中国血吸虫病防治杂志（中英文） ›› 2025, Vol. 37 ›› Issue (4): 371-379.

• 论著 • 上一篇    下一篇

2010—2023年我国发热伴血小板减少综合征流行特征分析

杜珊珊1, 2, 3△，师悦4△，陈曦4，刘慧慧1，张丽杰1*，黄晓霞2, 3*   

  1. 1 中国疾病预防控制中心现场流行病学培训项目（北京 100050）；2 中国疾病预防控制中心病毒病预防控制所（北京 102206）；3 传染病溯源预警与智能决策全国重点实验室（北京 102206）；4 中国疾病预防控制中心传染病处（北京 102206）
  • 出版日期:2025-08-25 发布日期:2025-09-30
  • 通讯作者: 张丽杰zhanglj@chinacdc.cn；黄晓霞huangxx@ivdc.chinacdc.cn
  • 作者简介:杜珊珊，女，助理研究员。研究方向：疾病控制 师悦，女，助理研究员。研究方向：疾病控制
  • 基金资助:
    中国现场流行病学培训项目；国家疾病预防控制局公共卫生人才培养支持项目（01063）

Epidemiological characteristics of severe fever with thrombocytopenia syndrome in China from 2010 to 2023

DU Shanshan1, 2, 3△, SHI Yue4△, CHEN Xi4, LIU Huihui1, ZHANG Lijie1*, HUANG Xiaoxia2, 3*   

  1. 1 Chinese Field Epidemiology Training Program (CFETP), Beijing 100050, China; 2 National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; 3 National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Beijing 102206, China; 4 Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing 102206, China
  • Online:2025-08-25 Published:2025-09-30

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摘要： 目的　分析2010—2023年我国发热伴血小板减少综合征（severe fever with thrombocytopenia syndrome，SFTS）流行特征及病例死亡影响因素，为该病科学防控提供参考。方法　在中国疾病预防控制信息系统传染病报告信息管理系统中获取于2010—2023年报告且经终审的SFTS病例数据，主要包括病例现住址、年龄、性别、职业、发病和死亡时间等，分析SFTS报告病例流行病学特征。以县级行政区为单位，对2010—2023年我国SFTS报告病例发病情况进行空间自相关分析，计算全局Moran’s I指数；基于泊松分布模型对SFTS病例数据进行时空扫描分析，计算相对危险度（relative risk，RR）、对数似然比（logarithmic likelihood ratio，LLR）。采用[χ2]检验和logistic回归模型分析SFTS病例死亡相关因素，采用比值比（odds ratio，OR）表征死亡风险。结果　2010—2023年我国累计报告SFTS病例27 457例，报告病例数由2010年的71例增加至2023年的5 062例，呈上升趋势（b = 5.567，t = 51.35，P < 0.05）；各年发病率在0.005/10万~ 0.359/10万。上述SFTS报告病例中，死亡1 326例，病死率为4.82%；各年病死率在2.70% ~ 12.70%。全国共有27个省份报告SFTS病例，病例主要分布于山东省（7 890例，占28.74%）、河南省（6 286例，占22.89%）、安徽省（5 718 例，占20.83%）、湖北省（3 938例，占14.34%）、辽宁省（1 418 例，占5.16%）、浙江省（990例，占3.61%）和江苏省（957例，占3.49%），上述7省报告病例数占我国SFTS报告病例总数的99.05%（27 197/27 457）。病例发病时间具有季节性特征，以5 ~ 7月为发病高峰；不同省份病例发病时间分布差异有统计学意义（P < 0.01）。27 457例SFTS报告病例中，男性12 894例（占46.96%），女性14 563例（占53.04%）。报告病例年龄以61岁及以上人群为主，占61.27%（16 823/27 457）；职业以农民为主，占84.74%（23 266/27 457）。全局空间自相关分析结果显示，2010—2023年我国SFTS发病率Moran’s I指数值在0.326 2 ~ 0.607 5，其中2011—2023年Moran’s I指数值均有统计学意义，病例分布存在空间聚集性（z = 10.207 ~ 18.101，P均< 0.001）。局部空间自相关分析结果显示，我国SFTS报告病例存在“高⁃高”、“低⁃高”、“高⁃低”和“低⁃低”聚集区，其中“高⁃高”聚集区主要分布于山东省、安徽省、湖北省、河南省及辽宁省，聚集区范围由2011年63个县（市、区）增至2023年134个县（市、区）。逐月时空扫描分析发现3处SFTS报告病例高聚集区，主要包括河南、山东、江苏省和安徽省4省。单因素分析发现，我国SFTS病例死亡相关因素包括省份（[χ2] = 605.48，P < 0.01）、性别（[χ2] = 23.421，P < 0.01）、年龄（[χ2] = 254.18，P < 0.01）、发病至诊断时间间隔（[χ2] = 49.895，P < 0.01）及职业（[χ2] = 30.685，P < 0.01）。多因素logistic回归分析结果表明，山东省［OR = 3.081，95% CI：（2.605，3.643）］、浙江省［OR = 4.280，95% CI：（3.367，5.441）］和江苏省［OR = 2.733，95% CI：（2.059，3.628）］SFTS报告病例死亡风险较高，70岁以上组［> 70 ~ 80岁：OR = 4.511，95% CI：（1.626，12.511）；> 80岁：OR = 3.632，95% CI：（1.241，10.631）］病例死亡风险较高，男性［OR = 1.243，95% CI：（1.114，1.387）］病例死亡风险高于女性，发病至诊断时间间隔≥ 30 d的病例死亡风险较高［OR = 1.660，95% CI：（1.254，2.197）］。结论　近年来我国SFTS报告病例数显著增加，发病范围逐渐扩大，发病具有季节和空间聚集性分布特征，亟需制定有针对性的防控措施。

关键词: 发热伴血小板减少综合征, 流行特征, 空间聚集性, 空间自相关

Abstract: Objective　To investigate the epidemiological characteristics of severe fever with thrombocytopenia syndrome (SFTS) and to identify factors affecting deaths among SFTS patients in China from 2010 to 2023, so as to provide insights into scientific prevention and control of SFTS. Methods　Demographic and epidemiological characteristics of reported, definitively diagnosed SFTS cases in China from 2010 to 2023 were captured from National Notifiable Infectious Disease Reporting System of China Information System for Disease Control and Prevention, including current residence address, age, gender, occupation, time of incidence and date of death, and the temporal, spatial and population distributions of SFTS cases were analyzed. The county⁃level incidence of reported SFTS cases in China from 2010 to 2023 was subjected to spatial autocorrelation analysis, and the global Moran's I index was calculated. The high⁃incidence clusters for SFTS were identified using space⁃time scan analysis based on a Poisson distribution model, and the relative risk (RR) and log⁃likelihood ratio (LLR) were estimated. In addition, factors affecting the death and their risk levels were identified among SFTS cases using chi⁃square test and logistic regression models, and the risk of death was evaluated with odds ratio (OR).  Results　A total of 27 457 SFTS cases were reported in China from 2010 to 2023, and the number of SFTS cases increased from 71 in 2010 to 5 062 in 2023, appearing a tendency towards a rise (b = 5.567, t = 51.35, P < 0.05). A total of 1 326 deaths occurred during the 14⁃year study period, with a case fatality rate of 4.82%, and the annual incidence and fatality of SFTS were 0.005/105 to 0.359/105, and 2.70% to 12.70%. SFTS cases were reported across 27 provinces in China, which were predominantly reported in 7 provinces of Shandong (7 890 cases, 28.74%), Henan (6 286 cases, 22.89%), Anhui (5 718 cases, 20.83%), Hubei (3 938 cases, 14.34%), Liaoning (1 418 cases, 5.16%), Zhejiang (990 cases, 3.61%), and Jiangsu (957 cases, 3.49%), accounting for 99.05% (27 197/27 457) of totally reported cases in China. The time of SFTS incidence appeared a seasonal distribution, and the incidence of SFTS peaked during the period from May to July, with a significant difference in the time of SFTS incidence among provinces (P < 0.01). Among all SFTS cases, there were 12 894 men (46.96%) and 14 563 women (53.04%), and there were 61.27% (16 823/27 457) of SFTS cases at ages of 61 years and older, with farmers as the predominant occupation (84.74%, 23 266/27 457). The annual Moran's I index for SFTS incidence ranged from 0.326 2 to 0.607 5 from 2010 to 2023, and there were significant differences in the Moran's I index for SFTS incidence each year from 2011 to 2023 (z = 10.207 to 18.101, all P values < 0.001), presenting spatial clusters. Local spatial autocorrelation analysis identified "high⁃high", "low⁃high", "high⁃low", and "low⁃low" clusters of reported SFTS cases in China, with "high⁃high" clusters predominantly distributed in 5 provinces of Shandong, Anhui, Hubei, Henan, and Liaoning, covering 63 counties (cities, districts) in 2011 to 134 counties (cities, districts) in 2023. Monthly space⁃time scans identified three high⁃incidence clusters for SFTS in 4 provinces of Henan, Shandong, Jiangsu and Anhui. Univariate analysis revealed the risk of death of reported SFTS cases was associated with province ([χ2] = 605.48, P < 0.01), gender ([χ2] = 23.421, P < 0.01), age ([χ2] = 254.18, P < 0.01), duration from disease onset to diagnosis ([χ2] = 49.895, P < 0.01), and occupation ([χ2] = 30.685, P < 0.01), and multivariate logistic regression analysis revealed a higher risk of death among SFTS cases reported in three provinces of Shandong [OR = 3.081, 95% confidence interval (CI): (2.605, 3.643)], Zhejiang [OR = 4.280, 95% CI: (3.367, 5.441)], and Jiangsu [OR = 2.733, 95% CI: (2.059, 3.628)]; among SFTS cases at ages of 70 years and older [> 70 to 80 years: OR = 4.511, 95% CI: (1.626, 12.511); > 80 years and older: OR = 3.632, 95% CI: (1.241, 10.631)]; among male SFTS cases males than among female cases [OR = 1.243, 95% CI: (1.114, 1.387)]; and among SFTS cases 31 days and longer duration from disease onset to diagnosis [OR = 1.660, 95% CI: (1.254, 2.197)]. Conclusions　The number of reported SFTS cases has remarkably risen in China in recent years, with expanded geographic distributions, seasonal distribution and spatial clusters. Targeted preventive and control measures for SFTS are urgently needed.

Key words: Severe fever with thrombocytopenia syndrome, Epidemiological characteristic, Spatial clustering, Spatial autocorrelation

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