發(fā)布時(shí)間：2018-03-31 03:04

  本文選題：內(nèi)臟利什曼病　切入點(diǎn)：時(shí)間-空間聚集性　出處：《中國疾病預(yù)防控制中心》2013年博士論文

【摘要】：新疆維吾爾自治區(qū)是目前我國內(nèi)臟利什曼病的主要流行區(qū)之一,其中克孜勒河流域的喀什、疏附、疏勒、伽師4縣(市)為重流行區(qū),有人源型和自然疫源型內(nèi)臟利什曼病的流行。內(nèi)臟利什曼病屬于被忽視的傳染病之一。既往工作主要圍繞著媒介白蛉的分類鑒定、地域分布和生態(tài)學(xué)等方面開展,鮮見與該病流行規(guī)律、傳播特征有關(guān)的研究,在白蛉分子生物學(xué)方面的研究也有限。近年來,隨著空間統(tǒng)計(jì)學(xué)和分子生物學(xué)方法、技術(shù)的廣泛應(yīng)用,為從不同角度研究我國內(nèi)臟利什曼病流行特征及白蛉群體遺傳結(jié)構(gòu)提供了新手段并具有重要現(xiàn)實(shí)意義。 本研究收集了克孜勒河流域4縣(市)逐鄉(xiāng)(鎮(zhèn))、逐月的發(fā)病數(shù)據(jù)、人口數(shù)據(jù)、地理空間數(shù)據(jù)、環(huán)境因素?cái)?shù)據(jù)以及部分鄉(xiāng)(鎮(zhèn))的媒介白蛉數(shù)據(jù)。通過運(yùn)用流行病學(xué)、空間統(tǒng)計(jì)學(xué)、分子生物學(xué)的方法對研究地區(qū)內(nèi)臟利什曼病發(fā)病的時(shí)間-空間聚集性、發(fā)病熱點(diǎn)的時(shí)空演變、疾病流行的環(huán)境因素、媒介白蛉的分子群體遺傳結(jié)構(gòu)進(jìn)行了研究,獲得以下主要結(jié)果： 一、內(nèi)臟利什曼病發(fā)病的時(shí)間-空間聚集性 運(yùn)用空間統(tǒng)計(jì)分析掃描統(tǒng)計(jì)量法對各鄉(xiāng)(鎮(zhèn))逐年的空間聚集性進(jìn)行掃描,獲得16次內(nèi)臟利什曼病發(fā)病的空間聚集(P均0.01),可歸為2個(gè)一級(jí)聚集區(qū)和1個(gè)二級(jí)聚集區(qū)。對連續(xù)13年的數(shù)據(jù)進(jìn)行時(shí)空聚集性掃描,獲得2個(gè)內(nèi)臟利什曼病發(fā)病的高危聚集區(qū)及其對應(yīng)的高風(fēng)險(xiǎn)時(shí)段,2個(gè)聚集區(qū)內(nèi)的內(nèi)臟利什曼病發(fā)病風(fēng)險(xiǎn)分別是其他相同人口半徑、相同時(shí)間間隔的掃描窗口發(fā)病風(fēng)險(xiǎn)的27.34倍和29.09倍(P均0.01) 二、內(nèi)臟利什曼病發(fā)病熱點(diǎn)的時(shí)空演變 運(yùn)用空間統(tǒng)計(jì)方法對研究地區(qū)內(nèi)臟利什曼病的發(fā)病進(jìn)行地理區(qū)域相關(guān)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),結(jié)果說明內(nèi)臟利什曼病的發(fā)病具有空間自相關(guān)性,且為高值聚集。運(yùn)用地統(tǒng)計(jì)分析模塊建立發(fā)病預(yù)測圖并進(jìn)行熱點(diǎn)分析,累計(jì)探測到80個(gè)發(fā)病熱點(diǎn),內(nèi)臟利什曼病在局部區(qū)域呈現(xiàn)中度甚至重度的聚集性,發(fā)病熱點(diǎn)隨時(shí)間的推移變化明顯,地理位置表現(xiàn)為熱點(diǎn)從中部-東部-中部的轉(zhuǎn)移趨勢,該病類型表現(xiàn)出從人源型-自然疫源型-人源型的轉(zhuǎn)移趨勢。 三、內(nèi)臟利什曼病流行的環(huán)境因素研究 運(yùn)用多元線性回歸篩選與年發(fā)病率(1/萬)相關(guān)的環(huán)境變量,建立不同類型內(nèi)臟利什曼病流行的疾病-環(huán)境模型,定量分析了環(huán)境相關(guān)因素對該病流行的影響。擬合的人源型和自然疫源型內(nèi)臟利什曼病模型分別見①和②： ①√INCIDENCE=-8.64+0.35QTM6Z8+9.46QEM6Z8-0.06QRM1Z3 經(jīng)過篩選,納入模型的環(huán)境變量有3個(gè),分別為：前一年6-8月平均地面溫度、前一年6-8月平均EVI、前一年1-3月平均地面降水。模型的決定系數(shù)R2=0.61,F=12.67,P0.01。 ②√INCIDENCE=-16.05+0.29T6+0.82QTMYEAR-0.21QRM1Z3 經(jīng)過篩選,納入模型的環(huán)境變量有3個(gè),分別為：當(dāng)年6月平均地面溫度、前一年全年平均地面溫度、前一年1-3月平均地面降水。模型的決定素?cái)?shù)R2=0.34,F=4.13,P0.05。 四、媒介白蛉的分子群體遺傳結(jié)構(gòu)研究 應(yīng)用mtDNA-Cytb基因研究了吳氏白蛉和長管白蛉的群體遺傳結(jié)構(gòu)。結(jié)果顯示FST的范圍最小值在長管白蛉群體間,最大值在吳氏白蛉與長管白蛉群體間,吳氏白蛉群體間FST均為負(fù)值,提示群體間的遺傳差異非常小。吳氏白蛉(R2=0.34,P0.05)與長管白蛉(R2=0.09,P0.05)基因流與地理距離均呈負(fù)相關(guān),群體遺傳結(jié)構(gòu)格局符合距離隔離模型。 結(jié)論：克孜勒河流域內(nèi)臟利什曼病流行存在2個(gè)一級(jí)聚集區(qū)和1個(gè)二級(jí)聚集區(qū)。2個(gè)一級(jí)聚集區(qū)分別是以綠洲生態(tài)型為特征的人源型聚集區(qū)和以荒漠生態(tài)型為特征的自然疫源型聚集區(qū)。構(gòu)建了該地區(qū)內(nèi)臟利什曼病的流行的疾病-環(huán)境模型,該病的傳播與特定時(shí)間的降水和溫度呈相關(guān)關(guān)系。媒介白蛉的分子群體遺傳結(jié)構(gòu)研究揭示了該地區(qū)不同蛉種的種群遺傳特征,為內(nèi)臟利什曼病的疫情評估、監(jiān)測預(yù)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.

【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R531.6

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