本文選題：瘧疾 + 病例對照研究�。� 參考：《大理學(xué)院》2013年碩士論文

【摘要】：[背景]瘧疾是嚴(yán)重危害人類健康的傳染性寄生蟲病,是全球主要公共衛(wèi)生問題之一。中國是近年瘧疾防治成效最為顯著的國家之一,2010年啟動了中國消除瘧疾行動計劃2010-2020。云南邊境地區(qū)是我國瘧疾流行最為嚴(yán)重,消除最為困難的地區(qū)。鑒定邊境地區(qū)境內(nèi)外瘧疾感染的危險因素,是減少輸入性瘧疾病例和阻斷當(dāng)?shù)貍鞑?實(shí)現(xiàn)消除瘧疾目標(biāo)的基礎(chǔ)。[目的]鑒定云南邊境地區(qū)瘧疾感染的危險因素及其程度；探討邊境地區(qū)預(yù)防瘧疾,減少輸入性病例和防止第二代病例發(fā)生的策略和措施。[方法]在云南省騰沖和盈江,兩個目前瘧疾最多的縣,對2010年9月-2011年12月報告的瘧疾病例,采用病例對照研究法調(diào)查瘧疾感染的危險因素；納入病例組和對照組人數(shù)比為1：2。調(diào)查前均對病例組血片進(jìn)行復(fù)查以確保是確診病例,對對照組進(jìn)行血檢,確保其未感染瘧疾。數(shù)據(jù)處理首先分別計算病例組和對照組中各因素的百分比或均數(shù),并進(jìn)行統(tǒng)計學(xué)差異顯著性檢驗(yàn)；然后以確診瘧疾作結(jié)果變量,其它因素作解釋變量,對瘧疾感染的潛在危險因素進(jìn)行逐步Logistic回歸分析,并通過多因素Logistic回歸分析控制混雜效應(yīng)。[結(jié)果]共完成642人的調(diào)查,其中男性582(90.7%)。根據(jù)排除標(biāo)準(zhǔn)檢查調(diào)查對象的有效性,審核完成問卷的完整性和邏輯性后,進(jìn)入分析的病例組人數(shù)是214,對照組人數(shù)是428。病例組平均年齡33.8±10.4歲,對照組34±9.7歲,兩組間無顯著差異(P=0.811)。214例確診病例中,間日瘧176(82.2%)例,惡性瘧38(17.8%)例；其中196(92.0%)系輸入性病例,17(8.0%)系當(dāng)?shù)馗腥荆?28名對照中,74(17.7%)在所對應(yīng)的病例發(fā)病前1個月有出境過夜經(jīng)歷。在國內(nèi)家中無防蚊措施經(jīng)多因素回歸分析排除其它因素混雜效應(yīng)后比值比(OR)是2.39(95%可信區(qū)間/95%CI：1.21-4.71),這顯示國內(nèi)尚未打斷瘧疾傳播,家中無防蚊措施是感染瘧疾的危險因素；發(fā)病前1個月出境的OR值是159.5(75.1-338.9)；在境外,與居住在山區(qū)相比,住在壩區(qū)(含壩邊山腳和城鎮(zhèn))OR值為5.45(2.52-11.80),居住在半山區(qū)的OR值為42.82(5.13-319.75)；居住地點(diǎn)100米內(nèi)有小溪的OR值為15.30(4.25-55.16),有稻田等其它水體的為10.12(4.36-55.76)。但本研究對象中的中低收入者OR值0.22(0.17-0.63),顯示感染瘧疾危險程度更低,原因是出境者通常比不出境者可以獲得更高的經(jīng)濟(jì)收入；出境伐木者OR值2.44(0.36-16.76),不能證明出境伐木更容易感染瘧疾；境外居住地周圍50米內(nèi)有森林OR值是0.44(0.08-2.36),住窩棚的OR值是0.71(0.16-3.23),不能說明森林和居住條件簡陋增加了瘧疾感染的危險程度,原因還是境外的瘧疾高流行區(qū)是壩區(qū)和半山區(qū),而山區(qū)多森林,居住條件簡陋；出境人員中無任何防蚊措施OR值是0.33(0.15-0.75),顯示在境外高瘧區(qū)僅靠蚊帳等防蚊措施的保護(hù)作用是相當(dāng)有限。[結(jié)論]出境是云南邊境地區(qū)的主要瘧疾感染危險因素,感染瘧疾的危險程度與境外的居住地點(diǎn)相關(guān),居住在壩區(qū)和半山區(qū),居住地周圍有媒介按蚊孳生地者,感染瘧疾的危險度更高；同時,云南邊境地區(qū)的瘧疾傳播條件依然存在,仍然有當(dāng)?shù)馗腥静±?使用防蚊措施可以減少瘧疾感染。但出境感染瘧疾的危險程度與在境外從事的活動,境外居住點(diǎn)附近是否有森林和居住條件好壞無關(guān)；在境外高瘧區(qū)僅靠媒介防護(hù)措施的作用是相當(dāng)有限,建議為出境到境外高瘧區(qū)者提供預(yù)防服藥服務(wù)。
[Abstract]:[background] malaria is an infectious parasitic disease that seriously endangers human health. It is one of the major public health problems in the world. China is one of the most significant countries in recent years. China has launched the China malaria elimination action plan (2010-2020.) in 2010. The Yunnan border area is the most serious and difficult to eliminate in China. The identification of the risk factors for malaria infection within and outside the border areas is the basis for reducing the input malaria cases and blocking local transmission and achieving the goal of eliminating malaria. [Objective] to identify the risk factors and degree of malaria infection in the border areas of Yunnan, to explore the prevention of malaria in the border areas, to reduce the input cases and to prevent the second generation of cases. Methods and measures. [Methods] a case control study was used to investigate the risk factors for malaria infection in two malaria cases in Tengchong and Yingjiang, Yunnan province and Yingjiang, the most malaria cases in December September 2010, and the number of cases group and control group was rechecked to ensure that the case group was rechecked before 1:2.. A confirmed case, blood test of the control group to ensure that it was not infected with malaria. Data processing first calculated the percentage or average of the factors in the case group and the control group, and carried out the statistical difference test; then the diagnosis was made by the diagnosis of malaria as the result variable, the other factors were used as the explanatory variables, and the potential risk factors for malaria infection were entered. Stepwise Logistic regression analysis and multiple factor Logistic regression analysis were used to control the confounding effect. [results] a total of 642 people were investigated, of which 582 (90.7%) were male. The number of cases enrolled in the analysis was 214 and the number of the control group was 428. after examining the validity of the subjects according to the exclusion criteria and examining the completeness and logic of the completed questionnaire. The average age of the case group was 33.8 + 10.4 years, and the control group was 34 + 9.7 years old. There was no significant difference between the two groups (P=0.811).214 cases, 176 (82.2%) and 38 (17.8%) cases of Plasmodium falciparum; 196 (92%) was an input case, 17 (8%) was a local infection. The ratio Ratio ratio (OR) was 2.39 (95% confidence interval /95%CI:1.21-4.71) after multiple factor regression analysis, which showed that there was no interruption of malaria transmission in China, and no mosquito prevention measures were the risk factors for malaria in home. The OR value of outbound 1 months before the onset of disease was 159.5 (75.1-338.9); Overseas, the OR value of living in the dam area (including the foot and town of the dam) is 5.45 (2.52-11.80), and the OR value of the living in the semi mountainous area is 42.82 (5.13-319.75), the OR value of the brook is 15.30 (4.25-55.16) and 10.12 (4.36-55.76) with the other water in the rice field, but the middle and low income person of the research object has OR value 0.2. 2 (0.17-0.63) shows that the risk of malaria infection is lower, because outbound people usually get higher economic income than non outbound ones; outbound lumber OR value 2.44 (0.36-16.76) can not prove that outbound logging is more susceptible to malaria; the OR value of forest within 50 meters around overseas residences is 0.44 (0.08-2.36) and the OR value of shelters is 0.71 (0.). 16-3.23) it is not clear that the poor forest and living conditions have increased the risk of malaria infection, because the high epidemic areas abroad are the dam area and the semi mountainous area, and the mountainous forests and the living conditions are simple; there is no anti mosquito measure of 0.33 (0.15-0.75) of the outbound personnel, which shows that the anti mosquito measures, such as the mosquito net only in the high malaria area abroad, show that the anti mosquito measures are only based on the mosquito nets. The protective effect is quite limited. [Conclusion] exit is a major risk factor for malaria infection in the border areas of Yunnan. The risk of malaria is related to the place of residence abroad, living in the dam and semi mountainous areas, and the population of Anopheles vectors around the residence, and the risk of malaria is higher; meanwhile, the transmission of malaria in the border region of Yunnan is transmitted. The conditions of sowing still exist and there are still cases of local infection, and the use of anti mosquito measures can reduce malaria infection. However, the risk of outbound malaria is irrelevant to whether there are forests and living conditions near overseas sites, and the role of media protection only in the high malaria area abroad is limited. Those who leave the country to the high malaria area provide preventive medicine service.

【學(xué)位授予單位】：大理學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R382.31

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