2011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（市、区）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,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 云南省在17个县（市、区）进行克山病病例搜索,诊断慢型克山病 118 例.在病例搜索出的118例慢型克山病病例中,男性（71例）多于女性（47例）.慢型克山病病例集中在45~54岁年龄段（42/118）及35~44岁年龄段（32/118）;在7个县（市）14个村进行克山病重点监测,共监测6 017人,检出克山病31人,总检出率为0.52%,其中慢型克山病4例,检出率0.07%,检出潜在型克山病27例,检出率0.45%,急型和亚急型未检出.在重点监测检出的31例克山病病例中,女性（18例）多于男性（13例）.潜在型克山病病例集中在3~14岁年龄段（13/27）,慢型克山病病例集中在25~64岁年龄段（4/4）.共检查心电图6017人,心电图异常1064人,异常率为17.68 %.共拍摄了52例2 m后前位X线胸片,心胸比例≤0.50的33例（33/52）,0.51~0.55的13例（13/52）,0.56~0.60的4例（4/52）,≥0.61的2例（2/52）.结论 克山病病例搜索结果表明,云南省克山病病区仍有相当数量的慢型克山病患者存在,以青壮年居多;克山病重点监测结果表明,云南省克山病病情处于平稳低发势态,克山病检出率较低,潜在型克山病以儿童为主,慢型克山病以青壮年为主,值得注意的是潜在型克山病检出率3~14岁年龄段占48.15%（13/27）,说明克山病致病因子仍然活跃,对克山病病区儿童危害较大.

Analysis of the surveillance Keshan disease in Yunnan province in 2011

Objective To master the current situation of Keshan disease （KD） in Yunnan province, and to scientifically evaluate the control and prevention results. Methods The KD cases in 17 counties were searched, the records of cardiomyopathies treated in the past 3 years in the internal medicine, pediatrics and emergency departments were collected. Then the suspected KD cases were confirmed according to patients＇ medical history, clinical symptoms and signs, medical examination results and epidemic clues. KD experts verified the suspected KD cases. 7 counties were monitored, 2 towns in each county were selected, and 1 village in each town was screened. All villagers in the village received clinical and electrocardiographic examinations, and suspected cases underwent 2ometer X-ray examination to be confirmed. Results A total of 118 cases of chronic KD were searched in 17 counties, including 71 male and 47 female cases, patients aged 45-54（42/118） and 35-44（32/118） years. In the 7 counties monitored, 6 017 residents were screened, and 31 cases of KD were found, including 18 female and 13 male cases, the total incidence rate being 0.52%. Among the 31 KD cases, 27 cases were latent, the incidence rate being 0.45%, patients aged 3-14（13/27） years. 4 cases were chronic, （4/4）. No acute or subacute cases were found. Of the the incidence rate being 0.07%, patients aged 25-64 6017 residents who received electrocardiographic examination, the abnormal rate was 17.68~ （1064/6017）. Among 52 X-ray films, 33 cases had a cardiothoracic ratio less than or equal to 0. 50（33/52） , 13 cases had the ratio between 0.51-0.55（13/52）, 4 cases had the ratio between 0.56-0.60（4/52）. 2 cases had the ratio more than or equal to 0.61 （2/52）. Oonclusiorls The search results indicated that many chronic cases still existed in KD areas of Yunnan province, and the majority of patients were youth. The results of KD surveillance presented a downward incidence trend, the majority of latent cases were children, and chronic cases were youth. As 48.15 % （13/27） latent cases were children aged 3 to 14, more attention should be paid to children in this age period.