【作者】 张文斌；

【导师】 王云海；

【作者基本信息】 新疆医科大学 ， 外科学， 2010， 博士

【摘要】 目的：本研究旨在通过社区流行病学调查及随访,研究新疆囊型包虫病流行情况,寻找包虫病易患因素。对查出的包虫病患者给予治疗,通过长期随访获得囊型包虫病治疗效果及自然转归的第一手资料。通过对已治愈后再次复发包虫病患者的长期随访工作,寻找二次发病患者的感染原因。积累社区预防控制包虫病人的经验,为建立和完善包虫病的监测体系,研究制订包虫病的防治标准、治疗方案提供参考依据。方法：1)社区流行病学普查。选择新疆和布克赛尔蒙古自治县和蒙古布尔根省作为研究点。所有社区人群填写编号、姓名、性别、年龄、族别、住址、职业、包虫病史、包虫病知识情况的问题、包虫病接触情况的问题、与包虫病有关的生活习惯等问卷调查。全部被查人口均做腹部B超检查,结果记录为正常、CE、AE、可疑、其他疾病等。对检出的包虫病,按WHO法和TSN法进行B超分类。全部被查人口均取耳垂血做快速免疫学检查,检出的包虫病患者和可疑者取静脉血做进一步血清免疫学检查；2)运用超声及血清学方法对51例患者,包括CE手术治疗者20人,PAIR治疗者4人,确诊CE未接受治疗者6人,超声可疑阳性者5人,肝脏孤立钙化灶8人,有既往手术史而超声未见异常者4人,超声未见异常而血清学阳性者4人,随访1-8年。B超分类采用WHO法和TSN法;3)2005年8月和2008年10月,分两次对和布克塞尔蒙古自治县进行了社区人群囊型包虫病再次随访研究,超声检查作为其主要诊断手段。结果：1)人囊型包虫病在新疆和布克赛尔蒙古自治县和蒙古布尔根省的患病率有显著不同。在和布克赛尔患病率为2.7%(49/1844)。在布尔根患病率为0.2%(4/1609)(P<0.001)。耳轮血涂片ELISA法显示B超图像正常、无手术史者被检测者血清阳性率在和布克赛尔为5.0%(87/1738),在布尔根为1.2%(19/1578),两个社区血清阳性率有统计学差异(P<0.01),中国和布克赛尔的血清阳性率明显高于蒙古布尔根。和布克赛尔狗粪抗原阳性率(36.0%,50/139)和布尔根狗细粒棘球绦虫感染率(35.7%,5/14)均处在一个较高的水平。比较影响两个社区人群CE患病率的可能危险因素主要存在以下不同：和布克赛尔农牧民所占的比例为48.5%,而在布尔根农牧民所占的比例为9.6%,两者有显著性统计学差异(P<0.01)。和布克赛尔地区拥有狗的人群比例为56.3%,拥有牲畜的比例为56.4%,高于布尔根拥有狗的人群比例25.8%及拥有牲畜的比例27.0%(P<0.01)；和布克赛尔在家屠宰牲畜的比例(78.9%)高于布尔根(28.1%)(P<0.01)；2)30例确诊CE患者中,6例未治疗者,1例4年后自发性治愈,另1例1年后随访由内囊塌陷型(T2)变为多子囊型(T3)；20例手术治疗者,2例4年后复发,5例持续为包虫残腔；4例PAIR治疗者,2例复发。大多数CE患者特异性IgG抗体水平呈持续阳性,但在CE术后治疗有效者中呈下降趋势,而在PAIR治疗组及术后复发者中呈上升趋势。3)2005年～2008年B超诊断24例CE中,22例原发性CE(包括手术18例,未治疗2例、化疗2例)。2例复发(1例接受手术,另一例是接受阿苯达唑片化疗),2例CE患者出现手术并发症。1例CE患者B超分型从术前的CE4转变为复发后的CE3。结论：1)新疆和布克赛尔人囊型包虫病患病率高于蒙古布尔根；2)治疗后及未治疗的包虫囊肿显示了多样的病理过程。血清IgG抗体水平总体来说对临床意义不大；3)社区人群包虫病流行病调查及再随访中,需要运用B超鉴别囊型包虫残腔积液、复发和再感染,CE患者手术治愈后,返回其原有的生活环境,多数患者并没有改变其生活习惯,是导致囊型包虫病再次感染的可能原因。更多还原

【Abstract】 Objective:This study aimed to investigate the prevalence and possible risk factors of human cystic echinococcosis (CE) in Hobukesar, Xingjiang Uygur autonomous Region. To understand the natural history of the disease through long term follow-up of curative effect and nature history of CE patients in Xingjiang. To understand the cause of re-infection through long-term follow-up of cured CE cases. Methods:1) Studies were carried out between 1995 and 2000 to investigate the prevalence of human cystic echinococcosis in traditional Mongolian communities in western Mongolia and Xinjiang (northwest China).2) Fifty-five cases including confirmed CE patients, ultrasound query cases, isolated calcification cases, previous CE surgery cases, as well as ultrasound normal but seropositive persons were resurvey using ultrasound and serology in Hobukesar, Xingjiang Uygur autonomous Region during the period 1995 to 2003.3) From August 2005 to October 2008, follow-up studies about cystic echinococcosis were carried out twice in Hobukesar, Xingjiang Uygur autonomous Region, ultrasonography as primary diagnostic method. Results:1) The prevalence of human hepatic CE in the two communities was significantly different. In Hobukesar human CE prevalence by ultrasound was 2.7% (49/1844), while in Bulgan it was 0.2% (4/1609) (P<0.001). Dog surveys showed that coproantigen positive rates or dog necropsy positives were similar in both communities, i.e.35.0% in Hobukesar and 35.7% in Bulgan. Comparing possible risk factors, there appeared to be some significant differences between the two communities, which might contribute to the observed difference in CE prevalence. These included, the proportion of herdsman or farmers recorded in Hobukesar (48.5%) was significantly higher than that in Bulgan (9.6%); the proportions of dog ownership and livestock ownership in Hobukesar (56%) were both higher than those in Bulgan (25-27%); and the proportion of families practicing home slaughter in Hobukesar (78.9%) was also significantly higher than that in Bulgan (28.1%).2) In the untreated patients, one case exhibited a spontaneous cure, another case changed form a hepatic hydatid cyst that contained a floating laminated membrane (type T3) to a cyst that contained daughter cysts (type T2). In the 20 surgically treated cases, two recurrent CE cases occurred, and five cases had residual cavities. Of the 4 PAIR treated cases, two recurrent. Serological follow-up date showed that specific IgG antibody levels were persistently positive in most CE casesbut exhibited a decreasing tendency in cases that were effectively treated by surgery. In contrast, serum IgG levels in the PAIR group or in the recurrent CE cases after surgery exhibited an increasing tendency.3) Among 24 patients comfirmed CE by ultrasonography,22 patients were primary CE (including surgery in 18 cases, no treat-ment in two cases, chemotherapy in two cases) and two patients were recurrence CE (one case underwent surgery, the other case received chemotherapy), two cases with surgical complications were found. Conclusion:1) In Hobukesar human CE prevalence was higher than that of Bulgan.2) The long-term follow-up studies demonstrated CE cases either treated nor untreated exhibited various pathologies. Serum IgG antibody levels has by and large not been very useful.3) Ultrasonography was required to differentiate residual effusion, recurrence and re-infection during epidemiological investigation and follow-up of CE. To control the main factors of re-infection has a profound impact on managing the prevalence of CE.更多还原