchester disease model respectively:
The root INCIDENCE=-8.64+0.35QTM6Z8+9.46QEM6Z8-0.06QRM1Z3
After screening, there are 3 environmental variables into the model. They are: the average ground temperature in the first 6-8 months of the year, the average monthly EVI in the previous year, 6-8 months, and the average ground rainfall in the first 1-3 months of the year. The determination coefficient of the model is R2=0.61, F=12.67 and P0.01..
The root INCIDENCE=-16.05+0.29T6+0.82QTMYEAR-0.21QRM1Z3
After screening, there are 3 environmental variables into the model. They are: the average surface temperature in June of the year, the average annual ground temperature in the previous year, and the 1-3 month average surface rainfall in the previous year. The prime number of the model is R2=0.34, F=4.13, P0.05..
Four, study on the molecular population genetic structure of the vector sandfly
Application of mtDNA-Cytb gene of Phlebotomus sandflies and long tube genetic structure. The results show that FST of the range of the minimum value in the long tube sandflies between groups, the maximum value in the long tube and Phlebotomus sandflies between groups, between groups of Phlebotomus FST are negative, suggesting that genetic differences between groups is very small. Phlebotomus (R2=0.34, P0.05) and long tube (R2=0.09, P0.05) in gene flow and geographical distance was negatively related to population genetic structure fits the isolation by distance model.
Conclusion: the prevalence of visceral leishmaniasis in river basin 2 level gathering area and 1 level two.2 gathering area a gathering area were natural foci of human source in Oasis ecotype characteristic gathering area and the ecological characteristics of desert area. The construction environment of the area of visceral leishmaniasis epidemic the disease model, there is a positive correlation between the precipitation and temperature in the spread of the disease, and the specific time. Study on molecular genetic structure vector sandfly revealed population genetic characteristics of different species in the region, as the epidemic assessment of visceral leishmaniasis, provides a new way of monitoring and early warning.

【学位授予单位】：中国疾病预防控制中心
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R531.6

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