云南边境地区疟疾感染危险因素病例对照研究

发布时间：2018-04-29 01:12

本文选题：疟疾 + 病例对照研究　；参考：《大理学院》2013年硕士论文

【摘要】：[背景]疟疾是严重危害人类健康的传染性寄生虫病,是全球主要公共卫生问题之一。中国是近年疟疾防治成效最为显著的国家之一,2010年启动了中国消除疟疾行动计划2010-2020。云南边境地区是我国疟疾流行最为严重,消除最为困难的地区。鉴定边境地区境内外疟疾感染的危险因素,是减少输入性疟疾病例和阻断当地传播,实现消除疟疾目标的基础。[目的]鉴定云南边境地区疟疾感染的危险因素及其程度；探讨边境地区预防疟疾,减少输入性病例和防止第二代病例发生的策略和措施。[方法]在云南省腾冲和盈江,两个目前疟疾最多的县,对2010年9月-2011年12月报告的疟疾病例,采用病例对照研究法调查疟疾感染的危险因素；纳入病例组和对照组人数比为1：2。调查前均对病例组血片进行复查以确保是确诊病例,对对照组进行血检,确保其未感染疟疾。数据处理首先分别计算病例组和对照组中各因素的百分比或均数,并进行统计学差异显著性检验；然后以确诊疟疾作结果变量,其它因素作解释变量,对疟疾感染的潜在危险因素进行逐步Logistic回归分析,并通过多因素Logistic回归分析控制混杂效应。[结果]共完成642人的调查,其中男性582(90.7%)。根据排除标准检查调查对象的有效性,审核完成问卷的完整性和逻辑性后,进入分析的病例组人数是214,对照组人数是428。病例组平均年龄33.8±10.4岁,对照组34±9.7岁,两组间无显著差异(P=0.811)。214例确诊病例中,间日疟176(82.2%)例,恶性疟38(17.8%)例；其中196(92.0%)系输入性病例,17(8.0%)系当地感染；428名对照中,74(17.7%)在所对应的病例发病前1个月有出境过夜经历。在国内家中无防蚊措施经多因素回归分析排除其它因素混杂效应后比值比(OR)是2.39(95%可信区间/95%CI：1.21-4.71),这显示国内尚未打断疟疾传播,家中无防蚊措施是感染疟疾的危险因素；发病前1个月出境的OR值是159.5(75.1-338.9)；在境外,与居住在山区相比,住在坝区(含坝边山脚和城镇)OR值为5.45(2.52-11.80),居住在半山区的OR值为42.82(5.13-319.75)；居住地点100米内有小溪的OR值为15.30(4.25-55.16),有稻田等其它水体的为10.12(4.36-55.76)。但本研究对象中的中低收入者OR值0.22(0.17-0.63),显示感染疟疾危险程度更低,原因是出境者通常比不出境者可以获得更高的经济收入；出境伐木者OR值2.44(0.36-16.76),不能证明出境伐木更容易感染疟疾；境外居住地周围50米内有森林OR值是0.44(0.08-2.36),住窝棚的OR值是0.71(0.16-3.23),不能说明森林和居住条件简陋增加了疟疾感染的危险程度,原因还是境外的疟疾高流行区是坝区和半山区,而山区多森林,居住条件简陋；出境人员中无任何防蚊措施OR值是0.33(0.15-0.75),显示在境外高疟区仅靠蚊帐等防蚊措施的保护作用是相当有限。[结论]出境是云南边境地区的主要疟疾感染危险因素,感染疟疾的危险程度与境外的居住地点相关,居住在坝区和半山区,居住地周围有媒介按蚊孳生地者,感染疟疾的危险度更高；同时,云南边境地区的疟疾传播条件依然存在,仍然有当地感染病例,使用防蚊措施可以减少疟疾感染。但出境感染疟疾的危险程度与在境外从事的活动,境外居住点附近是否有森林和居住条件好坏无关；在境外高疟区仅靠媒介防护措施的作用是相当有限,建议为出境到境外高疟区者提供预防服药服务。
[Abstract]:[background] malaria is an infectious parasitic disease that seriously endangers human health. It is one of the major public health problems in the world. China is one of the most significant countries in recent years. China has launched the China malaria elimination action plan (2010-2020.) in 2010. The Yunnan border area is the most serious and difficult to eliminate in China. The identification of the risk factors for malaria infection within and outside the border areas is the basis for reducing the input malaria cases and blocking local transmission and achieving the goal of eliminating malaria. [Objective] to identify the risk factors and degree of malaria infection in the border areas of Yunnan, to explore the prevention of malaria in the border areas, to reduce the input cases and to prevent the second generation of cases. Methods and measures. [Methods] a case control study was used to investigate the risk factors for malaria infection in two malaria cases in Tengchong and Yingjiang, Yunnan province and Yingjiang, the most malaria cases in December September 2010, and the number of cases group and control group was rechecked to ensure that the case group was rechecked before 1:2.. A confirmed case, blood test of the control group to ensure that it was not infected with malaria. Data processing first calculated the percentage or average of the factors in the case group and the control group, and carried out the statistical difference test; then the diagnosis was made by the diagnosis of malaria as the result variable, the other factors were used as the explanatory variables, and the potential risk factors for malaria infection were entered. Stepwise Logistic regression analysis and multiple factor Logistic regression analysis were used to control the confounding effect. [results] a total of 642 people were investigated, of which 582 (90.7%) were male. The number of cases enrolled in the analysis was 214 and the number of the control group was 428. after examining the validity of the subjects according to the exclusion criteria and examining the completeness and logic of the completed questionnaire. The average age of the case group was 33.8 + 10.4 years, and the control group was 34 + 9.7 years old. There was no significant difference between the two groups (P=0.811).214 cases, 176 (82.2%) and 38 (17.8%) cases of Plasmodium falciparum; 196 (92%) was an input case, 17 (8%) was a local infection. The ratio Ratio ratio (OR) was 2.39 (95% confidence interval /95%CI:1.21-4.71) after multiple factor regression analysis, which showed that there was no interruption of malaria transmission in China, and no mosquito prevention measures were the risk factors for malaria in home. The OR value of outbound 1 months before the onset of disease was 159.5 (75.1-338.9); Overseas, the OR value of living in the dam area (including the foot and town of the dam) is 5.45 (2.52-11.80), and the OR value of the living in the semi mountainous area is 42.82 (5.13-319.75), the OR value of the brook is 15.30 (4.25-55.16) and 10.12 (4.36-55.76) with the other water in the rice field, but the middle and low income person of the research object has OR value 0.2. 2 (0.17-0.63) shows that the risk of malaria infection is lower, because outbound people usually get higher economic income than non outbound ones; outbound lumber OR value 2.44 (0.36-16.76) can not prove that outbound logging is more susceptible to malaria; the OR value of forest within 50 meters around overseas residences is 0.44 (0.08-2.36) and the OR value of shelters is 0.71 (0.). 16-3.23) it is not clear that the poor forest and living conditions have increased the risk of malaria infection, because the high epidemic areas abroad are the dam area and the semi mountainous area, and the mountainous forests and the living conditions are simple; there is no anti mosquito measure of 0.33 (0.15-0.75) of the outbound personnel, which shows that the anti mosquito measures, such as the mosquito net only in the high malaria area abroad, show that the anti mosquito measures are only based on the mosquito nets. The protective effect is quite limited. [Conclusion] exit is a major risk factor for malaria infection in the border areas of Yunnan. The risk of malaria is related to the place of residence abroad, living in the dam and semi mountainous areas, and the population of Anopheles vectors around the residence, and the risk of malaria is higher; meanwhile, the transmission of malaria in the border region of Yunnan is transmitted. The conditions of sowing still exist and there are still cases of local infection, and the use of anti mosquito measures can reduce malaria infection. However, the risk of outbound malaria is irrelevant to whether there are forests and living conditions near overseas sites, and the role of media protection only in the high malaria area abroad is limited. Those who leave the country to the high malaria area provide preventive medicine service.

【学位授予单位】：大理学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R382.31

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