西藏藏族自治区大骨节病病情调查结果分析

目的 了解西藏藏族自治区（简称西藏）大骨节病病区分布，评估西藏大骨节病病情现状。方法 于2007、2008年，在西藏那曲、山南、林芝、日喀则地区中的26县，按东、南、西、北、中的方法选取乡（镇）、村作为基线调查点进行大骨节病流行病学调查。根据大骨节病调查方案，对成人进行大骨节病临床检查，对4～ 13岁儿童进行临床和右手正位X线检查。病区划分按照大骨节病病区判定和划分标准《GB 16395-1996》执行，轻病区：病区大骨节病临床Ⅰ度及其以上患病率＜10％或7～ 14岁儿童X线检出率＜10％；中病区：病区大骨节病临床Ⅰ度及其以上患病率在10％～20％或7～ 14岁儿童X线检出率在10％ ～ 30％;重病区：病区大骨节病临床Ⅰ度及其以上患病率＞20％或7～ 14岁儿童X线检出率＞30％。结果 在26个县共调查了108乡，临床检查成人14 686人，检出Ⅰ度以上（含Ⅰ度）病例663人，患病率为4.51％，无Ⅲ度病例检出。儿童拍右手正位X线片5769张，检出大骨节病阳性片102张，检出率为1.77％；儿童发病主要在干骺端，占89.2％(91/102)。有10个县成人大骨节病临床检出率为0，儿童大骨节病X线检出率也为0；有1个县成人大骨节病临床检出率为0，儿童大骨节病X线检出率为3.66(7/191);有12县成人大骨节病临床检出率为1.03％ ～ 7.54％，儿童大骨节病X线检出率为0 ～ 7.76％,其中有5个县检出率为0；有3个县成人大骨节病临床检出率为10.69％～13.88％,儿童大骨节病X线检出率在5.31％～7.76％。结论 根据大骨节病病区判定和划分标准，在调查的26县中有10县为大骨节病非病区、13县为轻病区、3县为中病区。至此，西藏大骨节病分布于全区7地(市)52县,病情流行分布较广，形势仍然严峻，需继续加强病情监测。

Analysis of a survey result on the state of Kashin-Beck disease in Tibet

Objective To investigate the distribution of Kashin-Beck disease(KBD) in Tibet, and assess the disease status. Methods Between 2007 and 2008, a survey was done on KBD epidemiology which was carried out in four prefectures of 26 counties according to the east, south, west, north and center in Nakchu,Lhoca, Nyingtri and Shigatse districts of Tibet, with towns and villages as baseline survey points. According to the KBD e survey scheme, KBD clinical examination for adults was also carried out and at the same time clinical and right hand anteroposterior X-ray examinations were given to children aged 4 - 13. The partition of endemic area was based on the criteria of national standards for Kashin-Beck disease diagnoses《GB 16395-1996》. Slight KBD area:clinical prevalence of Kashin-Beck disease grade Ⅰ and above was less than 10％ or X-ray detection rate ＜ 10％ of children; the moderate prevalent KBD area: clinical prevalence of Kashin-Beck disease grade Ⅰ and above was between 10％ and 20％ or X-ray detection rate was between 10％ and 30％ of children; severe KBD area: clinical prevalence of KBD grade Ⅰ and above was more than 20％ or X-ray detection rate was higher than 30％ of children.Results A total of 108 townships of 26 counties were surveyed, 14 686 adults were clinically examined, cases detection of grade Ⅰ and above were 637 people, the prevalence was 4.34％, and no case of grade Ⅲ was detected.Of 5769 children's right anteroposterior X-ray film, 102 were detected positive; the prevalence rate was 1.77％.Metaphysis was affected in most of the child cases, which accounting for 89.2％ (91/102). Amongst all the counties, there were 10 counties, clinical detection rate of adult KBD was 0, and children's X-ray detection rate of KBD was also 0. In 1 county the clinical prevalence rate for adults KBD was 0 and X-ray detection rate for children was 3.66(7/191 ). In 12 counties the clinical prevalence rate for adults KBD was between 1.03％ and 7.54％, X-ray detection rate for children was between 0 and 7.76％, amongst all these counties surveyed there were 5 counties,the detection rate for children was 0. In 3 counties the clinical prevalence rate for adult KBD was between 10.69％and 13.88％, the X-ray detection rate for children was between 5.31％ and 7.76％. Conclusions According to the criteria for diagnoses of KBD, within the 26 counties surveyed, 10 counties are non-endemic areas, 13 counties are slight endemic areas, 3 counties are medium endemic areas. So far, KBD is prevalent in 52 counties of 7 prefectures (cities) in Tibet, the disease is widely distributed, the situation is still severe, and there is a need to continue to strengthen KBD surveillance.