2010年云南省克山病监测结果分析

目的 掌握云南省克山病病情现状和消长趋势,科学评估防控效果.方法 云南省在17个县进行克山病病例搜索,由各监测县专业人员查阅辖区内县级医疗机构及病区乡(镇)医院内科、儿科、急诊科近3年内的出入院登记本、门诊及住院的心肌疾病病历.根据患者的病史、临床症状和体征、辅助检查结果和来自病区的流行病学线索等,确定疑似克山病病例.县级克山病专家组根据《克山病诊断标准》对疑似病例进行诊断核实.在7个县(市)进行克山病重点监测,在每个重点监测县抽取2个病区乡(镇),在每个抽中病区乡(镇)抽取1个病情相对较重的病区村作为监测点,对监测对象进行临床查体和十二导联心电图描记,对可疑克山病患者拍摄后前位2 m距离胸部正位X光片,按照《克山病诊断标准》确诊克山病病例,排除疑似病例.结果 2010年云南省在17个县进行克山病病例搜索,全省应搜索医疗单位624个,实际搜索583个,共有心肌疾病病例1 251例,疑似克山病146例.经各县级专家组集体讨论,诊断慢型克山病64例；在病例搜索出的64例慢型克山病病例中,男性(46例)多于女性(18例)；慢型克山病患者集中在45～54岁(27/64)及35～44岁(19/64).在7个县(市)14个村进行克山病重点监测,共监测6 206人,检出克山病50例,总检出率为0.81％,其中检出慢型克山病12例,检出率为0.19％,检出潜在型克山病38例,检出率为0.61％,急型和亚急型未检出；在重点监测检出的50例克山病病例中,女性(27例)多于男性(23例),潜在型克山病病例集中在3～14岁(9/38)、45～54岁(7/38)及＞65岁(7/38),慢型克山病病例集中在55～64岁(4/12)及45～54岁(3/12)；共检查心电图6 206人,心电图异常1 014人,异常率为16.34％.共拍摄了70例2 m后前位X线胸片,心胸比例≤0.50的36例(36/70),0.51～0.55的19例(19/70),0.56～0.60的9例(9/70),≥0.61的6例(6/70).结论 克山病病例搜索结果表明,云南省克山病发病虽明显减少,但未全部消除,在老病区仍有相当数量的慢性克山病患者存在,克山病致病因子仍对病区人群起着侵害作用.克山病重点监测结果表明,云南省克山病控制较好,克山病病情处于平稳低发势态,但在低年龄段(3～14岁、15～24岁、25～34岁)仍有慢型克山病检出,说明克山病致病因子仍然活跃,对克山病病区青少年危害较大,值得注意.

Analysis of Keshan disease investigation result in Yunnan province in 2010

Objective In order to master the current situation of Keshan disease（ KD） in Yunnan province,and scientifically evaluate the control and prevention result. Methods Searched the KD cases in 17 counties. Firstly, professional looked up the past three years cardiomyopathies record of internal medicine,pediatrics and emergency department by patient registration in county and town hospital. Then,confirmed the suspected KD cases according to medical history,clinical symptoms and signs, auxiliary check result and epidemic clue. KD experts who in project counties verify the suspected KD cases bases on the diagnostic standard of KD. Carried out KD investigate in 7 serious counties,2 towns were selected in each county,and 1 village was selected as surveillance site in each selected town. All the residents as the investigation object. To all objects, carried out clinical and electrocardiographic examination,and filmed 2 meters X-ray to the suspected cases. Correctly diagnosed KD cases by the diagnostic standard of KD,eliminated suspected cases. Iqesults 624 medical units should be searched about KD eases in the 17 selected counties, actually searched KD eases in 583 medical units. As the result, 1251 eases of cardiomyopathies and 146 eases of suspected KD were searched. Finally, 64 cases of chronic KD were confirmed diagnose. To the 64 chronic KD cases, male cases（46）more than female cases（18）, age mainly from 35 to 44 （19/64）and from 45 to 54 （27/64）. There were 6206 residents be investigated in the 14 investigation sites,and 50 cases of KD were found,the total incidence rate was 0.81%. Among the 50 KD eases,38 cases were latent KD,the incidence rate was 0.61%. 12 cases were chronic KD,the incidence rate was 0.19%. There was no any acute and sub acute eases be found. Female eases（ 27） more than male cases （ 23）. Latent cases age concentrated distribution from 3 to 14 （ 9 / 38）, from 45 to 54 （7 / 38）and more than 65（7/38）. Chronic eases age coneentrated distribution from 55 to 64（4/12）and from 45 to 54（3/ 12）. Electrocardiographic examination 6206 ,the abnormal rate was 16.34%（1014/6206）. Among 70 X-ray films,36 eases had a cardiothoracic ratio less than or equal to 0. 50,51. 43% （36/70） ,19 cases from 0.51 to 0.55,27.14% （19/ 70）. 9 cases from 0.56 to 0.60,12.86 % （9/70）. 6 cases more than or equal to 0.61,8.57 % （6/70）. Conclusions The result of search KD cases indicate that although KD case obviously reduce in Yunnan province, not all be eliminated~ There were still chronic case in old KD areas, the KD infectious agents still attack to the KD areas people. The result of surveillance KD presented the effect was good about control and prevention. The incidence ratio of KD was lower, and displayed downward trend in Yunnan province. However, there still chronic KD eases were detected who belong to low age group. The KD infectious agents were still strong and active. We need to pay more attentions to these.