2006年吉林市大骨节病现患调查报告

吉林市历史上曾是大骨节病重病区，病区分布广，病情严重。自上世纪50年代开始在全市大骨节病区实施了以改水为重点的综合防治措施，取得了显著成效，并于1993年通过了国家大骨节病基本控制病区的考核验收。为摸清目前吉林市大骨节病病情现状，为今后大骨节病防治提供科学依据，2006年3～6月在全市范围内进行了一次大骨节病的现患调查。现将调查结果报告如下。     

单纯性软骨坏死的病变程度划分记分法

单纯性软骨坏死(chondronecrosis simplex)是属于原发性的软骨坏死,即,病变单纯地以软骨坏死方式表现出来。相对而言,继发性软骨坏死时则因常可见到足以导致软骨坏死的其他病变同在,故病变比较复杂,因而,可称为非单纯性软骨坏死。 人类患大骨节病(KBD)时,透明软骨内的主要损害,以及动物骨软骨病(OC)的第三型软骨损害,都是属于单纯性软骨坏死。我国自1956年以来,使用KBD病区有关的某种(或某些)因素进行KBD动物模型复制时,也主要以引起这种单纯性软骨坏死为目标。可是,在人类KBD和有关动物模型复制、以及动物OC研究中,已往文献主要是对各个分散病例所见到的软骨坏死不同时期的表现,进行定性的描述;而缺乏对每个具体病例软骨坏死的病变严重程度,进行量上的评估。这样,就很难把软骨坏死所见同一些流行病学因素(或动物实验所用的因素——如,饮病区水、喂病区粮、饲料的低硒程度、投给某种元素或毒素、等等)之间,作出比较确切的联系分析和判断。     

我国大骨节病发病机制研究与展望

大骨节病是一种患病率和致残率很高的地方性、畸形性骨关节病，在世界范围内主要分布在我国、俄罗斯和朝鲜北部。自1849年发现大骨节病以来．其病因发病机制与防治研究一直是国内外关注的重点课题之一。我国多次组织医学、生物学和环境地理学等多学科协同攻关，重点研究了本病的疾病流行规律、临床、放射线与病理学诊断、环境致病因素及其预防措施，取得了丰硕的创新性研究成果。然而，目前大骨节病的发病机制仍然有许多关键问题尚未明确．特别是围绕环境致病因素如何与易感基因或环境反应基因相互作用，选择性地损害深层软骨细胞坏死的分子机制亟待解决。     

大骨节病病毒病因研究补遗

有关大骨节病(Kaschin-Beck disease, KBD)的病因问题至今仍有争论,本文对以往发表的文章添加必要的补充。以KBD病儿外周血白细胞的病变与KBD剖检病例软骨细胞和骨髓血细胞的病变对照比较。结果清晰地显示该3类细胞呈现完全相同的病变过程:胞核内出现由少到多、由小到大的嗜酸性包涵体,伴随以染色质被溶解破坏反比例地减少耗尽,最终细胞坏死、整个核形成一个嗜酸性包涵体的红色大团块。本文认为:隶属KBD的3类细胞的同一模式坏死,应是两次电镜所见的同一病毒所引起;KBD的本质应是该病毒引起的全身性传染病,软骨病变仅是其全身病变的一部分。     

成人大骨节病膝关节间隙的X线观察

Objective To observe and scale knee joint space of the patients who suffered adults' Kaschin-Beck disease (KBD) in Shangzhi City of Heilongjiang Province in order to acquire basic knowledge for upcoming intervention trial. Methods Clinical test was proceeded in adults aged above 40 in Guanghui Village of Shangzhi City in 2007. In typical patients, bilateral knee X-ray was taken and knee joint space was scaled. Three points were chosen on inner and outer epicondyle of each knee and results were recorded. Results There were 307 peoples over the age of 40 in the village. Two hundred eighty-two accepted clinical test, in a rate of 91.9%. Eighty out of 282 suffered KBD, accounting for 28.4%. When the patients' condition became more serious, measurements from flank, middle, inside points on outer epicondyle of joint space presented a narrowing trend [degree Ⅰ: (5.85±0.17), (4.84±0.17), (4.36±0.18)mm; degree Ⅱ: (5.11±0.43), (4.24±0.34), (3.48±0.28)nun; degree Ⅲ: (3.59± 0.78), (3.10±0.56), (2.14±0.62)mm; Fflank,middle,inside= 6.547,5.372,10.302, all P < 0.05], but those on inner epicondyle of joint space did not[degree Ⅰ:(3.66±0.17), (3.47±0.17), (3.73±0.18)mm; degree Ⅱ:(3.55± 0.34), (3.54±0.29), (4.35±0.35)mm; degree Ⅲ: (3.19±0.72), (3.92±0.66), (4.51±0.72)ram; Finside,middle,flank= 0.351,0.356,1.883, all P > 0.05]. Joint space < 5.00 mm were found in 618, among which 363 were measured on inner epieondyle, obviously greater than those measured on outer epicondyle of joint space(255), the difference being statistically signifieant(χ2=9.59, P<0.05). Conclusions Adult cases of KBD occur in Guanghui Village. Knee joint space of adult patients narrows obviously, the more serious, the narrower, especially occurring more obviously on outer epicondyle, but frequently on inner epicondyle.     

粮食中微量元素锌与大骨节病的关系

本文就西南大骨节病区粮食中微量元素锌、铁、锰、铜、铬测定作了初步分析。其中较有规律的是锌,并对锌在大骨节病发病过程中的作用进行了试探性讨论。认为锌在发病中占有重要的地位,很可能是硒对大骨节病作用的重要复合因子之一。     

成人大骨节病膝关节间隙的X线观察

Objective To observe and scale knee joint space of the patients who suffered adults' Kaschin-Beck disease (KBD) in Shangzhi City of Heilongjiang Province in order to acquire basic knowledge for upcoming intervention trial. Methods Clinical test was proceeded in adults aged above 40 in Guanghui Village of Shangzhi City in 2007. In typical patients, bilateral knee X-ray was taken and knee joint space was scaled. Three points were chosen on inner and outer epicondyle of each knee and results were recorded. Results There were 307 peoples over the age of 40 in the village. Two hundred eighty-two accepted clinical test, in a rate of 91.9%. Eighty out of 282 suffered KBD, accounting for 28.4%. When the patients' condition became more serious, measurements from flank, middle, inside points on outer epicondyle of joint space presented a narrowing trend [degree Ⅰ: (5.85±0.17), (4.84±0.17), (4.36±0.18)mm; degree Ⅱ: (5.11±0.43), (4.24±0.34), (3.48±0.28)nun; degree Ⅲ: (3.59± 0.78), (3.10±0.56), (2.14±0.62)mm; Fflank,middle,inside= 6.547,5.372,10.302, all P < 0.05], but those on inner epicondyle of joint space did not[degree Ⅰ:(3.66±0.17), (3.47±0.17), (3.73±0.18)mm; degree Ⅱ:(3.55± 0.34), (3.54±0.29), (4.35±0.35)mm; degree Ⅲ: (3.19±0.72), (3.92±0.66), (4.51±0.72)ram; Finside,middle,flank= 0.351,0.356,1.883, all P > 0.05]. Joint space < 5.00 mm were found in 618, among which 363 were measured on inner epieondyle, obviously greater than those measured on outer epicondyle of joint space(255), the difference being statistically signifieant(χ2=9.59, P<0.05). Conclusions Adult cases of KBD occur in Guanghui Village. Knee joint space of adult patients narrows obviously, the more serious, the narrower, especially occurring more obviously on outer epicondyle, but frequently on inner epicondyle.     

大骨节病儿童掌指骨X线损害特点的研究

本文报导了2800例4～13岁大骨节病儿童掌指骨与腕骨不同部位X线损害的特点及与年龄的关系,其结果表明本病掌指骨的 X 线损害是不均等的。Ⅱ—Ⅳ指骨中、基节与第Ⅰ掌指骨干骺端是相对易损害部位,而第Ⅰ掌指骨骨端部位最不易显示 X 线病变。同时掌指骨 X 线损害具有单部位与多部位损害的特点。随着年龄的增加,虽然干骺端 X 线征的检出率趋于下降,而骨端、骨骺与腕骨的 X 线征类型与检出率则呈上升趋势,说明大骨节病的关节病变的范围和程度有随年龄增长而扩大和增重的趋势。     

2003-2007年西安市大骨节病监测结果分析

大骨节病是以四肢透明软骨变性坏死为主要病理特征的地方性变形性骨关节病,该病致畸性很高,严重制约了病区社会生产力和经济的发展,使病区居民吴现因病致贫、因贫致病的恶性循环.     

陕西省大骨节病病情现状与相关因素调查

目的 进一步掌握陕西省大骨节病病情消长态势和相关环境因素对大骨节病发生、发展的影响,为今后大骨节病的防治决策提供依据.方法 在陕西省大骨节病病区范围内分别选择了6个项目调查点和20个省级自设监测点.临床检查7～12岁儿童2568例,右手X线拍片1788例.采集项目点粮样600份和发样300份,测定粮硒、发硒及食粮(180份)T-2毒素水平,调查相关因素与病情的关系.结果 全省23个病区县(区)26个调查点中,大骨节病临床Ⅰ度以上患者无检出,X线总检出率为1.29%;儿童发硒为(0.37±0.07)mg/kg,粮食硒(0.049±0.016)mg/kg,粮食T-2毒素(3.82±4.38)μg/kg.结论 陕西省儿童大骨节病病情处于基本控制后的平稳低发态势,病区内外环境硒水平的明显升高、饮食结构的明显改善、粮食卫生学质量的提高及经济收入的增加是病情得到控制的主要因素,应进一步深化防治措施落实和加强病区群众健康教育.