山东省1990-2007年克山病病情及发病相关因素动态变化

目的 分析山东省1990-2007年克山病病情及发病相关因素动态变化,为克山病的防治提供科学依据.方法 选择山东省莒县、沂水、平邑、邹城4个克山病病区县的发病村,设立观察点,从1990年起连续观察至2007年,每5年为一阶段,第1～3阶段以3～14岁多发人群和14岁以上可疑患者为观察对象,第4阶段以全年龄组人群为观察对象.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,随机采集头发、小麦、玉米、红薯干(地瓜干)进行硒含量测定,同时调查经济收入和人均占有粮食.结果 18年共观察人群14 510例/次,克山病年均检出率第1～4阶段依次为3.02%、2.31%、3.57%、3.65%.共检出异常心电图809例,总异常心电图检出率为5.49%,1990-2004年异常心电图检出率为3.52%～5.24%,2005-2007年为10.97%-10.91%.采集头发732份,小麦701份,玉米615份,地瓜干643份,采用荧光法测定硒含量,发硒水平逐年升高,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 k/人逐年增加至2007年的2968.0元/人、602.0ks/人.结论 山东省克山病病情处于稳定态势,内环境硒营养状况改善、经济收入与人均占有粮食增加是重要的环境条件.

Observation on conditions and related factors of Keshan disease in sllandong province,1990-2007

Objective To observe the serial changes of condition and related factors of Keshan disease (KSD) and provide the scientific basis for disease control and further research. Methods The villages in KSD epidemic area of Juxian, Yishui, Pingyi, Zoucheng counties were selected. Since 1990,every five-year was counted as a stage. For the first to third stage, 3-14 year-old residents and over 14 year-old suspicious patients were selected as surveillance subjects. And in the fourth stage, a11 residents were selected as surveillance subjects. 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, the selenium (Se) concentration in hair, wheat, corn and sweet potato was measured. The economic income and grain availability were also investigated. Results Totally, 14 510cases were visited during 18 years. The incidence of KSD was 3.02%in the first stage.2.3 1%in the second stage.3.57%in the third stages and 3.65%in the fourth stage.Totally,14 510 cases were examined by ECG.809 cases showed the abnormal ECG and the total incidence of abnormal ECG was5.49%.The incidence of abnormal ECG was 3.52%.5.24%from 1990 to 2004 but was 10.97%一10.91%from 2005 to 2007.732 of hair samples.701 of wheat samples, 615 of corn samples and 643 of sweet potato samples were collected and the Se concentration was determined by the fluorescent method. Se levels in hair samples had increased (P<0.05) year by year but Se levels in food have not changed significantly. The economic income and grain availability had increased gradually from 535.8 yuan and 254.6 kg per person in1990 to 2968.0 yuan and 602.0 kg per person in 2007.Conclusion The condition of KSD was in a stable situation in Shandong Province. Related factors improvement should be an important environmental condition.