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目的了解血吸虫病病原学及血清学检测方法在大山区流行区应用的效果,为制定防治对策提供科学依据。方法采用随机抽样法在大山区血吸虫病未控制县抽取流行程度轻、中、重的1个自然村,每村抽取35户作为调查对象。采用孵化法及Kato-Katz法进行病原学检查,同时采用检测抗体的ELISA和DDIA法对受试者进行血清学检查。结果总感染率为8.26%(29/351),孵化法三送三检与Kato-Katz法三送十二检2种病原学检查方法差异无统计学意义(χ2=1.831,P>0.05),孵化法一送一检与Kato-Katz法一送四检差异也无统计学意义(χ2=0.313,P>0.05)。不同流行程度村的查病结果Kato-Katz法差异无统计学意义(χ2=2.188,P>0.05),孵化法差异有统计学意义(χ2=7.203,P<0.05),DDIA和ELISA法在不同流行程度村的查病结果间差异均有统计学意义(χ2=22.36、36.282,P均<0.01)。ELISA、DDIA2种血清学筛检方法的敏感性、特异性和约登指数分别为65.52%、59.35%、0.25和44.83%、69.79%、0.15。ELISA法优于DDIA法(χ2=19.253,P<0.01)。ELISA结果与粪检有关联,但一致性较差(χ2=5.772,P<0.05,Kappa=0.076762),DDIA结果与粪检无关联(χ2=2.019,P>0.05)。结论防治实际工作中采用收集一次粪便孵化或制作三张Kato-Katz片,分别有62.07%、72.41%的感染者漏检,必将严重低估病情现状。检测血吸虫抗体的ELISA和DDIA2种血清学筛查方法将漏检34.48%、55.17%感染者,成为血吸虫病病情反弹的原因之一。
Objective To understand the application of schistosomiasis etiology and serological detection methods in the endemic areas of mountainous areas and provide a scientific basis for the development of control strategies. Methods A random sampling method was used to select one natural village with mild, moderate and severe epidemic proportions in the uncontrolled counties of schistosomiasis in the mountainous area, and 35 households in each village were selected as the survey subjects. Pathogenicity was tested by hatching method and Kato-Katz method. ELISA and DDIA were also performed on the subjects for serology. Results The total infection rate was 8.26% (29/351). There was no significant difference in the two etiological tests between the three methods of hatching method and Kato-Katz method (χ2 = 1.831, P> 0.05) There was also no significant difference between hatching test and Kato-Katz test (χ2 = 0.313, P> 0.05). Kato-Katz test showed that there was no significant difference in Kato-Katz test (χ2 = 2.188, P> 0.05), hatching method was statistically significant (χ2 = 7.203, P <0.05) The epidemiological village of the results of the difference between the two were statistically significant (χ2 = 22.36,36.282, P <0.01). The sensitivity, specificity and Youden index of ELISA and DDIA serological screening methods were 65.52%, 59.35%, 0.25 and 44.83%, 69.79% and 0.15 respectively. ELISA method was better than DDIA method (χ2 = 19.253, P <0.01). The results of ELISA were correlated with excrement tests, but the concordance was poor (χ2 = 5.772, P <0.05, Kappa = 0.076762). There was no correlation between DDIA and fecal examination (χ2 = 2.019, P> 0.05). Conclusion In the actual prevention and treatment work, we collected a faecal incubation or produced three Kato-Katz tablets, respectively. 62.07% and 72.41% of the infected patients missed the test, which would seriously underestimate the status quo. ELISA and DDIA2 serological tests to detect schistosoma japonicum antibody would miss 34.48% and 55.17% of those infected, making them one of the reasons for the rebound of schistosomiasis.