云南省地方性猝死的死因调查分析

Analysis of the causes of cases of Yunnan endemic cardiac death

目的调查云南省地方性猝死(亦称云南省地方性爆发性心肌炎,曾称云南省爆发性病毒性心肌炎)的死亡性质,为有效防治该病提供依据。方法以临床医学检查及现场流行病学调查为主要方法,调查15例死者的发病与死亡经过,并对5例死者做尸解,进行病理诊断以确定死因;同时对死者所在病区居民157人进行查体、心电图、X线检查、心肌酶学检查及现场流行病学调查,以确定各调查点的现有患者,为分析死亡原因提供重要依据。结果2004年调查的15例死者中,死因为克山病者10例,疑似克山病者2例,死于肺性脑病者2例,无法确定死因者1例;检诊病区居民共计157例,查出克山病现患5例,其中3例为新检出者。在所检查的死者和居民中均未发现可以诊断病毒性心肌炎或爆发性病毒性心肌炎的患者。结论在2004年所调查的15例云南省地方性猝死死者中有10例死者的死因确定为克山病。

Objective To explore into the nature of the Yunnan endemic sudden cardiac death （YESCD, also called Yunnan endemic fulminant myocarditis and Yunnan fulminant viral myocarditis）in order to provide evidence for effective prevention and treatment. Methods With clinical medical examination and using field epidemiological method, the occurrences and progress of 15 dead cases were investigated,and biopsy was performed in 5 cases to obtain pathological evidence for the causes of death. Meanwhile, 157 residents living in the same communities of the dead cases underwent physical examination, electrocardiogram, X-ray film, myocardial enzyme test and epidemiol0gical field investigation to identify the living patients, who served as reference for the analysis of death. Results Of the 15 deaths investigated in 2004, 10 cases died of Keshan disease （KD）, 2 cases were suspected to be KD, 2 cases died of pulmonary encephalopathy, and 1 case died of unknown reason. In the community, 5 out of 157 people surveyed were found to have KD, 3 of whom were newly detected. No viral myocarditis or fulminant viral myocarditis was found in the dead cases or the people surveyed. Conclusions Of the 15 died cases of YESCD investigated in 2004,10 are proven to have died of KD.