肺癌患者围手术期感染血清炎症因子与N末端脑钠肽前体水平变化及临床意义

目的探索肺癌患者围手术期感染的血清炎症因子与N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)的改变情况。方法选取2014年6月-2018年6月于承德医学院附属医院接受治疗的94例肺癌患者为研究对象,按照患者围手术期是否发生感染分为感染组和未感染组。分析感染患者病原菌检出情况。采集患者外周血检测血清炎症因子降钙素原(procalcitonin,PCT)、白介素-6(Interleukin-6,IL-6)、C-反应蛋白(C-reactive protein,CRP)和NT-proBNP指标水平。结果 94例肺癌患者术后发生感染患者28例,感染率为29.79%;其中16例肺部感染占57.14%,8例创口感染28.57%,4例其他感染占比14.29%。28例肺癌术后感染患者共检出39株病原菌,其中革兰阴性菌26株,革兰阳性菌10株,真菌3株。手术前感染组和未感染组患者PCT、IL-6、CRP、NT-proBNP水平比较差异无统计学意义,手术后感染组患者PCT、IL-6、CRP、NT-proBNP指标水平分别为(0.48±0.09)ng/ml、(89.62±20.34)pg/ml、(112.35±25.64)mg/L、(139.82±26.89)pg/ml均明显高于未感染组(P<0.05)。结论肺部感染是肺癌患者术后的主要感染类型,感染病原菌主要为革兰阴性菌,临床医师在治疗时可以根据患者病原菌种类合理使用抗菌药物,且患者感染后血清炎症因子及NT-proBNP水平变化明显,可以作为肺癌患者术后感染的辅助检查指标。     

食管癌术后患者肺部感染病原菌分布及对肺功能的影响

目的分析食管癌术后患者肺部感染病原菌分布特点及对肺功能的影响。方法选取2015年1月-2017年1月在医院接受治疗的食管癌术后肺部感染患者41例为感染组,食管癌术后未发生肺部感染患者50例为未感染组,另纳入60名健康体检者为对照组;采集感染组患者痰液标本进行细菌培养与鉴定;比较感染组与未感染组患者术后住院时间及病死率;比较各组受试者肺功能及血清细胞因子水平。结果感染组患者术后住院时间(18.9±3.1)d,显著长于未感染组患者(P<0.05);感染组患者住院期间病死率显著高于未感染组患者(P<0.05);41例感染组患者共分离致病菌60株,革兰阴性菌35株占58.33%,革兰阳性菌22株占36.67%,真菌3株占5.00%;感染组患者肺功能指标FVC、FEV1、FEV1%及FEV1/FVC均显著低于未感染组患者及对照组,组间比较差异均有统计学意义(P<0.05);感染组患者外周血CRP、TNF-α、IL-6及IL-1β水平显著高于未感染组及对照组(P<0.05)。结论食管癌患者术后肺部感染的病原菌以革兰阴性菌为主,感染导致术后住院日及病死率增高,并恶化肺功能及系统性炎症反应。     

高血压脑出血患者术后肺部感染病原菌分布及外周血指标的诊断评价

目的分析高血压脑出血患者术后并发肺部感染的病原菌分布,并通过检测患者术后外周血炎症因子水平探寻可用于预测诊断感染的指标。方法分析2014年1月-2016年12月在医院接受高血压脑出血微创手术治疗患者的临床资料,依据术后是否并发肺部感染分为感染组56例及未感染组61例,分别于术后1、3d采集两组患者外周血,检测白介素-10(IL-10)、降钙素原(PCT)、C-反应蛋白(CRP)及肿瘤坏死因子-α(TNF-α);检测两组患者肺功能指标,包括:用力肺活量(FVC)、第一秒用力呼气容积(FEV1)、FEV1/FVC及FEV1%。结果 56例感染组患者呼吸道分泌物中分离出致病菌65株;其中革兰阳性菌36株占55.38%,革兰阴性菌26株占40.00%,真菌3株占4.62%;感染组患者与未感染组患者FVC(2.41±0.18VS 3.15±0.12)、FEV1(1.82±0.22VS 2.23±0.15)、FEV1%(57.11±7.65VS 71.78±8.09)及FEV1/FVC(51.26±8.53VS 66.01±7.89)比较,差异均有统计学意义(P<0.05);术后3d,感染组患者与未感染组患者外周血CRP(29.77±6.16 VS20.19±4.92)、PCT(2.31±0.35VS 1.56±0.27)及TNF-α(39.98±7.84VS 22.30±7.22)比较,差异均有统计学意义(P<0.05);ROC曲线分析显示,以29.38ng/L为截点值,术后3dTNF-α诊断高血压脑出血术后并发肺部感染的敏感性为85.25%,特异性为91.07%,曲线下面积为0.94,优于CRP及PCT。结论高血压脑出血术后肺部感染的主要病原菌为革兰阳性菌,感染可导致患者肺功能显著降低,术后3d外周血指标对术后肺部感染具有一定预测诊断价值,其中TNF-α的诊断价值较高。     

脊柱手术后切口感染患者血清炎症因子变化及临床意义

目的分析脊柱手术切口感染患者的血清炎症因子变化特点及临床价值。方法选取2015年6月-2016年9月期间于医院接受脊柱手术的626例患者,将术后发生切口感染的82例患者作为切口感染组(根据感染深度分为浅部感染患者49例和深部感染患者33例),并选取85例未出现切口感染患者作为切口未感染组,抽取同期80名体检正常人作为健康组;统计分析切口感染患者病原菌分布,分析组间血清炎性因子表达的差异。结果82例切口感染患者,感染率为13.10%;感染患者标本中共分离获得病原菌198株,以革兰阴性菌为主,共134株占67.68%;切口感染组血清白介素-6(IL-6)、白介素-8(IL-8)、白介素-18(IL-18)、降钙素原(PCT)、中性粒细胞绝对值(ANC)、高敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)及干扰素-γ(INF-γ)水平高于切口未感染组和健康组(P<0.05),切口未感染组的血清IL-6、IL-8、IL-18、PCT、ANC、hs-CRP及TNF-α高于健康组(P<0.05);浅部感染患者血清IL-6、IL-8、IL-18、PCT、INF-γ、ANC、hs-CRP、TNF-α低于深部感染患者(P<0.05)。结论脊柱手术后切口感染主要致病菌为革兰阴性菌,在发生切口感染后患者的血清促炎症因子显著升高,且血清促炎性因子升高幅度可能与感染深度有密切关联。     

高血压脑出血患者术后肺部感染病原菌分布及外周血指标的诊断评价北大核心CSCD

目的分析高血压脑出血患者术后并发肺部感染的病原菌分布,并通过检测患者术后外周血炎症因子水平探寻可用于预测诊断感染的指标。方法分析2014年1月-2016年12月在医院接受高血压脑出血微创手术治疗患者的临床资料,依据术后是否并发肺部感染分为感染组56例及未感染组61例,分别于术后1、3d采集两组患者外周血,检测白介素-10(IL-10)、降钙素原(PCT)、C-反应蛋白(CRP)及肿瘤坏死因子-α(TNF-α);检测两组患者肺功能指标,包括:用力肺活量(FVC)、第一秒用力呼气容积(FEV1)、FEV1/FVC及FEV1%。结果 56例感染组患者呼吸道分泌物中分离出致病菌65株;其中革兰阳性菌36株占55.38%,革兰阴性菌26株占40.00%,真菌3株占4.62%;感染组患者与未感染组患者FVC(2.41±0.18VS 3.15±0.12)、FEV1(1.82±0.22VS 2.23±0.15)、FEV1%(57.11±7.65VS 71.78±8.09)及FEV1/FVC(51.26±8.53VS 66.01±7.89)比较,差异均有统计学意义(P<0.05);术后3d,感染组患者与未感染组患者外周血CRP(29.77±6.16 VS20.19±4.92)、PCT(2.31±0.35VS 1.56±0.27)及TNF-α(39.98±7.84VS 22.30±7.22)比较,差异均有统计学意义(P<0.05);ROC曲线分析显示,以29.38ng/L为截点值,术后3dTNF-α诊断高血压脑出血术后并发肺部感染的敏感性为85.25%,特异性为91.07%,曲线下面积为0.94,优于CRP及PCT。结论高血压脑出血术后肺部感染的主要病原菌为革兰阳性菌,感染可导致患者肺功能显著降低,术后3d外周血指标对术后肺部感染具有一定预测诊断价值,其中TNF-α的诊断价值较高。     

IL-6和PCT与Activin-A对急性白血病患者化疗后感染的诊断价值

目的探讨白细胞介素-6(Interleukin-6,IL-6)、降钙素原(Procalcitonin,PCT)、激活素A(Activin-A,ACTA)对急性白血病患者化疗后粒细胞缺乏期感染的诊断价值。方法选择2016年3月-2019年1月海南医学院第一附属医院收治的急性白血病化疗后粒细胞缺乏期患者192例为研究对象。根据化疗后是否合并感染,将患者分为感染组80例和未感染组112例。比较两组患者血清IL-6、PCT、ACTA的表达水平。采用ROC曲线法和Logistic回归分析IL-6、PCT、ACTA对急性白血病患者化疗后感染的诊断价值。结果 192例急性白血病患者化疗后发生医院感染80例,感染率为41.67%。感染部位以上呼吸道为主。80例感染患者共送检84个样本,分离病原菌96株,其中革兰阴性菌58株占60.42%,革兰阳性菌32株占33.33%,真菌6株占6.25%,以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和金黄色葡萄球菌为主;感染组血清IL-6、PCT、ACTA浓度分别为(7.23±2.01)ng/L、(2.68±1.08)ng/ml和(0.56±0.17)ng/ml,均高于未感染组(P<0.001)。ROC曲线分析结果显示,IL-6、PCT、ACTA预测感染的AUC分别为0.859、0.801和0.916。结论 IL-6、PCT、ACTA早期诊断急性白血病化疗后粒细胞缺乏期感染有较高的价值,具有一定的临床价值。     

人工髋关节置换术后深部感染病原分布及炎症介质的早期预测诊断价值

目的对行人工髋关节置换术后早期并发假体深部感染患者的感染病原菌进行分析,并观察术后人工髋关节置换术后患者外周血炎症因子水平的变化,以期为临床诊疗提供参考。方法纳入分析2010年9月-2017年8月医院50例接受人工髋关节置换术并发早期假体深部感染(感染组)患者的临床资料,另纳入同期医院60例接受人工髋关节置换术未并发感染(未感染组)患者的临床资料,分析感染组患者深部感染病原菌的种类及构成比。观察两组患者外周血白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、降钙素原(PCT)水平,探讨其对人工髋关节置换术后患者早期并发深部感染的诊断价值。结果 50例感染组患者共分离出病原菌55株,其中革兰阳性菌31株占56.36%,以金黄色葡萄球菌、凝固酶阴性葡萄球菌、粪肠球菌为主;革兰阴性菌24株占43.64%,以大肠埃希菌、鲍氏不动杆菌、铜绿假单胞菌为主;感染组患者血清IL-6、PCT水平均高于未感染组患者(P0.05);ROC曲线分析显示:IL-6在诊断人工髋关节置换术后早期并发深部感染的最佳阈值为20.37pg/ml,其敏感性为66.67%,特异性为66.04%;PCT在诊断人工髋关节置换术后早期并发深部感染的最佳阈值为3.12μg/L,其敏感性为65.24%,特异性为62.23%。结论人工髋关节置换术后患者早期易并发深部感染,外周血炎症因子IL-6、PCT对人工髋关节置换术后早期深部感染具有一定的诊断价值。     

老年糖尿病患者医院感染病原学特征及血清IL-6、PCT检测的临床意义

目的探讨老年糖尿病患者医院感染病原学特征及血清白细胞介素-6(IL-6)、降钙素原(PCT)检测的临床意义。方法选取浙江新安国际医院2017年4月-2018年10月收治的700例糖尿病患者为研究对象,回顾性分析患者医院感染发生率、感染部位及病原学特点,测定患者血清IL-6、PCT水平,并采用受试者工作特征曲线(ROC)分析两指标诊断患者发生感染的临床价值。结果 700例糖尿病患者共有99例发生感染,发生率为14.14%,其中呼吸道疾病、泌尿道感染分别占36.36%、21.21%;感染患者共检出病原菌151株,其中革兰阴性菌110株占72.85%、革兰阳性菌33株占21.85%、真菌8株占5.30%;感染组患者血清IL-6(25.51±3.05)ng/L、PCT(12.17±3.50)ng/L水平均高于未感染组(P<0.05);血清IL-6、PCT联合检测诊断糖尿病合并感染的ROC曲线下面积为0.959,大于IL-6、PCT单独检测。结论老年糖尿病患者医院感染以呼吸道感染为主,感染病原菌主要为革兰阴性菌,血清IL-6、PCT水平升高,二者联合检测可作为糖尿病患者感染评估的敏感指标。     

降钙素原和凝血酶原活动度在肝衰竭合并感染预后中的评估价值

目的 探讨凝血酶原活动度(PTA)、降钙素原(PCT)在肝衰竭合并感染预后中的评估价值。方法 回顾性分析2016年1月-2019年12月于遵义医科大学附属医院就诊的137例肝衰竭患者的临床资料，患者诊断均为病毒性肝炎。根据是否感染分为感染组83例和未感染组54例，比较两组患者血清PCT、白细胞介素-6(IL-6)、C-反应蛋白(CRP)及PTA。此外，根据肝衰竭感染患者治疗预后，分为死亡组和存活组，分析两亚组患者血清PCT、IL-6、CRP及PTA差异，并采用受试者工作曲线(ROC)分析血清PCT、IL-6、CRP及PTA对肝衰竭感染患者死亡预测价值。结果 肝衰竭患者感染率为60.58%(83/137),共培养分离病原菌36株，其中革兰阴性菌株12株占33.33%、革兰阳性菌9株占25.00%、真菌15株占41.67%;感染组血清PCT、IL-6及CRP高于未感染组(P<0.05),而PTA低于未感染组(P<0.05);肝衰竭合并感染患者中，死亡组患者血清PCT、IL-6及CRP高于存活组(P<0.05),而PTA低于存活组(P<0.05);PCT、IL-6、CRP及PTA对肝衰竭感染患者死亡预测价值的曲线下面积分别为0.744、0.831、0.802和0.721。结论 肝衰竭患者具有较高的感染发生风险，血清PCT及IL-6、CRP炎性指标和PTA可作为肝衰竭感染患者早期诊断和预后预测的潜在指标。     

糖尿病足感染患者炎症因子和Toll样受体信号通路的表达及意义

目的探讨糖尿病足感染患者炎症因子和Toll样受体(toll-like receptors,TLRs)信号通路表达的变化及其与感染的相关性,旨在为预防和诊断糖尿病足感染提供相关依据。方法选取2016年12月-2018年12月哈励逊国际和平医院收治的173例糖尿病足患者为研究对象,并根据患者是否并发感染分为感染组(84例)和非感染组(89例),选取同期健康体检者79名为对照组,分析感染患者病原菌检出情况,比较分析3组研究对象炎症因子血清超敏C-反应蛋白(Hypersensitive C-reactive protein,hs-CRP)、降钙素原(Procalcitonin,PCT)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-6(Interleukin-6,IL-6)及外周血单核细胞TLR2、TLR4水平变化情况,并分析各指标与感染严重程度的相关性。结果 84例感染患者共分离102株病原菌,其中革兰阴性菌61株(59.80%)、革兰阳性菌39株(38.24%)、真菌2株(1.96%)。感染组患者炎症因子hs-CRP、PCT、TNF-α、IL-6水平分别为(11.24±5.58)mg/L、(5.13±2.25)mg/L、(22.18±5.59)ng/L、(21.98±4.79)ng/L水平均高于未感染组和对照组(P<0.05);外周血单核细胞TLR2(61.25±11.38)%、TLR4(59.93±10.27)%水平均高于未感染组和对照组(P<0.05);且随着患者感染严重程度增加,各指标水平也有所上升(P<0.05)。相关性分析结果显示,血清hs-CRP、PCT、TNF-α、IL-6及外周血单核细胞TLR2、TLR4水平均与感染严重程度呈正相关关系(P<0.05)。结论感染性糖尿病足患者以革兰阴性菌感染为主,而血清hs-CRP、PCT、TNF-α、IL-6水平及外周血单核细胞TLR2、TLR4水平与糖尿病足感染的发生发展相关。     

Management of pregnancy and childbirth in England and Wales and in France

This paper reviews national data on obstetric and neonatal practices in England and Wales, and in France between 1970 and 1980. The data have been derived from national statistics and surveys on national samples of births in 1970, 1975 and 1980 in England and Wales, and 1972, 1976 and 1981 in France. The analysis shows that there was no major difference in pregnancy outcome, but wide variations in medical practices, and their trend over time. The main differences were: in England and Wales a higher number of antenatal visits, a higher percentage of inpatient admissions during pregnancy, a higher rate of induction, more episiotomies, a higher rate of resuscitation at birth, and admission to neonatal special care units; in France, a higher rate of caesarean sections before and during labour, some evidence of a more active management of labour, and a longer hospital post-natal stay. These differences in practice reflect differences in objectives and assessment of the effectiveness of care between the two countries: they point out the need for better monitoring and evaluation of obstetric and neonatal practices.     

2011年温州城乡九所中小学生超重肥胖患病状况调查

【目的】 调查温州城乡中小学生超重肥胖的患病状况。 【方法】 2011年5-8月随机抽取温州城区、城乡结合部及农村中小学共9所学校进行整群调查。记录学生的一般资料,同时测量身高体重两项发育指标,计算体质指数,按照2004年中国肥胖问题工作组(WGOC)推荐的诊断标准,评价温州市中小学生的超重及肥胖患病状况。 【结果】 共9 657名在校学生参与调查,其中男生5 114 名,女生4 543名,平均年龄(14.95±4.53)岁,被调查人群中超重占7.6%,肥胖占2.6%,男生超重和肥胖患病状况均显著高于女生(9.8% vs 5.2%,5.2% vs 1.2%,P值均<0.01),各年龄段中以7岁儿童肥胖及超重状况最为严重(27.15% vs 7.955%),城区及城乡结合部超重肥胖患病状况明显高于农村(P值均<0.01)。 【结论】 温州中小学校肥胖和超重总患病约为10%,男性,尤其是城区及城乡结合部男生超重肥胖患病情况最为严重,需要引起高度重视。     

Efficacy of single and double doses of albendazole and mebendazole alone and in combination in the treatment of Trichuris trichiura in school-age children in Uganda

A randomised clinical trial was conducted in Kabale District, southwestern Uganda, to compare the efficacies of single and double doses of a combination of 400 mg albendazole (ALB) and 500 mg mebendazole (MBZ) with those of single and double doses of each drug given alone in the treatment of Trichuris trichiura. Infected pupils (n = 611) were randomised to six treatment groups. Three groups received either a single dose of ALB, MBZ or the combination (ALB+MBZ). The other three groups received either a double dose of ALB (ALB/ALB), MBZ (MBZ/MBZ) or the combination (ALB+MBZ/ALB+MBZ). All double doses were given 8 h apart. Children were followed-up weekly for 1 month. Cure rates were significantly higher using double doses compared with single doses (irrespective of drug; z = −4.02, P < 0.0005) as well as using the drug combination compared with single drugs (irrespective of doses; z = −7.64, P < 0.0005). Cure rates measured at Day 7 were significantly higher than on Days 14 and 21 after treatment (Day 14, z = 9.90, P < 0.0005; Day 21, z = 7.36, P < 0.0005). Geometric mean (GM) intensities of positives were significantly lower on Day 7 compared with all other subsequent days (P < 0.00005), and on Day 28 GM intensities reached pre-treatment levels (P = 0.096). Whilst there was no difference in egg excretion between single and double doses of the same drug or drug combination (F_(df1) = 0.28, P = 0.60), the combination treatment resulted in lower egg excretion than use of single drugs (F_(df2) = 50.90, P < 0.00005). All the tested regimens of ALB and MBZ had low cure rates against T. trichiura in Uganda, but both combination treatments showed satisfactory egg reduction rates 3 weeks after treatment. [ClinicalTrials.gov identifier: NCT01050452]     

儿童铁和锌缺乏与营养素补充

营养性铁和锌缺乏症是严重影响儿童健康的常见营养素缺乏问题,在发展中国家是导致疾病负担加重和高死亡率的重要因素.铁和锌缺乏症每年引起约数万名5岁以下儿童死亡.婴幼儿是铁和锌缺乏的高危人群,摄入不足是造成铁和锌缺乏的主要原因.6～24个月婴幼儿的铁缺乏可对其智力发育产生不可逆的损害;锌缺乏是引起2岁以下幼儿生长发育迟缓的主要原因之一.补充微量营养素以及应用微量营养素强化食品可减少儿童铁和锌缺乏的发生,并具有较高的成本效益,应作为优先推荐的干预措施.该文就铁和锌缺乏的危害和干预研究进展作以综述.     

Dissipation and Residues of Difenoconazole and Azoxystrobin in Bananas and Soil in Two Agro-Climatic Zones of China

Residues of a fungicide suspension (12 % difenoconazole, 18 % azoxystrobin) in bananas and soil were studied under tropical and subtropical monsoon climates, in Hainan and Yunnan provinces, respectively. The half-lives in bananas were shorter in Hainan (difenoconazole: 8.4–10.7 days; azoxystrobin: 7.8–8.4 days) than Yunnan (difenoconazole: 11.3–13.0 days; azoxystrobin: 10.4–11.6 days), possibly because of the higher temperatures and solar radiation levels in Hainan. The half-lives in soil were shorter in Yunnan (difenoconazole: 15.5–16.7; azoxystrobin: 11.9–13.9 days) than Hainan (difenoconazole: 23.1–23.2 days; azoxystrobin: 16.0–16.1 days), possibly because the organic carbon content was higher and rainfall lower in Yunnan than Hainan. Their physico-chemical properties suggest difenoconazole and azoxystrobin should be stable in bananas and soil, but both decreased to safe concentrations by the minimum harvest time after spraying the mixture at the recommended dosage and 1.5 times that dosage, through physical, chemical, and biological processes.     

Concentrations of tetrachloroethene in blood and trichloroacetic acid in urine in workers and neighbours of dry-cleaning shops

Summary Tetrachloroethene concentrations in blood and trichloroacetic acid concentrations in urine were determined — primarily over the course of a week — for 29 persons living in the vicinity of dry-cleaning shops. The mean levels of tetrachloroethene increased during the week. In some neighbours concentrations were exceeding the German biological threshold limit value for tetrachloroethene (1000 g/l blood), persisting over the whole week in one case. The concentrations of tetrachloroethene in blood depended on the floor and the construction type of the building where these people were living, but not of the type of system used in the dry-cleaning shops. 5 of 12 drycleaners were found to have tetrachloroethene levels exceeding the German biological threshold limit value, some of them by a considerable amount.     

Toxicity and uptake of TRI- and dibutyltin in Daphnia magna in the absence and presence of nano-charcoal

Butyltins (BTs), such as tributyltin (TBT) and dibutyltin (DBT), are toxic to aquatic organisms, but the presence of the strong adsorbent, black carbon (BC), can markedly influence BT toxicity and uptake in organisms. In the present study, the acute toxicity and uptake of TBT and DBT in the crustacean, Daphnia magna, were investigated with and without addition of nano-charcoal at different pHs and water hardnesses. The results showed that the toxicity of TBT and DBT increased by lowering the pH from 8 to 6. This reflects a relatively higher toxicity of cationic BT species than of the neutral species. At pH 6, by enhancing the water hardness of the media from 0.6 to 2.5?mM, the toxicity of TBT and DBT consistently decreased due to competitive binding of bivalent cations (Mg2?, Ca2?) to biotic ligands of D. magna. Furthermore, the toxicity of TBT to D. magna significantly decreased in the presence of nano-charcoal compared with experiments without nano-charcoal at pH 6 and 8, while no significant decrease in toxicity of DBT was observed in the presence of nano-charcoal. This can be attributed to the insignificant decrease of free DBT concentration in the presence of nano-charcoal compared with that for TBT. Conversely, it was observed that more TBT and DBT were taken up in D. magna in the presence of nano-charcoal due to the uptake of TBT or DBT associated with nano-charcoal by Daphnia in gut systems, as seen by light microscopy. This indicated that only free nonadsorbed BTs were toxic to D. magna, at least during short periods of exposure.     

2018年洛宁县大骨节病病区与非病区内外环境硒含量监测分析

目的了解大骨节病病区与非病区内外环境硒含量,为大骨节病防治决策提供依据。方法在洛宁县故县镇选择历史重病区岭南村和非病区窑瓦村作为调查点,了解两村历史及目前儿童病情情况,采集两村6~12岁儿童发样各30份;以调查村为中心,排除近三年施用富硒肥的耕地,在东、南、西、北、东北、东南、西北、西南八个方位,8块农田中采集土样;每村按照东、南、西、北、中五个方位各调查2户家庭,共10户,每户采集白面,黄面,黄豆3种主粮,每份样品不少于50 g,检测样品硒含量。结果共采集6~12岁儿童发样49份,粮样60份,土样20份。病区村与非病区村儿童发硒分别为(0.2726±0.0420)mg/kg和(0.3633±0.0744)mg/kg,土硒分别为(0.1185±0.0092)mg/kg和(0.1194±0.0194)mg/kg,黄豆硒分别为(0.0179±0.0084)mg/kg和(0.0212±0.0112)mg/kg,白面硒分别为(0.0094±0.0059)mg/kg和(0.0643±0.0194)mg/kg,黄面硒分别为(0.0116±0.0011)mg/kg和(0.0150±0.0064)mg/kg。儿童发硒,白面,黄面硒均值比较均有统计学意义(P<0.01)。结论大骨节病区内环境硒营养水平基本充足,但外环境缺硒仍然存在,因此应坚持大骨节病监测,提高病区居民膳食中硒营养水平,及时掌握病情变化趋势,巩固防治成效,实现持续消除大骨节病目标。