2014-2015年四川省克山病调查结果分析

目的了解和掌握2014-2015年四川省克山病病区病情现状,为今后四川省克山病预防控制提供科学依据。方法按全国统一调查方案对四川省内54个病区县居民进行流行病学调查、临床查体、心电图,疑似克山病摄2 m后前位X线胸片及心脏超声检查。结果 54县(市)从调查点共调查62 973人,检出慢型和潜在型克山病共64例(检出率0.10%),其中慢型克山病14例(检出率0.02%),潜在型克山病50例(检出率0.08%),未发现急型和亚急型克山病例。结论四川省2014-2015年克山病病情低于2010年,已达到控制水平;中老年成为潜在型克山病的主要受威胁的对象,是今后监测及治疗工作的重点。     

中国克山病防控空间描述性研究

目的分析全国2015—2016年克山病病情及防控效果,为制定防控策略及合理分配卫生资源提供依据。方法采用重点调查与病例搜索相结合方式,调查15个全国克山病病区省,280个病区县的克山病病情、防控措施和防控效果。结果调查病区县占全国病区县的85.4%(280/328);病区居民23.7万人,共检出克山病患者802例,患病率为14.3/万,其中慢型克山病153例(患病率2.7/万),潜在型克山病649例(患病率11.6/万)。所调查病区县中达到克山病消除验收要求的病区县占75.7%;达到克山病控制标准的病区县占13.9%;未达到控制标准的病区县占10.4%,主要分布在甘肃、内蒙古、山东等省份。结论全国克山病病情已得到较好控制,但是在内蒙古、甘肃、山东等省份仍有未达到控制标准的病区县,这些地区应为今后克山病防控工作的重点区域。     

莒县克山病综合性防治回顾

[目的]莒县克山病综合性防治经验回顾。[方法]对莒县克山病综合性防治及流行病学调查资料进行统计分析。[结果]1969-2000年发生克山病906例。死亡632例。通过综合性防治已连续10年无病例发生,基本控制了克山病流行。[结论]通过对克山病的防治,2000年已达到“基本控制克山病区标准”。     

滕州市克山病流行概况与防治措施

滕州市位于鲁南,东部为山区丘陵,中部平原,西邻微山湖。全市22个乡镇,共140万人。自1972年发现克山病人至今累计发病120例,死亡75例,死亡率为62.50％。病人分布在21处乡镇,受威胁人群达80余万人。自1987年以来未再发现新病人。1992年9月经山东省卫生厅组织专家考核验收已达国家规定的基本控制标准。现将滕州市23年来克山病流行概况与防治措施分述如下:1 流行病学1.1 克山病流行情况 滕州市于1972年发现6例不明原因的心肌病患者,经积极抢救、治疗无效死亡3例,怀疑是克山病,遂     

五莲县1970～2000年克山病发病动态分析

五莲县是山东省克山病重病区之一 ,自 1970年发现首例克山病病人至今 ,共发现克山病病人 5 2 8例。1975～ 1979年为流行高峰 ,自 1980年发病显著下降 ,1992年得到了基本控制 ,2 0 0 0年经线索调查发现 3例克山病病人。为探讨克山病发病特点 ,现对五莲县1970～ 2 0 0 0年克山病不同时期的发病特点进行分析。1　资料与方法依据 1970～ 2 0 0 0年五莲县克山病发病资料。病人经查体、心电图、Ｘ线等检查确诊后 ,纳入克山病常规管理。临床诊断及转归均按照全国统一标准。2　结果2 1　发病与死亡情况　五莲县于 1970年 1月在洪凝镇李家沟村发现首…     

柯萨奇病毒B3感染与克山病

为探讨柯萨奇病毒B3 与克山病发病间的相关关系 ,先后采用特异性肠道病毒RTPCR、特异性B组柯萨奇病毒ELISA ,以及特异性柯萨奇病毒B3RTPCR对四川省冕宁县、喜德县、德昌县克山病病区潜慢型克山病患者以及健康人血中肠道病毒、B组柯萨奇病毒和柯萨奇病毒B3 分别进行检测。结果显示 :①肠道病毒在潜、慢型克山病组血标本中检出率很高 ,达 80 % ,与健康对照组差异显著 (P <0 0 1)。②血清CVB1～ 6IgM抗体阳性率明显高于健康对照组 (33%VS 0 % ,P <0 0 1) ;潜、慢型克山病组血清CVB1～ 6IgG抗体阳性率高于健康对照组 ,且差异显著 (2 3%VS 0 % ,P <0 0 1)。③柯萨奇病毒B3 潜、慢型克山病组的检出率仅为 10 % ,在B组柯萨奇病毒抗体IgM阳性病人中占 40 % (4 10 ) ,占肠道病毒阳性样本的 16 6 % (4 2 4)。认为病区潜、慢型克山病患者有肠道病毒感染存在 ,单独由柯萨奇病毒B3 无毒株在缺硒的环境中突变为有毒株后损伤心肌组织来解释克山病的发病机制理由尚不够充分     

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.     

克山病病人脂蛋白(a)水平探讨

目的探讨脂蛋白（a）[Lp（a）]水平与克山病的关系。方法采用酶联免疫分析技术检测22例克山病病人、20例心电图异常者、18例病区正常人和20例非病区正常人,用t检验比较四组不同Lp（a）浓度水平的关系。结果克山病病人、心电图异常者、病区正常人、非病区正常人比较,组与组无统计学意义（P〉0.05）。结论克山病与Lp（a）水平无相关性。     

武定县勒外村克山病病情调查

根据全国克山病监测方案要求 ,为探讨武定县克山病发病现状及影响因素 ,调整现阶段防治策略提供依据 ,2 0 0 0年 12月对历史上克山病发病区武定县高桥镇勒外村民委员会进行了克山病病情调查。1　内容与方法1 1　对勒外村民委员会钱家村、松子园一社、松子园二社、郭家村的 3～ 5 5岁人群进行普查。询问病史、临床体检、心电图 12导联描记 ,疑似克山病病人进行Ｘ线后前位拍摄胸片。心胸比按九肋法测量。每例患者均建立病情观察记录。1 2　克山病诊断标准按照 1995年全国地方病标准分会会议通过的《克山病诊断标准》执行。2　结果2 1　克山病…     

从红细胞中磷的代谢探讨克山病与缺氧问题

1.通过对克山病人(52例),克山病死亡病例(21例),病区健康人(39例)及非病区健康人(48例)红细胞中总磷(TP)及脂磷(LP)的分析,表明克山病人及克山病死亡病例的TP值与TP—LP值皆明显地高于病区健康人,病区健康人的TP值与TP—LP值皆明显地高于非病区健康人。2.分析了红细胞中TP—LP值的含义及其升高的意义,并对克山病病人和病区健康人群中存在的机体缺氧情况作了初步讨论。     

关于钼缺乏和克山病病因关系的研究

<正> 我们自1961年提出克山病的生物地球化学病因说以来,一直从两方面进行探索:一是利用实验病理学方法从病区粮食、蔬菜和饮水中寻找致病因素;二是对病区外环境中能引起心肌缺血、缺氧的因素进行研究,以期能逐步阐明克山病病因。本文将就我们在克山病病因研究工作中的进展作一综合报导。     

Prior infection of chickens with H1N1 avian influenza virus elicits heterologous protection against highly pathogenic H5N2

Current vaccines for influenza are primarily killed whole virus vaccines that elicit antibody responses to the homologous virus but lack protection against heterologous viruses. Using chickens as a model we have explored the possibility of using a live low pathogenic avian influenza (LPAI) A/goose/AB/223/2005 H1N1 virus as a vaccine to generate protective immunity against heterologous highly pathogenic avian influenza (HPAI) A/chicken/Pensylvania/1370/1983 H5N2 virus challenge. Virus replicated in chickens infected with LPAI H1N1 but did not cause clinical disease. In addition, these chickens developed neutralizing antibodies to LPAI H1N1 virus, but not HPAI H5N2, 21 days post infection (DPI). Furthermore, peripheral blood mononuclear cells from H1N1-infected chickens at 20 DPI had antigen specific proliferation and IFN-γ secretion following antigen stimulation to H5N2 indicating a heterologous HPAI H5N2 specific cell mediated immunity (CMI) following LPAI H1N1 infection. Following challenge with HPAI H5N2 virus, all control chickens developed clinical disease, while chickens previously infected with H1N1 did not develop clinical disease and shed significantly less virus by oral and cloacal routes. These results indicated that previous infection with LPAI virus can generate heterologous CMI capable of protecting against HPAI H5N2.     

Keshan disease--a review from the aspect of history and etiology

OBJECTIVE: Keshan disease is an endemic cardiomyopathy found in Keshan, north-east China. The first patient was identified in 1935. This disease is characterized by a blood circulation disorder, endocardium abnormality and myocardium necrosis. Selenium (Se) deficiency is thought to be a major factor by Chinese scientists. However, the exact etiology has not been clarified up to now. The government decided to apply sodium selenite to growing crops, and the incidence of the disease decreased dramatically. However, a few cases still occur as chronic or latent types. This paper reviews Keshan disease from a historical aspect and also the present situation. METHODS: We made a reference survey and summarised the etiology, pathological changes, clinical manifestation, and other views of Keshan disease. RESULT: So far, epidemiological surveys have shown that Keshan disease occurs in large areas in 14 provinces in China, mainly in the countryside. It has been confirmed by clinical and pathological studies that Keshan disease is an independent endemic myocardial disease caused by biological and geological factors. The largest prevalence age rates are boys under 15 years old and women of childbearing age. There are several hypotheses; acute carbon monoxide poisoning, virus infection, malnutrition, or selenium deficiency. The first is not currently believed to be the cause. The following was pointed out; studies on the relationship between diet and the endemic areas of Keshan disease in 1961, where the food custom of the local residents was relatively simple and a so-called "one-sided diet" (eating a limited variety of food) might be related to the incidence of Keshan disease. In 1973, large-scale investigations on the natural environments were performed in the endemic areas of Keshan disease in the whole country. As a result, it was reported that there was a relationship between the incidence of Keshan disease and the special natural environment in the endemic areas and the cause of Keshan disease was strongly supported by nutritional, biological, geological and chemical (selenium deficiency) factors. In 1981, on the other hand, it was found that the levels of antibodies against Coxsackie virus were higher in the serum of Keshan disease patients than of normal subjects. This fact supposed that the cause of Keshan disease was related to a virus infection. However, it is difficult to explain why the clinical and pathological manifestations of Keshan disease are similar to those of other diseases, e.g. idiopathic dilatational myocardial disease. Further research should be performed on Keshan disease to clarify the etiology.     

克山病患者及健康人血清游离氨基酸与蛋白质含量分析

对克山病病区健康人35例、克山病人38例的17种血清游离氨基酸与蛋白质含量进行了分析,并以非病区健康人31例作对照,发现病区居民血清游离氨基酸总量、必需氨基酸、非必需氨基酸及血清蛋白质显著降低。病区健康人苏氨酸、脯氨酸、胱氨酸、异亮氨酸、酪氨酸及色氨酸降低;克山病人苏氨酸、脯氨酸、丙氨酸、胱氨酸、缬氨酸、异亮氨酸、亮氨酸、酪氨酸、赖氨酸、组氨酸及色氨酸降低。结果表明,病区居民血中处于低氨基酸低蛋白状态,此可能是克山病发病的重要条件之一。     

克山病与自然环境和硒营养背景

<正> 克山病是一种病因未明、慢性病程的地方性心肌病。长期以来,提出过许多种病因假说,可归纳为二类,即生物性病因和非生物性病因。后者通常也称为水土病因,它包括有:一为中毒性病因,主要有环境中异常有机物中毒,亚硝酸盐中毒和其他化学元素中毒;一为缺乏病因,主要有缺硒、缺钼、饮食中某些化学物质缺乏与失调。总之通过长期研究与协     

Effects of exposure to carbon disulphide on low density lipoprotein cholesterol concentration and diastolic blood pressure.

The relation of carbon disulphide (CS2) exposure to risk factors for ischaemic heart disease was recently examined using data from a 1979 cross sectional study of 410 male textile workers, of whom 165 were exposed and 245 were unexposed to CS2. Average eight hour CS2 exposure concentrations ranged from 0.6 to 11.8 ppm by job title category among the exposed workers. A significant and positive linear trend in low density lipoprotein cholesterol concentration (LDLc) and diastolic blood pressure with increasing CS2 exposure was found after adjustment for potential confounders. When exposure was examined as a categorical variable (none, low, moderate, and high), the high exposure group had an adjusted mean LDLc that was 0.32 mmol/l greater than the non-exposed group (p = 0.02), and an adjusted mean diastolic blood pressure that was 3.16 mm Hg greater than the non-exposed group (p = 0.09). The effect of CS2 on diastolic blood pressure was strengthened in analyses limited to exposed workers: the high exposure group had an adjusted mean diastolic blood pressure that was 5 mm Hg greater than that of the low exposed group (p = 0.03). Triglyceride, high density lipoprotein cholesterol, and fasting glucose concentration, and systolic blood pressure were not affected by exposure. Blood lead concentration was positively associated with systolic and diastolic blood pressure. The results indicate that relatively modest exposure to CS2 may raise LDLc concentration and diastolic blood pressure and suggest mechanisms by which exposure to CS2 may influence risk of ischaemic heart disease. Also the results provide further support for the hypothesis of a possible association between blood lead concentration and blood pressure.     

Dose response effects of avian influenza (H7N7) vaccination of chickens: Serology,clinical protection and reduction of virus excretion

Knowledge of the relation between the antigen content of inactivated avian influenza (AI) vaccines, the serological response after vaccination and protection of vaccinated animals is important for the choice of optimal vaccines and vaccination regimes as well as for the assessment of criteria for the licensing of new AI-vaccines. We studied this relation in a dose response study using inactivated H7N7 avian influenza vaccines with varying antigen content. The serological response depended on the antigen content of the vaccines. Anti-AI antibodies were detected most frequently with ELISA, followed by the virus neutralisation test and the haemagglutination inhibition (HI) assay. Chickens with measurable HI-antibody titers, using homologous H7N7 antigen, were all protected against clinical disease after challenge with highly pathogenic A/chicken/Netherlands/621557/03 H7N7 virus. However, in these chickens high levels of virus could still be present on days 2–4 after challenge. The reduction of virus titers after challenge, depended on the antigen content of the vaccines as well as on the serum antibody titers. While 10 haemagglutinating units (HAU), equivalent to 0.8 μg haemagglutinin (HA) protein, per vaccine dose was sufficient for prevention of clinical disease, 128 HAU (9 μg HA) per dose was required for reduction of virus titers in all chickens to 10³ egg-infectious dose 50% (EID₅₀) or less. In order to reduce virus titers below 10³ EID₅₀ per swab a HI-antibody titer of 64 was required. After use of the vaccine with the highest antigen content, challenge still induced a booster of antibody titers which is indicative of replication of challenge virus.     

Se和VE对大鼠心肌肌球蛋白重链基因表达影响的研究

从克山病病区粮和非病区粮及病区粮补加Ｓｅ和ＶＥ喂养的大鼠心肌中提取总ＲＮＡ，采用斑点印迹法分析其中的α和β－心肌肌球蛋白重链（ＣＭＨＣ）ｍＲ－ＮＡ含量的变化，并对大鼠血清及心肌组织中的Ｔ４、Ｔ３含量及Ｔ４５－脱单碘酶活性进行了观测。结果表明，与对照组相比，病区粮喂养大鼠心肌组织中的α－ＣＭＨＣｍＲＮＡ含量降低而β－ＣＭＨＣｍＲＮＡ含量升高，同时心肌和血清中Ｔ３含量显著下降，血清Ｔ４增高而心肌Ｔ４变化不大，心肌中Ｔ４５－脱单碘酶活性降低。补加Ｓｅ和ＶＥ后上述改变明显回转，提示克山病致病因素可导致大鼠ＣＭＨＣ基因表达的偏移。Ｓｅ和ＶＥ对心肌肌球蛋白的保护作用可能与心肌Ｔ４５－脱单碘酶活性、Ｔ３含量及其对ＣＭＨＣ基因表达的调控有关。     

1961-2006年四川省凉山州克山病流行及防治

目的掌握凉山彝族自治州历史和现在的克山病病情,做好可持续性防治。方法分析整理1961-2006年的克山病疫情报表、监测县调查数据以及部分三级防治网健全地区的确诊病情资料。结果凉山州17个县中除2个县（盐源、木里）外其他15个县均陆续发现有克山病流行。1961-1996年累计发生克山病13097例,年均发病率为22.61/10万;1997年以后,凉山州15个病区县中,仅6个县有克山病病例报告,累计发病124例。口服亚硒酸钠片剂和硒盐预防克山病,服硒儿童发病率低于同龄儿童对照组发病率,差异有统计学意义。结论凉山州曾经是国内克山病最重病区之一,当前仍然存在局部病情活跃,硒盐预防克山病有显著效果。强化并做好克山病防治,是当前一项重要任务。     

Molecular immunophenotyping of lungs and spleens in naive and vaccinated chickens early after pulmonary avian influenza A (H9N2) virus infection

In a respiratory-infection-model with the avian influenza A H9N2 virus we studied lung and splenic immune reactions in chickens using a recently developed 5K chicken immuno-microarray. Groups of chickens were either mock-immunized (referred to as non-immune), vaccinated with inactivated viral antigen only (immune) or with viral antigen in a water-in-oil (W/O) immunopotentiator (immune potentiated). Three weeks after vaccination all animals were given a respiratory infection. Immune potentiated birds developed inhibitory antiviral antibodies, showed minimal lung histopathology and no detectable viral sequences, while non-immune animals showed microscopic immunopathology and detectable virus. Immune birds, receiving antigen in saline only, showed minimal microscopic histopathology, and intermediate levels of virus detection. These classical features in the different groups were mirrored by overlapping or specific mRNA gene expression profiles in lungs and spleen using microarray analysis. To our knowledge this is the first study demonstrating pneumonia-associated lung pathology of the low pathogenic avian influenza H9N2 virus. Our data provide insights into the molecular interaction of this virus with its natural host when naive or primed by vaccination.