云南省丽江市历年不明原因心源性猝死病流行因素探讨

Lijiang City,the calendar year sudden cardiac death of unknown factors of the epidemic

目的探讨1998年以来,丽江4个县1个区,10个乡镇,13个自然村,连续发生不明原因的心源性猝死(累计猝死42例)的流行因素。方法通过现场处置,从猝死家庭的亲戚发病中进行心电图检查,并采集所有可疑标本进行化学元素、细菌、病毒、毒物、心肌酶谱的检验。结果该病发病集中发生在6～8月,发病者多发于农民,发病突然,死亡快,临床症状不典型,多发生于青壮年,且女性多于男性,病区多分布在卫生条件差的山区、半山区,生活中粮食较单一,甚至为缺粮户,平时爱饮生水,水源为暴露性沟水,发病村厕所为简易性厕所或无厕户,家养牲畜为牛、猪、狗、鸡、马,居住环境界线不太分明,人畜共用盆、瓢、桶等餐饮工具,有明显的家庭聚集现象和亲源现象。结论经心肌形态学及病原学等方面的研究结果表明,发生在丽江的不明原因猝死病例,是由肠道病毒引起的急性病毒性心肌炎点状爆发流行,同时认为该病大多数病区与克山病病区相重叠,病区处于单一性食物环境,可能是缺乏维生素、硒、锌等化学元素,也可能是接触放射性物质引起的疾病。

Objective Discussion Since 1998, the importation of Lijiang in four districts in one county, 10 townships, 13 villages, a succession of unexplained sudden cardiac death （a total of 42 cases of sudden death） factors in the prevalence of language translation required. Methods Through on-site disposal, from the home of a relative incidence of sudden death in ECG; epidemiological investigation of all suspicious specimens collected for chemical elements, bacteria, viruses, toxins, enzymes to explore aspects of the test. Results According to the survey focused on the disease incidence occurred in the 6 to 8 months, the incidence more hair on the farmers, the sudden onset of death quickly, not typical clinical symptoms, occurs in many young and middle-aged, and women more than men, many wards in bad sanitary conditions Mid-levels of the mountain, over the life of a single food or even food-deficit households, normal love drinking unboiled water, water for the exposure of ditch water, the incidence for the simplicity of the village toilet or toilet households, domestic livestock as cattle, pigs, dogs, chicken, horse, not the living environment of the line is clear, humans and animals shared basins, dipper, bucket, such as food and beverage tools, there is a clear situation and pro-family gathered source phenomenon. Conclusion By myocardial morphology and etiology research, etc. The results show that happened at Lijiang cases of unexplained sudden death is caused by enterovirus punctate acute viral myocarditis outbreak, at the same time think the majority of endemic disease and Keshan disease area of overlap area in a single food environment, may be a lack of vitamins, selenium, zinc and other chemical elements can also be caused by exposure to radioactive substances diseases.