潜在型克山病临床特点及诊断

目的：研究潜在型克山病的临床特征，心脏大小及异常心电图的动态变化。方法：选择山东省克山疾病区高发年，低发年，基本控制在3－14岁人群3164例，调查克山病的检出率，分析临床特征，观察心脏大小及异常心电图的动态变化，并以非病区546人作为对照。结果：病区潜在型克山病的检出率高发年，低发年，基本控制年依次为5．00％，3．40％，3．15％，非病区符合潜在型克山病诊断标准的检出率为2．01。检出的119例潜在型患者中，10．1％，有克山病史，11．8％心界大，9．2％心尖区收缩期杂音，但均无明显自觉症状，异常心电图检出率为68．1％，仅有心电图改变者占32．8％，X线片心脏增大的检出率为63．0％，仅有X线改变者占27．7％，2项均异常者占35．3％，1年后随访3种不同临床特征的转复率，异常心电图为25．9％，心脏增大47．8％，2项改变18．2％，T波改变，房室传导阻滞（I度）及心胸比率0．51，0．52者易于转复，完全性右束支阻滞，频发室早及心胸比率较大者变化较小，结论：心脏增大和心电图异常是潜在型克山病的主要临床特征，各项异常的动态变化对于潜在型克山病的诊断，治疗及预后有一定参考价值。

Clinical features and diagnosis of Latent Keshan Disease

Objective To study clinical feature,abnormal electrocardiogram (ECG) and heart size of latent Keshan disease (KSD).Methods Thirty seven hundred and one cases of 3~14 years old children were chosen from the KSD endemic and non-endemic areas.The incidence rate of latent KSD was surveyed,clinieal feature analysed and abnormal ECG and heart size observed.Results The incidence rate of latent KSD of suveyed subjects was 5.00% in high incidence year,3.40% in low incidence year and 3.15% in control led year in KSD endemic area but 2.01% in KSD non-endemic area.Among 119 latent KSD cases detected,KSD had 10.1% onset history,11.8 widen heart boarder and 9.2% systalic murmur but without any apparent symptoms.The patients with abnormal ECG were 68.1%,the patients with ealarged heart on x-ray 63.0% and the patients with both of the changes 35.3%.Recovery rate of abnormal ECG was 25.9%,of enlarged heart on x-ray photograph 47.8% and of both changes 18.2%.T wave change and 0.51?0.52 of heart/chest ratio were easily recovered,but complete right bundle branch block,multiple ventricular premature beat,left posterior fascicular block and enlarged heart were not often changed.Conclusions The enlarged heart and abnormol ECG change were the main clinical feature of latent KSD.The dynanmic changes of abnormal ECG and enlarged heart were of important for diagnosis?treatment and prognosis of latent KSD.