克山病发病相关因素对病区居民患病情况的影响

目的观察克山病发病相关因素对克山病患病情况的影响,为病因研究提供科学依据。方法选择莒县、沂水、平邑、邹城4个克山病病区县(市)的克山病发病村设立监测点,自1990年起连续观察20年,每5年为一阶段。每阶段对同一组人群连续观察5年,第1、3、5年对全部观察对象进行临床查体和描记心电图,可疑病人X线胸部后前位摄片,诊断符合"克山病诊断标准"。同时采集头发、小麦、玉米、红薯干(地瓜干),应用荧光法测定硒含量。调查经济收入和人均占有粮食。结果 20年共观察人群15 368例/次,克山病年均检出率3.12%,潜在型为2.68%,慢型0.44%,慢型检出率并呈逐年下降趋势。采集发样800份,小麦766份,玉米658份和地瓜干668份。发硒水平逐年升高(P<0.05～0.01),1997年后达到硒适宜地区水平,粮食硒水平基本恒定。经济收入与人均占有粮食显著增加,从1990年的535.8元/人、254.6 kg/人逐年增加至2009年的3200.0元/人、683.0 kg/人。结论克山病病情稳定,慢型克山病病情呈逐年下降态势,硒营养状况改善是影响病情变化的重要因素。

Related factors of Keshan disease on incidence influence of residents in endemic area

Objective To observe the related factors of Keshan disease(KSD) on incidence influence of residents in endemic area in order to provide the scientific basis of etiology study of Keshan disease.Methods To choose the epidemic villages in KSD area of Juxian,Yishui,Pingyi,Zoucheng counties were set up observing points.Every five years was made as a stage since 1990.3 to 14-year-old residents and over 14-year-old suspicious patients were selected as surveillance subjects from first stage to third stage but all residents were selected as surveillance subjects in fourth stage.The same group of surveillance subjects in each stage were observed consecutively for 5 years.Surveillance contents included physical checkup,electrocardiogram(ECG)and X-ray.At the same time samples of hair,wheat,corn and sweet potato were collected and the selenium(Se)content was measured by fluorescence.Economic income and grain condition were investigated.Result Total 15 368 cases/time were observed during 20 years.The incidence of KSD was 3.12%,chronic type 0.44% and potential type 2.68% among them.And the incidence of chronic Keshan disease was down year after year.800 samples of hair,766 samples of wheat,658 samples of corn and 668 samples of sweet potato were collected.Hair Se levels was increased(P<0.05) year after year but food Se levels did not change significantly.The economic income and grain were increased annually from 1990’s 535.8 yuan/person and 254.6 kg/person to 2007’s 3200.0 yuan/person,and 683.0 kg/person.Conclusions The condition of KSD was in stable situation and the incidence of chronic Keshan disease was down year after year.Selenium nutrition improvement was important factors.