2013—2019年四川省凉山彝族自治州HIV/AIDS与结核病时空分布特征及相关性分析

doi:10.3969/j.issn.1000-6621.2021.07.012

摘要/Abstract

摘要： 目的比较2013—2019年四川省凉山彝族自治州(简称“凉山州”)HIV感染和艾滋病(HIV/AIDS)与结核病报告病例的时间及空间分布,分析两种疾病时间与空间的相关性和报告病例的热点地区,为制订相应的防治策略提供参考依据。方法通过中国疾病预防控制中心《传染病网络直报信息系统》,收集2013—2019年四川省凉山州HIV/AIDS与结核病报告病例数据。应用SPSS 23.0软件进行简单相关及线性回归分析,运用ArcGIS 10.0软件进行全局空间自相关和局部空间自相关分析,应用GeoDa 1.1.4软件进行双变量空间自相关分析。结果 2013—2019年凉山州17个县(区)均报告HIV/AIDS和结核病病例;各年度报告HIV/AIDS病例数分别为4139、4406、4005、4802、5570、10105和4694例,历年环比增长率分别为6.5%、-9.1%、19.9%、16.0%、81.4%、-53.5%;各年度报告结核病病例数分别为4590、4323、4453、5931、6748、6432和6893例,历年环比增长率分别为-5.8%、3.0%、33.1%、13.8%、-4.7%、7.2%。线性回归分析结果表明,凉山州HIV/AIDS与结核病报告病例数的相关系数(r_s)与年份(x)之间符合线性分布,线性回归方程为:r_s=-106.602+0.53x(回归系数检验:t=3.109,P=0.027),拟合优度一般(决定系数R ²=0.659,校正系数R ²=0.591)。全局空间自相关分析显示,HIV/AIDS报告发病率2013—2018年存在空间正相关(Moran’sI值分别为0.213、0.194、0.342、0.368、0.271、0.180,P值分别为0.028、0.033、0.003、0.002、0.008和0.027);结核病报告发病率2013—2019年均存在中等程度及以上空间正相关(Moran’sI值分别为0.374、0.500、0.451、0.347、0.487、0.472和0.532,P值均<0.05)。局部空间自相关分析显示,2013—2018年凉山州昭觉县、布拖县、金阳县为HIV/AIDS报告病例的热点地区。2013—2015年,结核病热点地区主要集中在雷波县、美姑县、金阳县;甘洛县2015—2017年是热点地区;昭觉县2014年加入热点地区,自2016年起持续成为热点地区,并辐射至越西县。双变量全局空间自相关分析显示,2013—2019年HIV/AIDS和结核病报告发病率均为正相关(Moran’sI值分别为0.312、0.345、0.385、0.419、0.388、0.345、0.293,P值均<0.05)。结论 HIV/AIDS与结核病报告病例在时空分布上存在较强的正相关性,提示凉山州在传染病防控工作中,要将两种疾病同等重视,紧密结合,提高对HIV和结核分枝杆菌双重感染者的诊疗水平,加强对重点地区、重点人群的防治措施,完善诊疗和保障水平。

关键词: 结核, HIV感染, 获得性免疫缺陷综合征, 时空聚类分析

Abstract: Objective To compare the temporal and spatial distribution of reported cases of HIV infection and AIDS (HIV/AIDS) and tuberculosis in Liangshan Yi Autonomous Prefecture (Liangshan Prefecture) in Sichuan from 2013 to 2019, and analyze the temporal and spatial correlation of the two diseases and the hot areas of the disease, so as to provide reference for formulating prevention and control strategies. Methods Numbers of reported HIV/AIDS and tuberculosis cases between 2013 and 2019 were collected from internet-based reporting system of Chinese Center for Disease Control and Prevention. The temporal and spatial correlation of the two diseases was analyzed by simple correlation, linear regression and spatial autocorrelation. SPSS 23.0 software was used to analyze the simple correlation and linear regression, ArcGIS 10.0 software was used to analyze the global spatial autocorrelation and local spatial autocorrelation, and the dual variable spatial autocorrelation analysis was carried out using GeoDa 1.1.4 software. Results HIV/AIDS and tuberculosis patients were reported from all the 17 counties (districts) in Liangshan Prefecture. The numbers in each year were 4139, 4406, 4005, 4802, 5570, 10105 and 4694, respectively, and the increasing rates were 6.5%, -9.1%, 19.9%, 16.0%, 81.4% and -53.5%, respectively. Numbers of reported tuberculosis cases in each year were 4590, 4323, 4453, 5931, 6748, 6432 and 6893, respectively, and the increasing rates were -5.8%, 3.0%, 33.1%, 13.8%, -4.7% and 7.2%, respectively. The results of linear regression analysis showed that the correlation coefficient (r_s) between numbers of reported cases of HIV/AIDS and tuberculosis in Liangshan Prefecture according to a linear distribution with the year (x). The linear regression equation was: r_s=-106.602+0.53x (regression coefficient test: t=3.109, P=0.027), the goodness of fit was average (determination coefficient R ²=0.659, correction coefficient R ²=0.591). Global spatial autocorrelation analysis showed that there was a positive spatial correlation between the reported incidence of HIV/AIDS from 2013 to 2018 (Moran’sI values were 0.213, 0.194, 0.342, 0.368, 0.271 and 0.180, respectively; P values were 0.028, 0.033, 0.003, 0.002, 0.008 and 0.027, respectively); the reported incidence of tuberculosis from 2013 to 2019 had a positive spatial correlation of medium degree and above (Moran’sI values were 0.374, 0.500, 0.451, 0.347, 0.487, 0.472 and 0.532, respectively; all P<0.05). Local spatial autocorrelation analysis showed that, from 2013 to 2018, Zhaojue County, Butuo County, and Jinyang County in Liangshan Prefecture were hot spots for reported cases of HIV/AIDS. From 2013 to 2015, the hot spots for tuberculosis were mainly concentrated on Leibo County, Meigu County, and Jinyang County; Ganluo County was a hot spot from 2015 to 2017; Zhaojue County became the hot spot in 2014 and had continued to be a hot spot since 2016, and it had spread to Yuexi County. The bivariate global spatial autocorrelation analysis showed that the reported incidence of HIV/AIDS and tuberculosis were positively correlated from 2013 to 2019 (Moran’sI values were 0.312, 0.345, 0.385, 0.419, 0.388, 0.345 and 0.293, respectively; all P<0.05). Conclusion There was a strong positive correlation between HIV/AIDS and tuberculosis reported cases in the temporal and spatial distribution, which suggested that Liangshan Prefecture should pay equal attention to the two diseases in the prevention and control of these two infectious diseases, close combination were needed, the diagnosis and treatment of HIV/AIDS and tuberculosis patients should be improved, the prevention and control measures for key areas and groups should be strengthened, and the diagnosis, treatment and health care should be improved.

Key words: Tuberculosis, HIV infections, Acquired immunodeficiency syndrome, Space-time clustering

李京, 袁风顺, 李婷, 李运葵, 高文凤, 杨成彬, 何金戈, 杨文. 2013—2019年四川省凉山彝族自治州HIV/AIDS与结核病时空分布特征及相关性分析[J]. 中国防痨杂志, 2021, 43(7): 708-715. doi: 10.3969/j.issn.1000-6621.2021.07.012

LI Jing, YUAN Feng-shun, LI Ting, LI Yun-kui, GAO Wen-feng, YANG Cheng-bin, HE Jin-ge, YANG Wen. Spatial and temporal distribution characteristics and correlation analysis of HIV/AIDS and tuberculosis in Liangshan Yi Autonomous Prefecture, Sichuan from 2013 to 2019[J]. Chinese Journal of Antituberculosis, 2021, 43(7): 708-715. doi: 10.3969/j.issn.1000-6621.2021.07.012

图/表 6

表1

表2

表3

图1

图2

表4

参考文献 16

[1]	何金戈, 常壤丹, 王梅引, 等. 四川省结核病患者中艾滋病病毒感染现状及流行特征研究. 预防医学情报杂志, 2013, 29(10):836-840.
[2]	山珂, 徐凌忠, 盖若琰, 等. 中国2002—2011年肺结核流行状况GIS空间分析. 中国公共卫生, 2014, 30(4):388-391. doi: 10.11847/zgggws2014-30-04-02. doi: 10.11847/zgggws2014-30-04-02
[3]	应倩, 陈坤. 应用G统计量分析2006年浙江省肺结核的空间异质性. 中华预防医学杂志, 2012, 46(6):524-526. doi: 10.3760/cma.j.issn.0253-9624.2012.06.010. doi: 10.3760/cma.j.issn.0253-9624.2012.06.010
[4]	周林, 刘二勇. 国内外Mtb与HIV双重感染防治进展与展望. 中国防痨杂志, 2014, 36(9):802-805. doi: 10.3969/j.issn.1000-6621.2014.09.011. doi: 10.3969/j.issn.1000-6621.2014.09.011
[5]	肖月, 夏岚, 宋杨, 等. 四川省结核分枝杆菌与HIV双重感染防治重点区县患者发现效果评价. 寄生虫病与感染性疾病, 2019, 17(4):204-208.
[6]	张克春, 付笑冰, 刘珺, 等. 2007—2017年广东省HIV/AIDS流行时空分布特征. 中华疾病控制杂志, 2018, 22(12):1211-1215. doi: 10.16462/j.cnki.zhjbkz.2018.12.003. doi: 10.16462/j.cnki.zhjbkz.2018.12.003
[7]	刘伦皓, 刘莉, 余刚, 等. 凉山州2005—2016年新发现HIV感染者的流行特征及趋势分析. 中国艾滋病性病, 2018, 24(4):345-347, 356. doi: 10.13419/j.cnki.aids.2018.04.08. doi: 10.13419/j.cnki.aids.2018.04.08
[8]	王启兴, 张素华, 杨淑娟, 等. 四川省凉山州2011—2014年HIV新发感染人群传播途径分析. 中国艾滋病性病, 2017, 23(8):719-722. doi: 10.13419/j.cnki.aids.2017.08.12. doi: 10.13419/j.cnki.aids.2017.08.12
[9]	李婷, 何金戈, 杨长虹, 等. 基于可变形空间扫描统计量法的四川省肺结核聚集性探测研究. 寄生虫病与感染性疾病, 2019, 17(1):18-22.
[10]	吴兵, 袁林, 潘映春, 等. 2009—2013年凉山州肺结核病防治状况分析. 现代预防医学, 2017, 44(5):769-771, 777.
[11]	李婷, 杨长虹, 何金戈, 等. 四川省凉山彝族自治州2011—2016年痰涂片阳性肺结核疫情时空分布特征. 中华流行病学杂志, 2017, 38(11):1518-1522. doi: 10.3760/cma.j.issn.0254-6450.2017.11.016. doi: 10.3760/cma.j.issn.0254-6450.2017.11.016
[12]	刘剑君, 么鸿雁, 刘二勇. 我国结核病疫情与社会经济因素的关系. 中华流行病学杂志, 2004, 25(12):1032-1034. doi: 10.3760/j.issn:0254-6450.2004.12.005. doi: 10.3760/j.issn:0254-6450.2004.12.005
[13]	高文凤, 何金戈, 高媛, 等. 凉山州布拖县HIV/AIDS病人中结核病病原学筛查阳性率分析. 中国艾滋病性病, 2020, 26(11):1157-1160. doi: 10.13419/j.cnki.aids.2020.11.04. doi: 10.13419/j.cnki.aids.2020.11.04
[14]	李婷, 何金戈, 苏茜, 等. 结核菌素试验在四川省布拖县HIV感染/AIDS患者中筛查结核感染的价值. 中国防痨杂志, 2020, 42(9):931-936. doi: 10.3969/j.issn.1000-6621.2020.09.009. doi: 10.3969/j.issn.1000-6621.2020.09.009
[15]	李运葵, 何金戈, 苏茜, 等. 结核病症状筛查在四川省布拖县HIV感染/AIDS患者中发现结核病患者的价值. 中国防痨杂志, 2020, 42(9):937-941. doi: 10.3969/j.issn.1000-6621.2020.09.010. doi: 10.3969/j.issn.1000-6621.2020.09.010
[16]	黄欢, 高文凤, 苏茜, 等. 艾滋病高流行地区HIV感染者结核潜伏性感染诊断方法比较. 中国艾滋病性病, 2020, 26(3):239-242. doi: 10.13419/j.cnki.aids.2020.03.04. doi: 10.13419/j.cnki.aids.2020.03.04

地区	HIV/AIDS(例)								结核病(例)
地区	2013年	2014年	2015年	2016年	2017年	2018年	2019年	合计	2013年	2014年	2015年	2016年	2017年	2018年	2019年	合计
西昌市	331	363	243	385	494	516	551	2883	453	471	428	674	729	580	556	3891
木里藏族自治县	7	11	7	12	24	13	14	88	107	89	117	122	166	147	128	876
盐源县	62	62	64	83	152	183	173	779	137	157	183	365	395	414	331	1982
德昌县	118	100	132	161	135	149	238	1033	56	61	138	107	127	119	94	702
会理县	37	62	68	77	80	76	95	495	307	296	125	149	139	129	124	1269
会东县	47	53	53	59	64	89	64	429	240	305	267	293	324	255	275	1959
宁南县	42	36	46	43	52	65	60	344	120	122	124	161	172	172	213	1084
普格县	161	196	190	253	243	487	337	1867	152	121	199	293	291	333	382	1771
布拖县	701	906	516	624	958	2526	793	7024	133	179	150	313	266	291	470	1802
金阳县	191	158	268	344	373	575	250	2159	501	476	330	468	509	425	474	3183
昭觉县	1213	904	849	857	941	1812	489	7065	393	445	306	329	498	773	709	3453
喜德县	120	161	129	162	183	439	389	1583	170	156	125	373	431	462	536	2253
冕宁县	152	155	183	258	264	262	343	1617	256	191	201	225	262	320	316	1771
越西县	379	555	594	632	708	1532	438	4838	328	238	475	645	767	566	671	3690
甘洛县	104	128	176	233	269	461	126	1497	480	251	476	484	466	413	461	3031
美姑县	407	465	406	498	527	844	244	3391	357	308	383	528	634	660	588	3458
雷波县	67	91	81	121	103	76	90	629	400	457	426	402	572	373	565	3195
合计	4139	4406	4005	4802	5570	10105	4694	37721	4590	4323	4453	5931	6748	6432	6893	39370