本文選題：結(jié)核病 + 肺結(jié)核　； 參考：《中國(guó)疾病預(yù)防控制中心》2014年博士論文

【摘要】：我國(guó)結(jié)核病和腸道寄生蟲(chóng)病依然是危害人民健康、影響社會(huì)經(jīng)濟(jì)發(fā)展的重要公共衛(wèi)生問(wèn)題。目前,我國(guó)已經(jīng)開(kāi)展了一些關(guān)于結(jié)核病和腸道寄生蟲(chóng)病疫情在局部區(qū)域的空間分布特征的研究。但在全國(guó)尺度下的肺結(jié)核患病率和腸道寄生蟲(chóng)感染率的空間分布特征及其影響因素的研究非常缺乏,同時(shí)對(duì)兩類疾病雙重流行區(qū)域空間分布的研究仍是空白。雙重流行是指在同一區(qū)域內(nèi)結(jié)核病和腸道寄生蟲(chóng)病疫情均較為嚴(yán)重且兩類病原體極有可能在人體內(nèi)發(fā)生雙重感染并在該區(qū)域造成傳播,因此雙重流行區(qū)域是發(fā)生雙重感染的高危區(qū)域。而雙重感染對(duì)人體造成的傷害可能會(huì)超過(guò)單類病原體的傷害或兩類病原體的單獨(dú)傷害之和。但對(duì)于結(jié)核菌和腸道寄生蟲(chóng)雙重感染的流行病學(xué)調(diào)查以及雙重感染時(shí)機(jī)體免疫狀態(tài)變化情況的研究卻也相當(dāng)匱乏。因此,我們從上述幾個(gè)方面對(duì)我國(guó)肺結(jié)核和腸道寄生蟲(chóng)病雙重流行進(jìn)行了研究,為制定兩類疾病的國(guó)家預(yù)防控制規(guī)劃提供技術(shù)支持。 首先,我們?cè)谌珖?guó)尺度下分析了影響肺結(jié)核疫情的生態(tài)學(xué)因素以及這些因素的空間差異性。我們從國(guó)家結(jié)核病防治規(guī)劃(2001-2010年)終期評(píng)估報(bào)告、2002-2011年中國(guó)衛(wèi)生統(tǒng)計(jì)年鑒、2002-2011年中國(guó)統(tǒng)計(jì)年鑒以及各省級(jí)政府門(mén)戶網(wǎng)站上收集2001-2010年的有關(guān)數(shù)據(jù),利用因子分析法從這些數(shù)據(jù)中提取潛在變量(肺結(jié)核疫情和生態(tài)學(xué)因素),然后利用偏最小二乘通徑模型建立肺結(jié)核疫情和生態(tài)學(xué)因素的結(jié)構(gòu)方程模型。根據(jù)結(jié)構(gòu)方程模型生成的參數(shù),我們用地理加權(quán)回歸模型分析了每個(gè)生態(tài)學(xué)因素的空間差異性。我們提取出了“結(jié)核病疫情”以及“結(jié)核病防治投入水平”、“結(jié)核病防治服務(wù)水平”、“衛(wèi)生投入水平”、“居民健康水平”、“社會(huì)經(jīng)濟(jì)水平”、“空氣質(zhì)量”、“氣候因素”和“地理因素”共8個(gè)生態(tài)學(xué)因素。分析結(jié)果顯示,“結(jié)核病防治投入水平”、衛(wèi)生投入水平“、社會(huì)經(jīng)濟(jì)水平”、空氣質(zhì)量“、氣候因素”和“地理因素”對(duì)“結(jié)核病疫情”有明確的可解釋的影響,而在這些生態(tài)學(xué)因素中,在不考慮“結(jié)核病防治投入水平”和“衛(wèi)生投入水平”(其對(duì)結(jié)核病疫情有直接且顯著的影響)的前提下,“社會(huì)經(jīng)濟(jì)水平”和“地理因素”對(duì)“結(jié)核病疫情”有相對(duì)較強(qiáng)的影響。此外,研究顯示,每個(gè)生態(tài)學(xué)因素在不同區(qū)域?qū)Α敖Y(jié)核病疫情”的影響強(qiáng)度也不同,呈現(xiàn)顯著的空間差異性。這些結(jié)果提示我們,在制定全國(guó)結(jié)核病預(yù)防控制規(guī)劃時(shí),不僅要綜合考慮多種因素的影響,而且要采取因地制宜的策略和措施。 在此研究結(jié)果的基礎(chǔ)上,我們?cè)谌珖?guó)尺度下預(yù)測(cè)了2010年肺結(jié)核患病率的空間分布特征,這有助于合理分配國(guó)家結(jié)核病預(yù)防控制規(guī)劃的有限資源。我們利用2010年全國(guó)第五次結(jié)核病流行病學(xué)抽樣調(diào)查的調(diào)查點(diǎn)患病率數(shù)據(jù),進(jìn)行普通克里格插值以生成連續(xù)性表面的肺結(jié)核患病率地圖。為了生成較為準(zhǔn)確的預(yù)測(cè)地圖,我們?cè)u(píng)估了普通克里格插值以及以社會(huì)經(jīng)濟(jì)因素和地理因素作為協(xié)變量的協(xié)同克里格插值在不同條件下(去趨勢(shì)類型、半方差函數(shù)模型和各向異性)的預(yù)測(cè)準(zhǔn)確性。根據(jù)評(píng)估結(jié)果,我們選取了以社會(huì)經(jīng)濟(jì)因素和地理因素作為協(xié)變量的全局性協(xié)同克里格插值作為最優(yōu)的插值方法,并生成了肺結(jié)核患病率的預(yù)測(cè)地圖。預(yù)測(cè)地圖顯示,我國(guó)肺結(jié)核患病率在京津滬和東南沿海地區(qū)較低,在西部和西南地區(qū)較高,在中部地區(qū)呈現(xiàn)高低交錯(cuò)分布的狀態(tài)。通過(guò)評(píng)估最優(yōu)插值方法,再次證實(shí)了社會(huì)經(jīng)濟(jì)因素和地理因素對(duì)我國(guó)結(jié)核病疫情的影響。 第二,我們?cè)谌珖?guó)尺度下探尋了肺結(jié)核和腸道寄生蟲(chóng)病雙重流行的空間分布特征。我們利用2010年全國(guó)第五次結(jié)核病流行病學(xué)抽樣調(diào)查的調(diào)查點(diǎn)患病率數(shù)據(jù)以及2004年完成的第二次全國(guó)人體重要寄生蟲(chóng)病現(xiàn)狀調(diào)查的調(diào)查點(diǎn)感染率數(shù)據(jù),并在提供數(shù)據(jù)資源的網(wǎng)站上收集2001-2010年社會(huì)經(jīng)濟(jì)、氣候、地理和環(huán)境因素的數(shù)據(jù)集,通過(guò)擬合貝葉斯地統(tǒng)計(jì)logistic回歸模型來(lái)分別分析肺結(jié)核和腸道蠕蟲(chóng)感染與社會(huì)經(jīng)濟(jì)、氣候、地理和環(huán)境因素之間的關(guān)系。根據(jù)擬合的模型,利用貝葉斯克里格插值模型分別生成連續(xù)性表面的肺結(jié)核患病率地圖和腸道蠕蟲(chóng)感染率地圖。在此基礎(chǔ)上,我們通過(guò)貝葉斯共有組分模型對(duì)兩類疾病的預(yù)測(cè)地圖進(jìn)行聯(lián)合分析,生成了兩類疾病雙重流行(共有組分)的相對(duì)危險(xiǎn)地圖。貝葉斯共有組分模型是在假設(shè)潛在共有危險(xiǎn)因素的前提下評(píng)估兩類疾病共有方差和專有方差占各自相對(duì)危險(xiǎn)在空間上的總方差的比例,從而分析兩類疾病相對(duì)危險(xiǎn)的共有組分和專有組分。結(jié)果顯示,人均GDP較高地區(qū)的肺結(jié)核患病率水平較低,而農(nóng)村地區(qū)、干旱和高寒氣候區(qū)域和海拔較高地區(qū)是肺結(jié)核患病率的高水平地區(qū)；人均GDP較高地區(qū)和距離水源較遠(yuǎn)地區(qū)的腸道蠕蟲(chóng)感染率水平較低,而暖濕氣候區(qū)域和歸一化植被指數(shù)較高地區(qū)是腸道蠕蟲(chóng)感染率的高水平地區(qū)。預(yù)測(cè)地圖顯示,我國(guó)西部地區(qū)是肺結(jié)核患病率的中高水平區(qū)域,但卻是腸道蠕蟲(chóng)感染率的低水平區(qū)域；中部以北地區(qū)和東南沿海地區(qū)是肺結(jié)核患病率的中低水平區(qū)域,也是腸道蠕蟲(chóng)感染率的低水平區(qū)域；西南地區(qū)是肺結(jié)核患病率的中高水平區(qū)域,也是腸道蠕蟲(chóng)感染率的高水平區(qū)域。根據(jù)貝葉斯共有組分模型的分析結(jié)果,我們發(fā)現(xiàn)西南地區(qū)是我國(guó)肺結(jié)核和腸道寄生蟲(chóng)感染的雙重流行區(qū)域,并推測(cè)社會(huì)經(jīng)濟(jì)因素如人均GDP可能是潛在共有危險(xiǎn)因素。因此,我們應(yīng)該把兩類疾病的雙重流行區(qū)域作為疾病防治的優(yōu)先區(qū)域,制定以改善當(dāng)?shù)厣鐣?huì)經(jīng)濟(jì)水平為主要措施的雙重感染預(yù)防控制策略。 第三,在完成全國(guó)尺度下的研究后,我們開(kāi)展了人體結(jié)核菌和腸道寄生蟲(chóng)雙重感染的流行病學(xué)調(diào)查。我們?cè)诤幽鲜〉囊粋�(gè)農(nóng)業(yè)縣開(kāi)展了橫斷面調(diào)查,對(duì)該縣正在接受抗結(jié)核治療的肺結(jié)核患者以及按照鄰近區(qū)域(同社區(qū)或同村)、年齡相仿(±5歲)和同性別匹配的健康對(duì)照人群進(jìn)行了問(wèn)卷調(diào)查,問(wèn)卷調(diào)查內(nèi)容包括社會(huì)人口學(xué)情況、健康狀況、衛(wèi)生習(xí)慣以及農(nóng)田勞動(dòng)情況,并采集了他們的糞樣和血樣分別進(jìn)行了糞檢、血常規(guī)和HIV檢測(cè)。我們用Pearson x2檢驗(yàn)進(jìn)行腸道寄生蟲(chóng)感染的單因素分析(OR值和95%CI),用多因素logistic回歸模型對(duì)潛在的混雜因素進(jìn)行調(diào)整(AOR值和95%CI)。而且,我們利用Mantel-Haenszelχ2檢驗(yàn)分析了抗結(jié)核治療時(shí)間長(zhǎng)度對(duì)腸道寄生蟲(chóng)感染率的影響。我們總共納入369名肺結(jié)核患者和366名健康對(duì)照,他們均為HIV陰性。肺結(jié)核患者的腸道寄生蟲(chóng)總感染率為14.9%,其中腸道原蟲(chóng)感染率為7.9%,腸道蠕蟲(chóng)感染率為7.6%,其感染譜從低到高分別為人毛滴蟲(chóng)(0.3%)、華支睪吸蟲(chóng)(0.3%)、蛔蟲(chóng)(0.5%)、阿米巴(1.4%)、鞭蟲(chóng)(2.2%)、鉤蟲(chóng)(4.6%)和人芽囊原蟲(chóng)(6.2%)。經(jīng)過(guò)對(duì)潛在的混雜因素進(jìn)行調(diào)整,我們沒(méi)有發(fā)現(xiàn)肺結(jié)核患者和健康對(duì)照的腸道寄生蟲(chóng)總感染率有顯著性差異,也未發(fā)現(xiàn)有影響因素能夠?qū)е聝山M人群總感染率出現(xiàn)差異。但女性(AOR=2.05,95%CI=1.01-4.17)、BMI≤19(AOR=3.02,95%CI=1.47-6.20)和貧血(AOR=2.43,95%CI=1.17-5.03)是肺結(jié)核患者感染腸道寄生蟲(chóng)的危險(xiǎn)因素；而在農(nóng)田平均勞動(dòng)時(shí)間2個(gè)月(AOR=4.50,95%CI=2.03-10.00)是健康對(duì)照人群感染腸道寄生蟲(chóng)的危險(xiǎn)因素。此外,我們未發(fā)現(xiàn)抗結(jié)核治療時(shí)間長(zhǎng)度與腸道寄生蟲(chóng)感染率之間存在劑量反應(yīng)關(guān)系。因此,在本研究中我們尚未獲得證據(jù)證明肺結(jié)核患者對(duì)腸道寄生蟲(chóng)易感,但發(fā)現(xiàn)在肺結(jié)核患者中女性和健康狀況不良者更容易感染腸道寄生蟲(chóng)。 我們將肺結(jié)核患者分為四組：僅感染腸道原蟲(chóng)者、僅感染腸道蠕蟲(chóng)者、同時(shí)感染腸道原蟲(chóng)和蠕蟲(chóng)者以及未感染任何腸道寄生蟲(chóng)者,進(jìn)一步分析了僅感染腸道原蟲(chóng)和僅感染腸道蠕蟲(chóng)的影響因素以及抗結(jié)核治療時(shí)間長(zhǎng)度對(duì)這兩種感染狀態(tài)的影響。我們發(fā)現(xiàn)有7.3%的肺結(jié)核患者僅感染了腸道原蟲(chóng),其感染譜從高到低分別為人芽囊原蟲(chóng)(6.0%)、阿米巴(1.1%)和人毛滴蟲(chóng)(0.3%)；有7.0%的肺結(jié)核患者僅感染了腸道蠕蟲(chóng),其感染譜從高到低分別為鉤蟲(chóng)(4.3%)、鞭蟲(chóng)(1.9%)、蛔蟲(chóng)(0.5%)和華支睪吸蟲(chóng)(0.3%)；僅有0.5%的肺結(jié)核患者同時(shí)感染了腸道原蟲(chóng)和蠕蟲(chóng)。BMI≤18(AOR=3.30,95%CI=1.44-7.54)和飼養(yǎng)家禽或家畜(如,雞、鴨、豬)(AOR=3.96,95%CI=1.32-11.89)是肺結(jié)核患者僅感染腸道原蟲(chóng)的危險(xiǎn)因素；BMI≤18(AOR=3.32,95%CI=1.39-7.91)、貧血(AOR=3.40,95%CI=1.44-8.02)和曾在農(nóng)田赤腳勞動(dòng)(AOR=4.54,95%CI=1.88-10.92)是肺結(jié)核患者僅感染腸道蠕蟲(chóng)的危險(xiǎn)因素。我們也未發(fā)現(xiàn)抗結(jié)核治療時(shí)間長(zhǎng)度與腸道原蟲(chóng)和蠕蟲(chóng)感染率之間存在劑量反應(yīng)關(guān)系�？偟膩�(lái)說(shuō),采取改善營(yíng)養(yǎng)狀況、避免非保護(hù)性接觸原蟲(chóng)宿主、開(kāi)展良好衛(wèi)生習(xí)慣方面的健康教育(如外出要穿鞋)等措施有助于在肺結(jié)核患者中預(yù)防腸道原蟲(chóng)和蠕蟲(chóng)的感染。 第四,在流行病學(xué)調(diào)查的基礎(chǔ)上,我們對(duì)結(jié)核菌和腸道寄生蟲(chóng)感染時(shí)宿主機(jī)體免疫反應(yīng)的變化情況進(jìn)行了研究。有研究顯示,體液免疫和細(xì)胞免疫在結(jié)核菌感染時(shí)對(duì)宿主機(jī)體發(fā)揮著保護(hù)性作用,但也有研究顯示,鉤蟲(chóng)感染可降低宿主對(duì)鉤蟲(chóng)和其他同時(shí)存在的病原體的免疫反應(yīng)。因此,為了評(píng)估結(jié)核菌和鉤蟲(chóng)雙重感染時(shí)宿主機(jī)體B、T淋巴細(xì)胞免疫反應(yīng)的變化情況,我們從前期流行病學(xué)調(diào)查的研究對(duì)象中選擇了17個(gè)感染鉤蟲(chóng)的肺結(jié)核患者、26個(gè)未感染任何腸道寄生蟲(chóng)的肺結(jié)核患者、15個(gè)感染鉤蟲(chóng)的健康對(duì)照和24個(gè)未感染任何腸道寄生蟲(chóng)的健康對(duì)照,利用多色流式細(xì)胞術(shù)對(duì)所選研究對(duì)象外周血中CD3、CD4、 CD8、CD10、CD19、CD20、CD21、CD25、CD27、CD38、FoxP3和PD-1的表達(dá)進(jìn)行了檢測(cè)。對(duì)于感染鉤蟲(chóng)的肺結(jié)核患者,其B淋巴細(xì)胞亞群(CD19+)中的幼稚B細(xì)胞(CD10-CD27-CD21+CD20+)、漿細(xì)胞(CD10-CD27+CD21-CD20-)和組織樣記憶B細(xì)胞(CD10-CD27-CD21-CD20+)的比例較其他組高,靜息記憶B細(xì)胞(CD10-CD27+CD21+CD20+)的比例較其他組低,而活化的記憶B細(xì)胞(CD10-CD27+CD21-CD20+)的比例在各組之間無(wú)差異；其T淋巴細(xì)胞亞群(CD3+)中的調(diào)節(jié)性T細(xì)胞(CD4+CD25+Foxp3+)、耗竭性CD4+T細(xì)胞(CD4+PD-1+)和耗竭性CD8+T細(xì)胞(CD8+PD-1+)的比例較其他組高,活化的CD4+T細(xì)胞(CD4+CD38+)和活化的CD8+T細(xì)胞(CD8+CD38+)的比例較其他組低。結(jié)果表明,在結(jié)核菌和鉤蟲(chóng)雙重感染時(shí)宿主機(jī)體的體液免疫反應(yīng)和細(xì)胞免疫反應(yīng)均可能受到更多抑制,從而導(dǎo)致肺結(jié)核患者的不良治療結(jié)局以及增大其在人群中傳播的機(jī)會(huì),提示在結(jié)核病和腸道寄生蟲(chóng)病雙重流行區(qū)域預(yù)防和控制雙重感染的重要性。 綜上所述,雖然我們?cè)谖覈?guó)中部農(nóng)村地區(qū)開(kāi)展了結(jié)核菌和腸道寄生蟲(chóng)雙重感染的流行病學(xué)調(diào)查,但卻發(fā)現(xiàn)西南地區(qū)結(jié)核病和腸道寄生蟲(chóng)病雙重流行的風(fēng)險(xiǎn)要高于中部地區(qū),因此我們建議在我國(guó)西南地區(qū)開(kāi)展結(jié)核菌和腸道寄生蟲(chóng)雙重感染的流行病學(xué)調(diào)查,全面了解當(dāng)?shù)匾咔?并采取有針對(duì)性的干預(yù)措施控制雙重感染的發(fā)生和發(fā)展。我們認(rèn)為在雙重流行的高風(fēng)險(xiǎn)地區(qū)要采取大力發(fā)展當(dāng)?shù)亟?jīng)濟(jì)、改善人群營(yíng)養(yǎng)狀況、強(qiáng)化大眾健康教育以及培養(yǎng)大眾良好衛(wèi)生習(xí)慣的綜合防控雙重感染的措施,同時(shí)要對(duì)肺結(jié)核患者進(jìn)行腸道寄生蟲(chóng)感染的篩查,尤其是女性患者和久治不愈的患者,還要制定抗結(jié)核和驅(qū)蟲(chóng)的聯(lián)合用藥方案對(duì)雙重感染患者進(jìn)行規(guī)范治療。
[Abstract]:Tuberculosis and intestinal parasitology in China are still an important public health problem endangering the health of the people and affecting social and economic development. At present, some studies have been carried out on the spatial distribution characteristics of tuberculosis and intestinal parasitic diseases in local areas. However, the prevalence of tuberculosis and intestinal parasites at the national scale are also studied. The study of the spatial distribution characteristics of the infection rate and its influencing factors is very short. At the same time, the study of the spatial distribution of the double epidemic regions of the two types of diseases is still blank. Regions cause transmission, so double epidemic areas are high risk areas for double infection. And double infection may cause more harm than single pathogens or two types of pathogens alone. Therefore, we have studied the dual epidemic of tuberculosis and intestinal parasitology in China from these aspects, and provide technical support for the national prevention and control planning for the formulation of two kinds of diseases.
First, we analyzed the ecological factors affecting the tuberculosis epidemic and the spatial differences of these factors at the national scale, and we collected 2001- from the national tuberculosis control program (2001-2010 years), the 2002-2011 year Chinese Health Statistics Yearbook, the 2002-2011 year Chinese unification Yearbook and the provincial government portal. The related data in 2010 are used to extract potential variables (tuberculosis and ecological factors) from these data by factor analysis, and then use the partial least squares path model to establish the structural equation model of the epidemic and ecological factors of tuberculosis. We have extracted the "tuberculosis epidemic" and "tuberculosis prevention and control input level", "tuberculosis control service level", "health input level", "health level of residents", "socioeconomic level", "air quality", "climate factors" and "geographical factors" altogether 8 ecology. The results show that "tuberculosis control input level", health input level, socioeconomic level, air quality, climate factors and geographical factors have a clear and interpretable effect on "tuberculosis epidemic", and in these ecological factors, "tuberculosis control input level" and "Wei" are not considered. The "socioeconomic level" and "geographical factors" have a relatively strong impact on the "tuberculosis epidemic" on the premise of a direct and significant impact on the epidemic. Furthermore, the study shows that the impact of each ecological factor on the "tuberculosis epidemic" varies in different regions, showing significant vacant levels. These results suggest that we should not only consider the impact of a variety of factors, but also take measures and measures adapted to local conditions in the formulation of the national tuberculosis prevention and control plan.
On the basis of this study, we predict the spatial distribution characteristics of the prevalence of tuberculosis in 2010 at the national scale, which helps to allocate the limited resources of the national tuberculosis prevention and control program. We use the data of the prevalence rate of the fifth tuberculosis epidemiological survey in 2010 to carry out the general Kerrey Lattice interpolation to generate a map of the prevalence of tuberculosis on a continuous surface. In order to generate a more accurate prediction map, we evaluated the prediction of common Craig interpolation and cooperative Craig interpolation with socioeconomic factors and geographical factors as covariate in different conditions (detrending type, semi variance function model and anisotropy). According to the results, we selected the global cooperative Craig interpolation using socioeconomic factors and geographical factors as the covariate as the best interpolation method, and generated a prediction map of the prevalence of tuberculosis. The prediction map shows that the prevalence rate of tuberculosis in China is lower in the Beijing, Tianjin, Shanghai and southeast coastal areas, in the West and in the West. The southwest region is high in the middle region and presents a state of high and low staggered distribution. By evaluating the optimal interpolation method, the influence of socioeconomic factors and geographical factors on the epidemic situation of tuberculosis in China is confirmed again.
Second, we explored the spatial distribution characteristics of the dual epidemic of tuberculosis and intestinal parasitosis at the national scale. We used the data of the prevalence of the survey points in the 2010 National fifth tuberculosis epidemiological survey and the survey point of the infection rate of the survey of the status of the second national human weight parasitism survey completed in 2004. The data collection of social economic, climatic, geographical and environmental factors for 2001-2010 years is collected on the web site which provides data resources. The relationship between tuberculosis and intestinal worms infection and socioeconomic, climatic, geographical and environmental factors is analyzed by fitting Bayesian statistical logistic regression model. On the basis of the Bayesian common component model, we jointly analyze the prediction maps of the two types of diseases and generate the relative risk map of the dual epidemic (common components) of the two types of diseases. The component model is to assess the proportion of the total variance and exclusive variance of two types of diseases, which account for the relative risk in the space, on the premise of the potential common risk factors, and then analyze the common components and the proprietary components of the relative risk of the two types of diseases. The results show that the prevalence of pulmonary tuberculosis in higher areas with higher GDP per capita is lower than that in the higher areas. In rural areas, arid and alpine climates and high altitude regions are high levels of the prevalence of tuberculosis; the rate of intestinal helminth infection is low in higher areas with per capita GDP and in areas far away from the water source, while the warm and wet regions and the higher normalized vegetation index areas are high levels of the infection rate of intestinal worms. The picture shows that the western region of China is the middle and high level area of the prevalence of tuberculosis, but it is a low level area of the infection rate of the intestinal worms; the north region and the southeast coastal area are the middle and low level area of the prevalence of tuberculosis, and the low level of the infection rate of the intestinal worms; the southwest is the middle and high water of the prevalence of tuberculosis. The flat area is also a high level area for the infection rate of intestinal worms. According to the analysis of the Bayesian common component model, we found that the southwest region is a dual epidemic area of tuberculosis and intestinal parasitic infection in China, and that the socioeconomic factors, such as per capita GDP, may be potential common risk factors. Therefore, we should put two types of diseases. The dual epidemic area of disease is a priority area for disease prevention and control, and a dual infection prevention and control strategy is established to improve local social and economic level.
Third, after completing a national scale study, we carried out an epidemiological survey of the dual infection of human tuberculosis and intestinal parasites. We conducted a cross-sectional survey in an agricultural county in Henan Province, which was the same age as tuberculosis patients in the county and in the neighbouring region (with the community or the same village). A questionnaire survey was conducted among healthy controls matched by 5 years of age. The questionnaire included social demography, health, health habits, and farmland work, and collected feces and blood samples from their feces, blood routine and HIV tests. We used Pearson x2 test to infect intestinal parasites. A single factor analysis (OR value and 95%CI) was used to adjust potential confounding factors (AOR and 95%CI) with multiple factor Logistic regression models. Furthermore, we used the Mantel-Haenszel chi 2 test to analyze the effect of the time length of anti tuberculosis treatment on the infection rate of intestinal parasites. We included 369 tuberculosis patients and 366 healthy controls. The total infection rate of intestinal parasites in the patients with pulmonary tuberculosis was 14.9%, of which the infection rate of intestinal protozoa was 7.9%, the infection rate of intestinal worms was 7.6%, and the infection spectrum from low to high was Mao Dichong (0.3%), Clonorchis sinensis (0.3%), Ascaris (0.5%), Amiba (1.4%), flagellum (2.2%), hookworm (4.6%) and human bud bursoma (6.2%). We did not find a significant difference in the total infection rate of the intestinal parasites in the pulmonary tuberculosis patients and the healthy controls, and there were no factors that could lead to the difference in the total infection rate between the two groups, but women (AOR=2.05,95%CI=1.01-4.17), BMI < 19 (AOR=3.02,95%CI=1.47-6.20) and anemia (AOR=2.43,95%CI= 1.17-5.03) is a risk factor for the infection of intestinal parasites in patients with pulmonary tuberculosis; and the average working time of 2 months (AOR=4.50,95%CI=2.03-10.00) is a risk factor for the infection of intestinal parasites in healthy controls. In addition, we have not found a dose response relationship between the length of anti tuberculosis treatment time and the rate of intestinal parasite infection. In this study, we have not yet obtained evidence that tuberculosis patients are susceptible to intestinal parasites, but it is found that in patients with tuberculosis, women and those with poor health are more likely to infect intestinal parasites.
We divided the pulmonary tuberculosis patients into four groups: infected with intestinal protozoa only, infected with intestinal helminth only, infected with intestinal protozoa and worms, and those who did not infect any intestinal parasites, further analyzed the factors affecting intestinal protozoa and only infection of intestinal worms, and the length of anti tuberculosis treatment time to these two infections. We found that 7.3% of tuberculosis patients were infected only with intestinal protozoa, whose infection spectrum was from high to low (6%), Amiba (1.1%) and human Mao Dichong (0.3%); 7% of tuberculosis patients were infected only with intestinal worms, and the infection spectrum from high to low were hookworm (4.3%), flagellum (1.9%), Ascaris (0.5%) and Chinese branch. Testosterone (0.3%); only 0.5% of tuberculosis patients infected with intestinal protozoa and worm.BMI less than 18 (AOR=3.30,95%CI=1.44-7.54) and poultry or domestic animals (such as chickens, ducks, pigs) (AOR=3.96,95%CI=1.32-11.89) were the risk factors for the infection of the intestinal protozoa only in the patients with pulmonary tuberculosis; BMI < 18 (AOR=3.32,95%CI=1.39-7.91), anemia (AOR=3.40,95%CI=). 1.44-8.02) and former cropland barefoot labor (AOR=4.54,95%CI=1.88-10.92) are the risk factors for the only infection of intestinal worms in patients with tuberculosis. We have not found a dose response relationship between the length of anti tuberculosis treatment and the rate of intestinal protozoa and worm infection. In general, it is necessary to improve nutritional status and avoid unprotected contact with protozoa. The main idea is to carry out health education in good health habits (such as shoes to go out) and other measures to prevent infection of intestinal protozoa and worms in patients with pulmonary tuberculosis.
Fourth, based on the epidemiological investigation, we studied the changes in the host immune response to the tuberculosis and intestinal parasites. Studies have shown that humoral and cellular immunity play a protective role in the host organism when the Mycobacterium tuberculosis infection is infected, but there are also studies showing that the hookworm infection can reduce the host's effect. The immune responses of the hookworm and other concurrently existing pathogens, so in order to assess the changes in the immune response of the host body B and T lymphocytes during the dual infection of tuberculosis and hookworm, we selected 17 lung nodules from the early epidemiological investigation and 26 lungs that were not infected with any intestinal parasite. TB patients, healthy controls of 15 hookworm infections and 24 healthy controls that were not infected with any intestinal parasite, were tested by polychromatic cytometry for the expression of CD3, CD4, CD8, CD10, CD19, CD20, CD21, CD25, CD27, CD38, FoxP3 and PD-1 in the peripheral blood of selected subjects.
【學(xué)位授予單位】：中國(guó)疾病預(yù)防控制中心
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R52;R53
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本文編號(hào)：2029274