陕西省克山病病情与内外环境中微量元素水平关系的动态观察

Dynamic observation on the relationship between the Keshan Disease incidence and some element in internal and external environment in Shanxi Province

目的动态观察陕西省克山病病情与内外环境中微量元素水平的变化。方法按照全国克山病监测方案,以黄陵县克山病观察点的全体居民作为监测对象,动态观察监测点克山病病情,并采集病区、非病区儿童头发以及居民食用粮,分别用荧光法和原子吸收法分析其硒、锌、铜、铁、锰水平。结果（1）监测点15年共检出潜在型克山病447例次,检出率在3.6%-10.9%之间,平均检出率6.14%,呈缓慢上升趋势,新发生潜在型克山病25例,新发生率在0-55.6/万之间,平均34.34/万,呈平稳低发下降趋势。（2）病区自产粮食硒含量明显低于非病区;病区儿童发硒含量逐年上升,1995年后已达到并稳定在非病区儿童水平。病区儿童发铁水平显著高于非病区,其它元素与非病区儿童相比差异均无显著性,病区内外环境所测元素含量均无明显年度变化。结论克山病病情的下降和稳定与病区居民内环境硒水平的提高有关,但即使病区居民内环境硒水平达到并稳定在非病区水平时,仍未能阻止新的潜在型克山病发生,说明硒是克山病发病的重要条件致病因素。

Objective To observe the dynamic changes of condition in Keshan Disease（KSD） and trace element in internal and external environment. Methods Based on the standard of KSD surveillance and diagnosis, surveillances site of KSD was set up in Huangling country and all local residents were listed as surveillance subjects. Dynamic changes of condition in KSD were observe. Meanwhile, the hair samples of children and cereals in surveillances sites were selected, and the content of Se, Cu, Ze, Fe and Mn in above samples were determined by atomic absorption spectrometry and fluorospectrophotometry respectively. Results （1）There were 447 cases of Latent KSD were diagnosed during 15 years. The incidence rates of KSD among people mainly monitored were 3.6% - 10.9%. （The average incidence rate was 6.14% ） . The incidence rates of KSD were risen slowly and were reached steadily. The numbers of new diagnosed cases of latent KSD were 25. The new incidence rates were 0 - 55.6/ten thousand. The average incidence rate was 34.34~ten thousand, which was decreased slowly. （2）The Se level of wheat in endemic area was significantly lower than that in nonendemic, the hair Se level of children in endemic area was risen yearly and could already reach and steadily stabilize with non-endemic since 1995. Hair Fe level of children in endemic area was significantly higher than that in non-endemic. Conclusion The decline and stabilization of KSD could be associated with increase of Se level in inside environment among the residents in endemic area. However, even if the Se level in inside environment of residents in endemic area could reach the level in non-endemic area, new cases of latent KSD patients were still found in these areas, which suggested that Se could be an important factor that can cause KSD rather than the only factor.