本文選題：瘧疾 + 發(fā)病率　； 參考：《中國(guó)疾病預(yù)防控制中心》2008年博士論文

【摘要】： 背景:瘧疾是一種由瘧原蟲(chóng)引起的、經(jīng)按蚊叮咬而傳播的重要的寄生蟲(chóng)病。全球仍有107個(gè)國(guó)家和地區(qū),約32億人口受到瘧疾的威脅,每年有3億多人受感染,病死者超過(guò)100萬(wàn)。上世紀(jì)50、60年代,我國(guó)瘧疾流行嚴(yán)重,經(jīng)過(guò)半個(gè)多世紀(jì)的努力,我國(guó)瘧疾防治工作取得巨大成效,20世紀(jì)末全國(guó)瘧疾疫情下降到最低,但近年來(lái)瘧疾發(fā)病數(shù)呈明顯回升。2000年以來(lái)以安徽省為代表的中部地區(qū)在北緯32°以北的單一中華按蚊區(qū)陸續(xù)出現(xiàn)瘧疾疫情回升、小暴發(fā)點(diǎn)或局部暴發(fā)流行。影響瘧疾流行的因素復(fù)雜,寄生蟲(chóng)、蚊媒、人類(lèi)宿主和環(huán)境等因素及其交互作用決定了瘧疾傳播和感染的風(fēng)險(xiǎn)。近年來(lái)基于地理信息系統(tǒng)的3S已成為瘧疾等自然疫源性傳染病研究新的技術(shù)手段與方法,而將統(tǒng)計(jì)學(xué)方法與空間技術(shù)相結(jié)合也成為一個(gè)新的研究方向。 目的:通過(guò)對(duì)20世紀(jì)90年代以來(lái)安徽省瘧疾疫情時(shí)空分析及影響因素研究,為該省及類(lèi)似地區(qū)的瘧疾防控提供科學(xué)依據(jù)。通過(guò)嘗試3S空間分析技術(shù)與統(tǒng)計(jì)分析方法在瘧疾研究領(lǐng)域的綜合應(yīng)用,為類(lèi)似的研究提供方法學(xué)參考。 方法:收集整理1990～2006年安徽省瘧疾疫情監(jiān)測(cè)數(shù)據(jù),安徽省1:1 000 000縣區(qū)級(jí)數(shù)字區(qū),并加工處理安徽省1:5萬(wàn)的鄉(xiāng)鎮(zhèn)邊界圖。采用空間分析技術(shù)提取安徽省各鄉(xiāng)鎮(zhèn)溫度、降雨量等氣象監(jiān)測(cè)數(shù)據(jù),海拔、NDVI、濕度指數(shù)、水體等環(huán)境數(shù)據(jù)以及人口、GDP等數(shù)據(jù),建立鄉(xiāng)鎮(zhèn)瘧疾流行的地理信息系統(tǒng)數(shù)據(jù)庫(kù)。對(duì)淮北地區(qū)高發(fā)自然村莊采用抽樣調(diào)查及GPS定位的方法,收集居民生產(chǎn)生活及行為因素、瘧疾病例診治及水體定位等相關(guān)信息,建立村莊尺度的研究數(shù)據(jù)庫(kù)。綜合應(yīng)用時(shí)空掃描聚類(lèi)分析方法、時(shí)間序列分析方法、主成分分析及l(fā)ogistic回歸模型、Poisson回歸模型等統(tǒng)計(jì)分析方法對(duì)資料進(jìn)行分析處理。所采用的軟件包括Arc GIS 9.0軟件、SaTScan7.0空間聚類(lèi)分析軟件、SAS9.1及SPSS13.0統(tǒng)計(jì)分析軟件。 結(jié)果:①“2004～2006年淮北地區(qū)”是安徽省20世紀(jì)90年代以來(lái)瘧疾流行新“熱點(diǎn)”,淮北地區(qū)瘧疾傳播季節(jié)延長(zhǎng)。②時(shí)間縱向上,溫度、降雨量與瘧疾發(fā)病率序列呈現(xiàn)顯著的互相關(guān)關(guān)系,即“月平均氣溫”升高則“月瘧疾發(fā)病率”上升,呈現(xiàn)正相關(guān)關(guān)系,在滯后0～3個(gè)月的相關(guān)性均顯著;“月降雨量”增加則“月瘧疾發(fā)病率”上升,在滯后1～3個(gè)月的相關(guān)性顯著,不同的是,其相關(guān)性出現(xiàn)在至少滯后1個(gè)月,表明降雨量與瘧疾發(fā)病間的關(guān)系相對(duì)緩慢一些。③地區(qū)橫向上,安徽省各鄉(xiāng)鎮(zhèn)的瘧疾發(fā)病率與溫度、降雨量、NDVI和海拔因素有關(guān),即“冬季/年最低氣溫”、“年降雨總量”、“海拔”和“NDVI”4個(gè)因素與安徽鄉(xiāng)鎮(zhèn)是否發(fā)生瘧疾有關(guān)。在控制模型中其它自變量不變的情況下,前3個(gè)因素?cái)?shù)值增加,則鄉(xiāng)鎮(zhèn)瘧疾發(fā)生的可能性越小,而NDVI增加,則鄉(xiāng)鎮(zhèn)發(fā)生瘧疾的可能性越大。④淮北地區(qū)居民不良生活生產(chǎn)行為使該地區(qū)瘧疾發(fā)病風(fēng)險(xiǎn)增加,分析結(jié)果顯示,村民露宿習(xí)慣比例每增加1%,村發(fā)生瘧疾病例的風(fēng)險(xiǎn)增加18%,而耕種豆類(lèi)農(nóng)作物也增加了村民發(fā)生瘧疾的危險(xiǎn)。⑤采用2000～2007年5月安徽省瘧疾月發(fā)病率建立的ARIMA時(shí)間序列模型對(duì)2007年6月份的發(fā)病率的預(yù)測(cè)值為5.437/10萬(wàn),95%可信區(qū)間為[2.308/10萬(wàn),12.808/0萬(wàn)],實(shí)際監(jiān)測(cè)發(fā)病率為5.334/10萬(wàn),預(yù)測(cè)的相對(duì)誤差為1.9%,預(yù)測(cè)效果良好。 結(jié)論:本課題研究重點(diǎn)回答了2000年以來(lái)安徽省瘧疾疫情回升的新的時(shí)空熱點(diǎn)地區(qū),并重點(diǎn)回答了安徽省南北地區(qū)瘧疾疫情存在差異的主要影響因素。淮北地區(qū)除當(dāng)?shù)氐匦蔚孛�、自然環(huán)境等特點(diǎn)影響其瘧疾流行外,當(dāng)?shù)鼐用癫涣嫉纳a(chǎn)生活行為因素加大了蚊媒接觸機(jī)率,增加了瘧疾發(fā)生的機(jī)率,研究結(jié)果具有很現(xiàn)實(shí)的指導(dǎo)意義。研究中雖然沒(méi)有直接得出病例診治及時(shí)性對(duì)該地區(qū)瘧疾疫情的實(shí)際影響,但從控制傳染源的理論出發(fā),瘧疾病人的及時(shí)發(fā)現(xiàn)和治療無(wú)疑也是控制瘧疾疫情流行的重要方面。課題研究結(jié)果將為安徽等我國(guó)中部瘧疾流行地區(qū)建立瘧疾的早期預(yù)警預(yù)測(cè)系統(tǒng)奠定基礎(chǔ)。 此外,時(shí)間序列模型可以很好地?cái)M合瘧疾發(fā)病率在時(shí)間序列上的變動(dòng)趨勢(shì),在人群免疫狀態(tài)、人口流動(dòng)、防制措施等人群瘧疾易感性指標(biāo)沒(méi)有發(fā)生大幅度變化的情況下,可以用來(lái)對(duì)未來(lái)的瘧疾發(fā)病率進(jìn)行預(yù)測(cè),為瘧疾防治工作提供服務(wù)。
[Abstract]:Background: malaria is an important parasitic disease caused by the malaria parasite, which is transmitted by the Anopheles bite. There are still 107 countries and regions around the world, about 3 billion 200 million people are threatened by malaria, more than 300 million people are infected each year and the deceased more than 1 million. In the 50,60 years of last century, China's malaria epidemic was serious, after half a century of efforts, our country The malaria control work has made great achievements, and the malaria epidemic in the whole country declined to the lowest level at the end of twentieth Century, but in recent years, the number of malaria incidence showed an obvious recovery in.2000 years since.2000, the single Anopheles sinensis area in the central region of the north latitude 32 degrees north of the north latitude was gradually rising, the small outbreak point or the local outbreak. The factors such as parasites, mosquito vectors, human hosts and environment and their interaction determine the risk of malaria transmission and infection. In recent years, 3S based on GIS has become a new technical means and method for the research of natural epidemic infectious diseases such as malaria, and the combination of the method of integration and the space technology has also become a one. New research direction.
Objective: to provide scientific basis for the prevention and control of malaria in the province and the similar areas, through the analysis of the spatio-temporal analysis of the epidemic situation of malaria in Anhui province since 1990s, and the comprehensive application of the 3S spatial analysis technique and statistical analysis method in the field of malaria research, and provide a methodological reference for the similar research.
Methods: to collect and collate the data of malaria surveillance in Anhui province for 1990~2006 years, Anhui province 1:1 000000 county level digital area, and processing and processing the township boundary map of 1:5 million in Anhui Province, and using spatial analysis technology to extract the meteorological monitoring data, such as the temperature and rainfall of each township in Anhui Province, the sea drawing, the NDVI, humidity index, water body and other environmental data and population. Based on the data of GDP and other data, the geographic information system database of malaria in villages and towns is set up. The method of sampling survey and GPS positioning for the high incidence natural villages in Huaibei area is adopted to collect the related information of the living and behavioral factors, the diagnosis and treatment of malaria cases and the location of the water body, and to establish the research database of the village scale. Analysis method, time series analysis method, principal component analysis and logistic regression model, Poisson regression model and other statistical analysis methods are used to analyze the data. The software used includes Arc GIS 9 software, SaTScan7.0 spatial clustering analysis software, SAS9.1 and SPSS13.0 statistical analysis software.
Results: (1) the "2004~2006 year Huaibei area" was the new "hot spot" of malaria epidemic in Anhui province since 1990s, and the malaria transmission season in Huaibei region was prolonged. The correlation is significant in the 0~3 month lag; "monthly rainfall" increases, the incidence of "monthly malaria" rises, and the correlation of the lag of 1~3 months is significant. The correlation occurs at least for 1 months, indicating that the relationship between rainfall and malaria is relatively slow. (3) the region is horizontal, Anhui The incidence of malaria in each township is related to the temperature, rainfall, NDVI and altitude factors, namely, "winter / annual minimum temperature", "annual rainfall total", "altitude" and "NDVI", 4 factors are related to the occurrence of malaria in Anhui township. In the control model, the other independent variables are unchanged, the first 3 factors increase, then the township malaria The smaller the possibility of the occurrence, and the increase in NDVI, the greater the possibility of malaria in the villages and towns. (4) the risk of malaria in the Huaibei region increased the risk of malaria in the region. The analysis showed that the proportion of villagers' habit of sleeping was increased by 1%, and the risk of malaria cases increased by 18%, while the cultivated legumes also increased the villagers. The ARIMA time series model based on the monthly incidence of malaria in Anhui province in May of 2000~2007 years was predicted to be 5.437/10 million in June 2007, 95% confidence interval of [2.308/10 million, 12.808/0 million), the actual monitoring incidence was 5.334/10 million, the relative error of pre test was 1.9%, and the prediction effect was good.
Conclusion: the research focuses on the new hot spots of the recovery of malaria in Anhui province since 2000, and emphatically answered the main factors affecting the difference in malaria epidemic in the northern and southern regions of Anhui province. In addition to the local topography, the natural environment and other characteristics of Huaibei, the poor production of local residents Life and behavior factors increase the rate of mosquito contact and increase the probability of malaria. The research results have practical guiding significance. Although the study does not directly affect the actual impact of case diagnosis and treatment on the epidemic situation in this area, the timely discovery and treatment of malaria patients are undoubtedly also from the theory of controlling the source of infection. The results of the study will lay the foundation for the establishment of early warning system for early warning of malaria in Anhui and other malaria endemic areas in Central China.
In addition, the time series model can well fit the change trend of the incidence of malaria in time series. In the case of population immune state, population flow, control measures and others, the malaria susceptibility index can be used to predict the incidence of malaria in the future and provide service for malaria control work.

【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】：2008
【分類(lèi)號(hào)】：R181.8;R531.3

【引證文獻(xiàn)】

相關(guān)期刊論文 前1條

1 吳崧霖;王德全;;GIS和RS技術(shù)在蚊媒傳染病研究中的應(yīng)用進(jìn)展[J];實(shí)用預(yù)防醫(yī)學(xué);2012年01期

相關(guān)碩士學(xué)位論文 前1條

1 楊海翔;基于GIS的長(zhǎng)沙市腎綜合征出血熱時(shí)空分布及其風(fēng)險(xiǎn)因子研究[D];湖南師范大學(xué);2011年

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本文編號(hào)：1780285