目的 观察阿苯达唑(ABZ)和毗喹酮(PQT)交替联合用药及ABZ单药治疗藏族牧民棘球蚴病的效果和不良反应,为药物治疗棘球蚴病提供参考依据.方法 采用B超检查结合血清学检测对四川省阿坝州若尔盖县和壤塘县牧民进行棘球蚴病筛查,确诊患者纳入治疗和观察.将病例随机分为ABZ+PTQ交替联合用药治疗组(ABZ+PQT组)和ABZ单药治疗组(对照组,ABZ组).ABZ+PQT组患者ABZ片剂15 mg/(kg,d),分2次服用,连服25 d,随后改服PQT片剂40 mg/(kg,d),顿服,连服5d,依次交替服药,3个月为一个疗程,疗程中间不停药.ABZ组患者ABZ片剂15 mg/(kg,d),分2次服用,连续服药3个月,停药1周后开始下个疗程.两组患者的治疗时间均为2年.治疗期间,两组患者每半年进行一次影像学疗效评估、血清抗棘球蚴IgG抗体检测和肝功能指标监测.通过问卷调查和主要肝功能指标监测了解不良反应.结果 纳入治疗随访观察的临床诊断棘球蚴病病例共97例.ABZ+PQT组共55例病例,其中细粒棘球蚴病(CE) 31例、多房棘球蚴病(AE) 24例;ABZ组共42例病例,其中CE 22例、AE 20例.通过2年的治疗和随访观察,ABZ+PQT组对CE的治愈率为19.4％ (6/31),有效率为58.1％ (18/31);对AE的治愈率为12.5％ (3/24),有效率为50.0％ (12/24).ABZ组对CE的治愈率为9.1％ (2/22),有效率为18.2％ (4/22);对AE的治愈率为5.0％ (1/20),有效率为20.0％(4/20).两组在抗棘球蚴IgG抗体滴度变化差异不显著.血清抗棘球蚴IgG抗体检测结果显示,治疗前,ABZ+PQT组血清抗体吸光度(A450值)为0.39±0.06,服药3个月后上升至0.45±0.05,此后基本维持在相同水平,但在治疗12月后下降至0.38±0.07,后保持稳态;ABZ组血清抗体A450值变化趋势与ABZ+PQT组相似,服药前为0.41±0.07,服药3个月后升至0.43±0.08,治疗12个月时降为0.39±0.07,后基本平稳;不同疗程时间对血清抗体A 450值的影响有统计学意义(P＜0.05).治疗期间总不良反应发生率为23.7％ (23/97),其中ABZ+PQT组有8例(占34.8％),ABZ组有15例(占65.2％),主要是胃肠不适等轻度不良反应;重度不良反应主要为肝功能受损,服药3个月时,6例(ABZ+PQT治疗组1例,ABZ治疗组5例)丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)都升高,此后随访逐渐下降至正常.结论 ABZ+PQT组对CE和AE的治疗有效率高于ABZ组;ABZ+PQT组产生的药物不良反应明显低于ABZ组;血清抗棘球蚴IgG抗体变化不能反映病灶进展情况.

BackgroundEchinococcosis is a parasitic zoonosis caused by Echinococcus larvae parasitism causing high mortality. The Tibetan Region of Sichuan Province is a high prevalence area for echinococcosis in China. Understanding the geographic distribution pattern is necessary for precise control and prevention. In this study, a spatial analysis was conducted to explore the town-level epidemiology of echinococcosis in the Sichuan Tibetan Region and to provide guidance for formulating regional prevention and control strategies.MethodsThe study was based on reported echinococcosis cases by the end of 2017, and each case was geo-coded at the town level. Spatial empirical Bayes smoothing and global spatial autocorrelation were used to detect the spatial distribution pattern. Spatial scan statistics were applied to examine local clusters.ResultsThe spatial distribution of echinococcosis in the Sichuan Tibetan Region was mapped at the town level in terms of the crude prevalence rate, excess hazard and spatial smoothed prevalence rate. The spatial distribution of echinococcosis was non-random and clustered with the significant global spatial autocorrelation (I=0.7301, P=0.001). Additionally, five significant spatial clusters were detected through the spatial scan statistic.ConclusionsThere was evidence for the existence of significant echinococcosis clusters in the Tibetan Region of Sichuan Province, China. The results of this study may assist local health departments with developing better prevention strategies and prompt more efficient public health interventions.

Objective To analyze characteristics of and trends in the prevalence of hydatidosis in Aba Prefecture from 2004 to 2012.Methods Surveillance data on hydatidosis collected from the Infectious Diseases Reporting System were statistically analyzed using SAS9.2 software.Results In total,812 cases of hydatidosis were reported.Cases were reported during all of the years in question.A total of 594 cases were reported from 2009 to 2012,accounting for 73.15% of the total cases.The sex ratio was 1:1.41.Affected individuals ranged in age from 4-95,with a mean age of 48 years.Of those affected,681 were between 24 and 65 years of age,accounting for 83.87%.Herdsman and famers were most often affected(735 cases,accounting for 90.52 % of all cases).Affected individuals were mainly in 5 counties including Ruoergai,Aba,Maerkang,Rangtang,and Hongyuan;affected individuals in these 5 accounted for 90.64% of all cases.Conclusion Aba Prefecture faces a serious epidemic of hydatidosis.In the future,efforts to control hydatidosis should continue to be enhanced.This will effectively curb outbreaks of hydatidosis.

Objective To investigate and evaluate the prevelance of human echinococcosis in Sichuan province.Methods With randomly stratified cluster sampling method,people in 31 counties in Ganzi and Aba prefectures,Sichuan province,was screened for echinococcosis using B ultrasound scanning combined with sera anti-echinococcus antibody IgG detection.The prevelance of echinococcosis in human was determined and the numbers of cases were estimated.Results The standarded prevelance of human echinococcosis in Sichuan province was to 1.06%,human cases were estimated to be around 20 000.Most human echinococcosis cases were found in Ganzi prefecture,where the prevelance of echinococcos was counted for 1.55% and the estimated human case was 15 335,mainly distributed in 8 counties including Shiqu,Seda,Ganzi,Dege,Baiyu,Luhuo,Xinlong and Litang.Whereas 48% of echinococcosis prevelance was eastimated for Aba prefecture,where 4 112 of human cases were primarily dispersed in Ruoergai,Maerkang,Aba,Jinchuan,Hongyuan,Songpan and Rangtan.Conclusion Echinococcosis was highly prevelant in 8 counties in Ganzi prefecture and in 7 counties in Aba prefecture.Control strategy towards this disease should be mainly focused on these heavily endemic counties in order to obtain more effective control outcomes.