西藏地区1 172例包虫病患者临床流行病学分析

Clinical characteristics and prognosis of echinococcosis in Tibet: An analysis of 1 172 cases

  • 摘要:
      背景  包虫病(Echinococcosis)是一种世界范围内流行的人畜共患疾病,我国西藏地区包虫病高发,但当地对该病的了解依然欠缺。
      目的  分析近年来西藏地区包虫病住院患者的临床特点及影响其疾病转归的因素。
      方法  回顾性分析2013年8月1日- 2018年8月1日在西藏自治区人民医院诊断为包虫病的1 172例住院患者的病例资料,并对患者进行定期随访,分析其临床诊治特点及疾病转归。
      结果  1 172例患者中,男性484例,占41.3%,平均年龄(39.3±19.5)岁;女性688例,占58.7%,平均年龄为(41.3±17.7)岁。48.0%的患者来自那曲,职业分布中农牧民占71.5%。临床症状与包虫寄生部位相关,部分患者可无任何相关症状或体征。最常见的寄生部位为肝,亦发现一些罕见部位的包虫病,如纵隔、甲状腺、子宫、肌肉等,83.7%的患者仅有一个受累部位。除220例预后不详外,489例(41.7%)完全治愈,256例(21.8%)好转,205例(17.5%)未愈,2例死亡。年龄对于包虫病患者的预后存在影响(OR=0.992,95% CI:0.984 ~ 1.000),年龄越大,预后越差。与未治疗相比,手术联合药物治疗可显著改善患者预后(OR=216.618,95% CI:124.650 ~ 376.441)。
      结论  针对西藏地区包虫病的科普教育及预防工作有待加强,年龄对于包虫病患者预后存在影响,手术联合药物治疗可显著改善患者预后。

     

    Abstract:
      Background  Echinococcosis is a worldwide endemic zoonotic disease with a high prevalence in Tibet, while the local awareness of this disease is still low.
      Objective  To analyze the clinical characteristics of hospitalized patients with echinococcosis in Tibet in recent years and the factors affecting their disease prognosis.
      Methods  Clinical data about 1 172 hospitalized patients diagnosed with echinococcosis in the People's Hospital of Tibet Autonomous Region from August 1, 2013 to August 1, 2018 were retrospectively analyzed. The patients were followed up regularly. We analyzed the clinical characteristics and disease outcomes.
      Results   Of the 1 172 patients, 484 (41.3%) cases were male, with an average age of (39.3±19.5) years, and 688 (58.7%) were female, with an average age of (41.3±17.7) years; 48.0% of the patients were from Naqu city. Farmers and herdsmen accounted for 71.5%. Clinical symptoms were associated with the site of hydatid parasitism, and some patients might not have any associated symptoms or signs. The liver is the most frequent location of parasitic cysts, and some rare locations, such as septum, thyroid gland, uterus, and muscle, were also found; 83.7% of the patients had single-organ involvement. Except for 220 cases lost for follow-up, 489 cases (41.7%) were completely cured, 256 cases (21.8%) were improved, 205 cases (17.5%) were not healed (including no change or deterioration of symptoms), and 2 cases died. Age were associated with the prognosis of the patients with echinococcosis, and the odds ratio (OR) was 0.992 (95% CI: 0.984-1.000, P=0.048), indicating that advanced age was associated with poor prognosis. When compared to no treatment, surgery combined with medication significantly improved the prognosis of patients (OR: 216.618, 95% CI: 124.650-376.441, P<0.001).
      Conclusion  Health education to public and prevention of echinococcosis in Tibet need to be strengthened. Age has an effect on the prognosis of patients with echinococcosis. Surgery combined with medical treatment can significantly improve the prognosis .

     

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