2006年陕西省克山病病情现状与相关因素调查分析

Investigation and analysis of Keshan disease status and associated factors in Shaanxi Province in 2006

目的掌握陕西省克山病基本控制10年后病情消长态势和相关因素对克山病发生发展的影响，为今后克山病的防治决策提供科学依据。方法2006年采用整群分层抽样方法，在陕西省克山病病区选取轻、中、重病区各2个县（区），每个县（区）再选取2个病区村作为调查点。对3岁以上全体居民进行临床体检和心电图描记．可疑心脏异常者进行X线胸部摄片和心脏超声检查；采集调查点居民主食粮样及克山病患者、病区对照人群发样和血样及非病区对照人群血样，检测含硒量和谷胱甘肽过氧化物酶（GSH—Px）活性。结果①潜、慢型克山病总检出率为2．44％（139／5692）。②异常心电图检出率为9．19％（523／5692）。③可疑患者X线胸片和心脏超声检查心脏扩大检出率分别为45．6％（72／158）和34．5％（59／171）。④居民食用粮（小麦、玉米）含硒量为（0．045±0．036）、（0．035±0．025）mg／kg；克山病患者和病区对照人群发硒分别为（0．376±0．091）、（0．384±0．077）mg／kg，组间比较差异无统计学意义（u=0．77，P〉0．05）；克山病患者及病区、非病区对照人群血硒分别为（0．071±0．017）、（0．077±0．017）、（0．090±0．016）mg／L，组间比较差异有统计学意义（F=4．55，P〈0．05），克山病患者低于病区对照人群（P〈0．05），病区对照人群低于非病区对照人群（P〈0．01）。结论陕西省克山病病情依然处于基本控制后的平稳低发态势。病区内、外环境硒水平明显升高是病情继续得到控制的主要因素。

Objective To know the prevalence tendency of Keshan disease（KSD） under control after 10 years in Sbaanxi Province, the factors that causes or relative to the disease, to provide scientific reference for disease＇s prevention and control. Methods Through stratified cluster sampling, based on the severity of KSD in endemic area of Shaanxi Province, 12 villages from 6 counties were randomly selected as investigation points in 2006. The people older than 3 year-old were chosen to do clinical check up and electrocardiogram tracing. Among them, suspicious or abnormal cases were asked to take chest X-ray and cardiac ultrasound. Maize and rice, hair and whole blood were randomly collected to test the selenium content, the activity of Glutathione peroxidase （GSH- Px）. Results The total detection rate of potential or chronic KSD was 2.44% （139/5694）, the detection rate of abnormal ECG was 9.19% （523/5692）, the detection rate of cardiac enlargement from chest X-ray and cardiac ultrasound were 45.6% （72/158） and 34.5%（59/171 ） respectively. The average content of selenium in staple foods （wheat and corn） were[ （0.045 ± 0.036）, （0.035 ±0.025）mg/kg, respectively]. The level of hair selenium in patients and healthy people were[ （0.376 ± 0.091 ）, （0.384 ± 0.077）mg/kg, respectively], with non-significant different （u = 0.77, P 〉 0.05）. There were significant differences in whole blood selenium of patients, healthy people in KSD areas and healthy people in non-KSD areas[ （0.071± 0.017）, （0.077 ± 0.017）, （0.090 ± 0.016）mg/L, respectively; F = 4.55, P 〈 0.05）, the whole blood selenium in patients lower than in healthy people in KSD areas （P 〈 0.05）, in healthy people in KSD areas lower than in non-KSD areas（P 〈 0.05）. Conclusions After the KSD condition being controlled, the situation in Shaanxi Province has become stable and exhibited a decreasing tendency. The selenium level of both internal and external environment in the endemic area increased significantly, that is the main factors of controlling disease.