2008年陕西省克山病病情调查结果分析

Analysis of the survey results of Keshan disease in Shaanxi province in 2008

目的掌握陕西省克山病病情现状，为今后克山病防治决策提供科学依据。方法2008年在陕西省克山病病区范围内采用整群分层随机抽样的方法选取19个病区县（区），每个病区县（区）选取1个病区村作为调查点，对调查点内3岁以上全体居民进行临床检查和心电图描记，可疑心脏异常者拍摄后前位2m距离X线胸片：采集调查点部分居民主食粮样，测定粮硒水平。结果共调查病区居民10228人，检出克山病患者110例，总检出率为1．08％（110／10228）。其中潜在型克山病92例，检出率为0．90％（92／10228）；慢型克山病18例．检出率为0．18％（18／10228）；无急型、亚急型克山病病例检出。潜在型克山病心电图异常改变以完全性右束支传导阻滞[占48．57％（51／105）]、ST-T改变[占19．05％（20／105）]、多发性室性早搏[占10．48％（11／105）]、左心室肥大[占5．71％（6／105）]、左前分支传导阻滞[占5．71％（6／105）]多见，而慢型克山病以心房纤颤[占24．00％（6／25）]、左心室肥大[占20．00％（5／25）]、完全性右束支传导阻滞[占20．00％（5／25）]为主。可疑心脏异常者X线心胸比例增大率为18．08％（32／177）。调查点小麦、玉米、小米、大米含硒量分别为（0．096±0．028）、（0．089±0．029）、（0．087±0．016）、（0．047±0．016）mg／kg。结论陕西省克山病病情处于基本控制后的平稳低发态势，潜在型、慢型克山病是目前患病的主要临床类型。病区居民粮食含硒量明显升高，已达到非病区水平。

Objective To explore the status of Keshan disease in Shaanxi province to provide a scientific basis for decision-making of prevention and control of Keshan disease. Methods Nineteen infected villages were randomly selected in 19 infected counties in the range of Keshan disease infected area in Shaanxi province in 2008 as the investigation sites. Clinical examination and electrocardiography were performed in the chosen people at every spots, chest X-ray of posteroanterior position film in 2-meter distance was taken in suspicious cardiac patients, and determining the selenium contents was also determined in the collected grain samples of the investigators. Results Of the 10 228 investigated residents in the endemic area, 110 Keshan disease patients were detected, the total detection rate was 1.08% （110/10 228）. Among the 110 patients, 92 were potential Keshan disease, which accounted 0.90%（92/10 228）; 18 chronic Keshan disease formed a detection rate of 0.18%（18/10 228）; no acute and sub-acute type of Keshan disease had been inspected. Potential Keshan disease patients often showed electrocardiogram abnormality of complete right bundle branch block [48.57% （51/105） ], ST-T change [ 19.05% （ 20/105 ） ], frequent premature ventricular contraction [ 10.48 % （ 11 / 105 ） ], left ventricular hypertrophy [ 5.71% （6/105 ） ], block in the anterosuperior division of the left branch [ 5.71% （6/105） ] ; Chronic of Keshan patients mostly presented atrial fibrillation [ 24.00% （6/25） ], left ventricular hypertrophy [ 20.00% （5/25） ], complete right bundle branch block [ 20.00% （5/25） ]. The increase rate of cardiothoracic ratio was 18.08% （32/177）. Food samples of wheat, corn, millet and rice in infected area residents were of selenium content, being （0.096 ± 0.028）, （0.089 ± 0.029）, （0.087 ± 0.016）, （0.047 ± 0.016）mg/kg, respectively. Conclusions Keshan disease in Shaanxi province is steadily declining, potential and chronic Keshan diseases are currently the main clinical types. Selenium content of food in endemic area has reached the level of the non-endetnic area.