2009年黑龙江省大骨节病历史病区成人颈动脉粥样硬化调查

Objective To assess the prevalence of carotid atherosclerosis in adult patients with KaschinBeck disease(KBD) in endemic area, and to investigate the association between KBD and atherosclerosis. Methods B-mode ultrasound was used to investigate carotid atherosclerosis in patients with KBD over 40 years old in Shanhe farm and Shangzhi city and residents in Shuangcheng county in 2009. Ultrasonography images were saved and graded according to intima media morphology. Results The prevalence rates of carotid atherosclerosis in patients with KBD from the 5 villages affiliated to Shanhe farm were 50.0%(26/52),37.3%( 19/51 ),42.5%(30/71 ),58.2% (39/67) and 44.0% (22/50) , respectively. The prevalence rates of carotid atherosclerosis in patients with KBD from the 5 villages affiliated to Shangzhi city were 63.0% (34/54), 45.3% (24/53), 47.2% (25/53), 60.0% (30/50)and 51.9% (28/54), respectively. The prevalence rates of carotid atherosclerosis in people without KBD in the 5 control villages affiliated to Shuangcheng county were 63.9% (46/72),43.1% (31/72),57.1% (40/70),46.9% (30/64) and 53.0%(35/66), respectively. Ten villages in KBD endemic area and 5 villages in control area were investigated. The prevalence rates of carotid atherosclerosis in the 15 villages were standardized and compared by Wilcoxon test. The differences were not significant between two KBD endemic areas and one control( T = 25.0,24.5,all P ＞ 0.05). There was no significant difference in prevalence of atherosclerosis in the 3 areas(x2 = 0.36, P＞0.05). Comparing the severity of carotid atherosclerosis in 3 locations, the difference was statistically significant (x2 = 15.28, P ＜ 0.05) and there was significant difference statistically between the subjects in Shangzhi city and that in the control group(x2 = 8.92, P ＜ 0.05). There was no significant difference between the detection rate of atherosclerosis and the severity of KBD, and similar results in the grade of atherosclerosis and the severity of KBD were found (x2 = 1.88,5.07, all P ＞ 0.05). Conclusions The prevalence rate of carotid atherosclerosis in historical endemic area in Heilongjiang province is not higher than that in the control area.     

2008年黑龙江省饮水型地方性氟中毒病区成人颈动脉粥样硬化病情调查

目的 调查黑龙江省饮水型地方性氟中毒(简称地氟病)病区成人颈动脉粥样硬化病情,探讨饮水型氟中毒与颈动脉粥样硬化发生的关系.方法 2008年,在黑龙江省肇州县选取4个饮水含氟量≥1.0 mg/L的自然村作为病区组,在泰来县选取4个饮水含氟量＜1.0 mg/L的自然村作为对照组.用B超对40岁以上居民进行了颈动脉粥样硬化检查,保留超声图片并做记分、诊断、评分.结果病区组4个村(新丰村、太平山村、宝产村和后郑村)共检查266人,颈动脉粥样硬化检出率分别为47.3%(35/74)、63.5%(40/63)、73.3%(33/45)、60.7%(51/84);对照组4个村(哈拉村、乾兴村、三家村、爱林村)共检查283人,颈动脉粥样硬化检出率分别为32.7%(17/52)、32.9%(24/73)、39.2%(31/79)、30.4%(24/79),两组间检出率比较,差异有统计学意义(T=26,P＜0.05);病区村与对照村按年龄标准化后的颈动脉动脉粥样硬化检出率分别为47.3%、63.5%、73.3%、60.7%,34.7%、36.3%、43.0%、41.3%,两组间预期阳性率[57.5%(153/266)、37.8%(107/283)]比较,差异有统计学意义(x2=21.36,P＜0.01);按年龄标准化的颈动脉粥样硬化病例病变严重程度两组间比较,差异有统计学意义(x2=36.15,P＜0.01).结论饮水型地氟病病区成人颈动脉粥样硬化的检出率高于对照,病变程度重于对照,高氟与动脉粥样硬化的发生存在一定的关系.     

2008年黑龙江省饮水型地方性氟中毒病区成人颈动脉粥样硬化病情调查

Objective To investigate the disease situation of adult carotid atherosclerosis in water-related endemic fluorosis areas in Heilongjiang province in 2008 so as to explore the relationship between water-related endemic fluorosis and incidence of carotid atherosclerosis disease. Methods A total of 266 participants over the age of 40 from four villages in Zhaozhou county with water fluoride ≥ 1.0 mg/L in a fluorosis area and 283 residents over the age of 40 from four villages in Tailai county with water fluoride ＜ 1.0 mg/L in a nonfluorosis area were investigated. A portable-type B mode color ultrasound was used to examine the left carotid artery of all participants.The carotid atherosclerosis was diagnosed and graded through the ultrasonograms. Results The prevalence rates of carotid atherosclerosis in the 4 fluorosis villages(Xinfeng, Taipingshan, Baochan and Houzheng villages) were 47.3% (35/74), 63.5%(40/63), 73.3%(33/45) and 60.7%(51/84), respectively, and in the 4 nonfluorosis villages(Hala,Qianxing, Sanjia and Ailin villages) were 32.7% (17/52), 32.9% (24/73), 39.2% (31/79) and 30.4% (24/79),respectively. The prevalence rates of carotid atherosclerosis in every villages standardized by age were 47.3% ,63.5%,73.3% ,60.7% and 34.7% ,36.3% ,43.0% ,41.3%, respectively. Statistic method used was Wilcoxon two sample test and the differences were significant(T = 26, P ＜ 0.05 ). Total carotid atherosclerosis positive rate standardized by age in the 4 fluorosis villages was significantly higher than that in the 4 nonfluorosis villages[57.5%(153/266) ,37.8% (107/283), x2 = 21.36, P ＜ 0.01 ]. After standardized by age, the severity of carotid atherosclerosis was significantly different between fluorosis villages and nonfluorosis villages (x2 = 36.15, P ＜ 0.01 ). Conclusion The prevalence rate of carotid atherosclerosis in endemic fluorosis area is higher than that in nonfluorosis area.     

2009年山西省饮水高砷区成人颈动脉粥样硬化调查

目的 探讨饮水型砷中毒与成人颈动脉粥样硬化发生的关系.方法 2009年,在山西省应县,根据<地方性砷中毒病区判定和划分标准>(WS 277-2007),选择东辛寨村、北湛村、大西头村、赤堡村和杏寨村为病区组,选择龙泉村、接马峪村、城下庄村、罗庄村和南丰町村作为对照组,利用彩超对40岁以上的饮水型高砷地区居民285人和对照地区居民293人进行颈动脉粥样硬化检查,并进行诊断、记分.在对年龄构成标准化后,计算动脉粥样硬化的标准化检出率.每个调查村各抽取10人,采用原子荧光法检测水砷和发砷.结果在病区组中,东辛寨村、北湛村、大西头村、赤堡村和杏寨村成人颈动脉粥样硬化检出率分别为35.09%(20/57)、55.74%(34/61)、38.46%(20/52)、36.51%(23/63)、46.15%(24/52);标准化检出率分别为32.5%、33.8%、34.9%、46.2%、47.3%;在对照组,龙泉村、接马峪村、城下庄村、罗庄村和南丰町村成人颈动脉粥样硬化检出率分别为18.18%(10/55)、30.77%(16/52)、20.00%(10/50)、18.67%(14/75)和21.31%(13/61);标准化检出率为22.4%、17.7%、10.7%、24.6%、18.9%.病区组的标准化检出率[39.50%(113/285)]高于对照组[21.70%(64/293),T=26,P＜0.01],病区组成人颈部动脉粥样硬化4～7分的构成[17.70%(20/113)]与对照组[14.06%(9/64)]比较,差异无统计学意义(x2=0.26,P＞0.05).结论山西省饮水型砷中毒病区成人的动脉粥样硬化检出率高于对照区.为进一步证实砷中毒可致动脉粥样硬化症提供了证据.     

2009年山西省饮水高砷区成人颈动脉粥样硬化调查

Objective To investigate the relationship between drinking-water type of endemic arsenicosis and adult carotid artery atherosclerosis. Methods In 2009, 285 participants aged over 40 from drinking-water type of endemic arsenism areas and 293 residents aged over 40 from control areas were investigated in Yingxian county,Shanxi province. Portable-type B mode color ultrasound was used to examine the carotid artery of all participants.The carotid atherosclerosis were diagnosed and graded through the ultrasonograms. Content of water arsenic and hair arsenic of 10 people randomly selected in every villages were detected. Results A total of 5 villages with drinkingwater type of endemic arsenicosis as observation group and 5 villages without drinking-water type of endemic arsenicosis as control group were investigated. The prevalence rates of adult carotid atherosclerosis within observation group were 35.09%(20/57), 55.74%(34/61), 38.46%(20/52), 36.51%(23/63) and 46.15%(24/52), respectively,and standardized prevalence rates were 32.5%, 33.8%, 34.9%, 46.2% and 47.3%, respectively and the prevalence rates of adult carotid atherosclerosis within control group were 18.18%(10/55), 30.77%(16/52), 20.00%(10/50),18.67% (14/75) and 21.31% ( 13/61 ), respectively; the standardize prevalence rates were 22.4%, 17.7%, 10.7%,24.6%, 18.9%, respectively. The standardize prevalence rates were higher in observation group [39.50%(113/285) ]than that in control group[39.50%(113/285), T = 26, P ＜ 0.01 ]. The severity of adult carotid atherosclerosis (composition of 4 - 7 scores ) was compared between observation group [ 17.70%(20/113 )] and control group [ 14.06% (9/64) ], and the difference was insignificant(x2 = 0.26, P ＞ 0.05). Conclusions The prevalence rate of carotid atherosclerosis in drinking-water type of endemic arsenicosis areas is higher than that of the control areas.The study provides evidence that arsenic poisoning can cause atherosclerosis.     

2008年山东省地方性水源性高碘病区成人颈动脉粥样硬化调查

目的 调查2008年山东省地方性水源性高碘病区成人颈动脉粥样硬化患病情况,探讨水源性高碘与颈动脉粥样硬化发生的关系.方法选择山东省郓城县和巨野县作为高碘病区和对照区,以郓城县的大陈楼村、魏垓村、刘一村和二十里铺村为高碘病村,以巨野县的章西村、毕海南村、夏官屯和祁集村为对照村.利用彩超对40岁以上的高碘病区居民299人和对照区居民323人进行颈动脉粥样硬化检查、诊断和记分.结果大陈楼村、魏垓村、刘一村和二十里铺村4个高碘病村成人颈动脉粥样硬化检出率分别为47.1%(33/70)、62.2%(51/82)、67.5%(52/77)和58.6%(41/70);章西村、毕海南村、夏官屯和祁集村4个对照村成人颈动脉粥样硬化检出率分别为40.7%(35/86)、40.8%(31/76)、38.2%(34/89)和37.5%(27/72).高碘病村和对照村成人颈动脉粥样硬化检出率按年龄标准化后分别为45.81%、58.18%、61.63%、55.34%和34.66%、36.25%、43.01%、41.30%,高碘病村的检出率高于对照村(T=26,P＜0.05).高碘病区299人中,检出阳性163人、阴性136人,0分136人、1～3分120人、4～7分43人;对照区323人中,检出阳性122人、阴性201人,0分201人、1～3分87人、4～7分35人.高碘病区与对照区成人颈动脉粥样硬化阳性检出情况及病变严重程度比较,差异有统计学意义(x2值分别为17.54、18.42,P均＜0.01).结论高碘病区成人动脉粥样硬化检出率增高、病变严重程度增大.

Abstract：

Objective To survey the prevalence rates of adult carotid atherosclerosis in water-sourceoriginated high iodine area in Shandong province in 2008 and discuss the relationship between water-sourceoriginated high iodine and carotid atherosclerosis occurrence. Methods Yuncheng county was chosen as observation area which included Dachenlou, Weigai, Liuyi and Ershilipu villages. Juye county was chosen as control that included Zhangxi, Bihainan, Xiaguan and Qiji villages. Two hundred and ninety-nine participants aged over 40 from water-source-originated high iodine areas and 323 residents aged over 40 from normal iodine areas were investigated.Portable-type B mode color Doppler was performed to examine the carotid artery of all participants. The adult carotid atherosclerosis was diagnosed and graded through the ultrasonograms. Results The prevalence rates of adult carotid atherosclerosis in the 4 water-source-originated high iodine villages of Dachenlou, Weigai, Liuyi and Ershilipu were 47.1% (33/70) ,62.2% (51/82) ,67.5% (52/77) and 58.6% (41/70), respectively and the prevalence rates of adult carotid atherosclerosis in the 4 normal iodine villages of Zhangxi, Bihainan, Xiaguan and Qiji were 40.7%(35/86),40.8% (31/76),38.2% (34/89) and 37.5% (27/72), respectively. The prevalence rates of adult carotid atherosclerosis standardized by age in the 4 high iodine villages and the 4 normal iodine villages were 45.81% ,58.18% ,61.63%,55.34% and 34.66%,36.25%,43.01% ,41.30%, respectively. The prevalence rates were higher in high iodine villages than that in control villages(T = 26, P ＜ 0.05 ). There were 136 people scored "0", 120 people scored "1 -3",43 people scored "4 - 7", and total 299 people. There were 201 people scored "0", 87 people scored "1 - 3", 35 people scored "4 - 7", and total 323 people. The expected prevalence rates and severity of adult carotid atherosclerosis was significantly different between high iodine area and normal iodine area (x2 = 17.54,18.42, all P ＜ 0.01).Conclusion The prevalence rate and severity of adult atherosclerosis in water-source-originatod high iodine area is higher than that in normal iodine area.     

颈动脉粥样硬化超声检查的新进展

颈动脉粥样硬化在卒中的发病中有重要作用,颈动脉的超声检查近年来发展迅速,新技术不断涌现,文章综述了功率多普勒成像、混合成像、四维成像、四维彩色多普勒血流成像等动脉粥样硬化检测、评价的新技术,以及内膜-中膜厚度与病理的相关性、动脉粥样硬化斑块脱落的可能性评价及其与栓塞性卒中发生的相关性。     

2008年山东省地方性水源性高碘病区成人颈动脉粥样硬化调查

Objective To survey the prevalence rates of adult carotid atherosclerosis in water-sourceoriginated high iodine area in Shandong province in 2008 and discuss the relationship between water-sourceoriginated high iodine and carotid atherosclerosis occurrence. Methods Yuncheng county was chosen as observation area which included Dachenlou, Weigai, Liuyi and Ershilipu villages. Juye county was chosen as control that included Zhangxi, Bihainan, Xiaguan and Qiji villages. Two hundred and ninety-nine participants aged over 40 from water-source-originated high iodine areas and 323 residents aged over 40 from normal iodine areas were investigated.Portable-type B mode color Doppler was performed to examine the carotid artery of all participants. The adult carotid atherosclerosis was diagnosed and graded through the ultrasonograms. Results The prevalence rates of adult carotid atherosclerosis in the 4 water-source-originated high iodine villages of Dachenlou, Weigai, Liuyi and Ershilipu were 47.1% (33/70) ,62.2% (51/82) ,67.5% (52/77) and 58.6% (41/70), respectively and the prevalence rates of adult carotid atherosclerosis in the 4 normal iodine villages of Zhangxi, Bihainan, Xiaguan and Qiji were 40.7%(35/86),40.8% (31/76),38.2% (34/89) and 37.5% (27/72), respectively. The prevalence rates of adult carotid atherosclerosis standardized by age in the 4 high iodine villages and the 4 normal iodine villages were 45.81% ,58.18% ,61.63%,55.34% and 34.66%,36.25%,43.01% ,41.30%, respectively. The prevalence rates were higher in high iodine villages than that in control villages(T = 26, P ＜ 0.05 ). There were 136 people scored "0", 120 people scored "1 -3",43 people scored "4 - 7", and total 299 people. There were 201 people scored "0", 87 people scored "1 - 3", 35 people scored "4 - 7", and total 323 people. The expected prevalence rates and severity of adult carotid atherosclerosis was significantly different between high iodine area and normal iodine area (x2 = 17.54,18.42, all P ＜ 0.01).Conclusion The prevalence rate and severity of adult atherosclerosis in water-source-originatod high iodine area is higher than that in normal iodine area.     

颈动脉粥样硬化斑块稳定性超声检查研究进展

<正>动脉粥样硬化(AS)斑块分为稳定性和不稳定性斑块(即易损斑块),AS斑块的稳定性与心脑血管疾病有重要的关系,大部分心脑血管急性事件是由AS易损斑块破裂继发血栓所致~([1,2])。易损斑块的早期识别、早期干预,可减少心脑血管急性事件的发生,对临床有重要意义。本文就颈AS(CAS)斑块的     

2009年四川省阿坝州大骨节病病区居民大骨节病认知调查

目的 了解阿坝州大骨节病病区居民对大骨节病的认知情况.方法 2009年,采用分层整群随机抽样的方法,在四川省阿坝州大骨节病病区抽取13个村作为调查点,调查居民的一般人口学特征、大骨节病患病情况、认知情况.结果 共计调查了1007名居民,大骨节病知识回答正确率为36.7%(7361/20 080),女性[40.2%(4427/11012)]高于男性[32.3%(2934/9084),x2=134.80,P＜0.05];50年龄组[42.5%(2789/6562)],藏族[42.8%(6775/15829)],半农半牧区居民[47.2%(5777/12239)],务农[42.6%(4585/10762)]、丧失劳动力[42.7%(1487/3482)]、无业[42.8%(941/2199)],已婚[41.6%(6067/14584)],大骨节病患者[47.6%(4585/9632)]回答正确率相对较高(x2值分别为92.41、148.04、578.56、116.35、36.96、371.29,P均＜0.05).63.9%(978/1530)通过医疗卫生人员获取大骨节病相关知识.结论 阿坝州病区居民对大骨节病的认知现况不容乐观,不同人口学特征人群其认知率差异明显.应针对不同特征人群制订有针对性的健康教育策略和措施.     

甘肃省成人大骨节病病情调查

目的了解甘肃省成人大骨节病病情,为成人大骨节病治疗提供科学依据。方法选取26个县（区）的60个调查点,对所有16岁以上常住人口进行大骨节病病情调查,统计检出率及构成比。结果临床检查34 941人,Ⅰ°以上患者6 125人,Ⅰ°以上检出率17.53%,其中Ⅰ°检出率10.70%,Ⅱ°检出率5.44%,Ⅲ°检出率1.39%;男、女检出率差异无统计学意义（χ2=0.150,P=0.901〉0.05）;检出率以46岁以上年龄段为高,各年龄段检出率差异有统计学意义;60个调查点中,检出率≥20%的点有26个,占43.33%。结论甘肃省部分地区成人大骨节病病情严重,应开展综合防治,提高大骨节病患者的生存质量。     

2009年河北省儿童大骨节病监测报告

目的掌握河北省大骨节病病情动态,为制定防治策略提供科学依据。方法根据2008年度大骨节病防治项目技术方案要求,对7～12岁在校学生进行临床及右手正位X线拍片检查,分别统计临床患病率与X线阳性率。结果全部监测点未检出临床Ⅰ度及以上病人,以县为单位统计X线阳性检出率丰宁县0.9%,崇礼县1.2%,各监测点最高检出率为2.2%,其中一个监测点检出率为0。结论河北省大骨节病病情处于稳定状态,且都达到国家控制标准。     

青海省班玛县大骨节病病区居民饮食结构与病情关系调查

目的探讨青海省班玛县大骨节病病区居民饮食结构与病情的关系。方法采用问卷调查方法调查居民20年饮食结构,结合1984-2004年班玛县大骨节病病情监测资料进行二者间的关系分析。结果从20世纪80年代至2004年,居民饮食构成中主食越来越少,副食逐渐增多;自产粮越来越少,外购粮逐渐增多;1984年大骨节病X线检出率(成人和儿童)为42．01％,1990年儿童大骨节病X线检出率7．50％,1998、 2004年分别降为0。结论班玛县大骨节病病情自然消退,居民病情下降可能与饮食结构改变有关。     

2009年青海省兴海县儿童大骨节病病情及影响因素调查

目的 调查青海省兴海县大骨节病相对活跃病区儿童大骨节病流行现状,以及当地儿童硒营养水平和家庭主食粮食T-2毒素污染水平.方法 2009年对兴海县唐乃亥乡上、中、下3个村7～ 12岁儿童进行右手X线拍片,根据《大骨节病诊断标准》(GB 16003-1995)进行诊断.同时采集拍片儿童的枕部发样、饮水以及主食粮食(小麦和/或面粉),2,3-二氨基萘荧光法测定其头发、饮水和主食粮食硒含量,酶联免疫吸附试验(ELISA法)检测主食粮食T-2毒素污染水平.结果 儿童大骨节病X线总检出率为12.20％(31/254),其中下村X线检出率达到14.97％(22/147),上村X线检出率为9.52％(6/63),中村X线检出率为6.82％(3/44).病区儿童内外环境硒水平普遍较低,头发、饮水、小麦、面粉硒含量分别为(0.250±0.136)mg/kg、(0.16±0.05)μg/L、(0.0045±0.0030)mg/kg、(0.0067±0.0116)mg/kg.病区儿童家庭主食粮食T-2毒素含量较高,小麦为(78.91±46.17)μg/kg;面粉为(47.47±46.47) μg/kg.结论 青海省兴海县大骨节病相对活跃病区7～ 12岁儿童内外环境硒水平较低,而主食粮食T-2毒素污染水平较高,与当地儿童大骨节病病情分布基本一致.