四川省1990-2008年克山病监测

Surveillance on Keshan disease from 1990 to 2008 in Sichuan province

目的探索四川省克山病病情演变规律与流行特点。方法采用描述流行病学方法，收集汇总1990-2008年资料数据，并进行统计分析。结果四川省克山病19年间，急型、亚急型克山病累计发病87例。病例均为农业户儿童，彝族儿童居多，发病年龄最小5月龄，最大18岁，2—6岁最多，年发病率波动在0／10万～1．73／10万之间，以1999年最高（1．73／10万）；临床慢型、潜在型克山病累计检出310例，总检出率0．28％～2．8％，以1992年最高；19年间的病区人群硒营养水平，1995年最低（0．1345μg／g），1990-2000年次之（0．1558μg／g），属于病区硒水平。结论四川省克山病病情演变过程可分为5个阶段，2个上升阶段，3个下降阶段，各阶段差异均有统计学意义，而病情下降的3个阶段均为采取了以补硒为主要手段的防控措施之后，表明贫硒与克山病发病关系密切。

Objective To study the epidemiological characteristics of Keshan disease （KD） and its trend so as to provide evidences for further research, prevention and treatment of the disease in Sichuan province. Methods Based on KD related data from 1990 to 2008, descriptive method was used to analyze the epidemiological characteristics of KD. Results 87 KD cases were identified during the 19 years. All cases were children from the countryside, with majority of them were Yi nationality. Age of the patients ranged from 5 months to 18 years, with majority at 2-6 year-olds. The annual incidence rates were from 0/100 000 to 1.73/100 000 with 1999 the highest （1.73/100 000）. A total number of 310 preclinical or chronic KD cases were identified and the total detection rates were between 0.28% and 2.8%, with 1992 the highest. As for levels of blood selenium during the 19 years： 1995 appeared the lowest （0.1345 μg/g）, followed by 1990--2000 （0.1558μg/g） but all of them fell in to the level in the KD epidemic areas. Conclusion There were 5 stages in the development trend of KD disease in Sichuan province, with 2 ascending and 3 descending. The differences between any of the two stages were statistically significant. The 3 descending stages all appeared right after the selenium supplement intervention was taken. Our data showed that the program of selenium supplement was closely related to the incidence of KD, suggesting that a long term mechanism of Selenium supplement in the epidemic areas should be taking into account.