克山病患者和病区健康人硒营养水平调查

An investigation of serum and hair levels of selenium in patient with Keshan disease and in healthy controls of Keshan disease area

目的 观察山东、四川和内蒙古克山病病区克山病患者和病区健康人血清硒水平及山东克山病区居民发硒和血清硒的变化,为克山病的防治研究提供科学依据.方法 2009年,采用横断面调查方法,在山东、四川和内蒙古克山病病区,以克山病患者及病区健康人作为观察对象,其中山东病区患者77例,健康人63例 四川病区患者35例,健康人36例 内蒙古病区患者17例,健康人18例 并以非病区33例健康人作为对照.采集受检者血液及发样,2,3-二氨基萘荧光法测定样品含硒量.采用资料回顾性方法,收集1976-2004年山东克山病病区居民发硒、血清硒的测定结果,观察1976-2009年（含本次调查结果）病区居民发硒、血清硒的动态变化,比较二者的变化规律.结果 ①山东和内蒙古病区克山病患者的血清硒[（0.0773±0.0113）、（0.0347±0.0107）mg/L]低于病区健康人[（0.0895±0.0256）、（0.0469±0.0161）mg/L,t值分别为3.52、3.87,P均〈0.01],四川病区两者之间比较差异无统计学意义[（0.0792±0.0162）、（0.0774±0.0103）mg/L,t=0.55,P〉0.05].②山东、四川和内蒙古病区克山病患者血清硒均低于非病区健康人[（0.0988±0.0231）mg/L,q值分别为6.74、5.83、19.47,P均〈0.01] 四川、内蒙古病区健康人低于非病区健康人（q值分别为6.68、16.36,P〈0.01） 内蒙古病区克山病患者和病区健康人血清硒明显低于山东和四川病区克山病患者和病区健康人（q值分别为13.63、14.74、13.62、11.46,P〈0.01）.③从1976-2009年山东病区居民发硒、血清硒均逐渐增高,与1976年比较,2009年发硒增加了1.68倍（0.343/0.128-1）,血清硒增加了0.98倍（0.091/0.046-1） 但发硒与血清硒平均环比增长率比较,差异无统计学意义（χ2=1.38,P〉0.05）.结论 ①病区克山病患者和病区健康人内环境硒水平仍然低于非病区 ②山东、四川和内蒙古病区克山病患者和病区健康人血清硒水平不同 ③30多年来山东病区居民发硒、血清硒呈逐渐上升趋势.建议在克山病病区继续推行以补硒为主的综合性防治措施.

Objective To measure the serum selenium levels in patient with Keshan disease（KSD）and in healthy controls in Shandong,Sichuan and Inner Mongolia KSD areas,to monitor the long-term dynamic changes of hair and serum selenium levels in Shandong KSD areas,and to provide scientific basis for preventing KSD.Methods A cross-sectional survey was carried out in KSD areas of Shandong,Sichuan and Inner Mongolia in 2009.The research subjects which come from KSD areas were 77 cases and 63 healthy controls from Shandong 35 patients and 36 healthy controls from Sichuan and 17 patients and 18 healthy controls from Inner Mongolia.Additional 33 healthy people from Jinan city were selected as controls of non-KSD areas.Blood and hair samples were collected and selenium levels were measured by 2,3-diaminonaphthalene fluorescence spectrometry.Retrospective method was used to analyze the hair and serum selenium data collected between 1976 and 2004 in Shandong KSD areas.and these data were eompard with the data of 2009 to observe the long-term dynamic changes.Results ① The serum selenium levels of KSD patients in Shandong and Inner Mongolia were significantly lower than that of healthy subjects of KSD areas[（0.0773±0.0113）vs（0.0895±0.0256）,（0.0347±0.0107）vs（0.0469±0.0161）,t=3.52,3.87,all P〈0.01].No significant difference was found between KSD patients and healthy people in Sichuan[（0.0792±0.0162）vs（0.0774±0.0103）,t=0.55,P〉0.05].②The serum selenium levels of KSD patients in Shandong,Sichuan and Inner Mongolia KSD areas were lower than that of non-KSD area[（0.0988±0.0231）mg/L,q=6.74,5.83,19.47,all P〈0.01].The serum selenium levels of healthy people in Sichuan and Inner Mongoha KSD areas were significantly lower than that of non-KSD area（q=6.68,16.36,all P〈0.01）.The serum selenium levels of healthy controls in Inner Mongolia were lower than that of in Shandong and Sichuan（q=13.63,14.74,13.62,1.46,all P〈0.01）.③From 1976 to 2009,the hair and serum selenium levels of Shandong resident were increased 1.68 times（0.343/0.128-1）for hair and 0.98 times（0.091/0.046-1）for serum,respectively.But there was no significant difference between the average growth rate of hair and serum selenium levels（χ2=1.38,P〉0.05）.Conclusions ①The hair and serum selenium levels of KSD patients are lower than that of healthy controls in non-KSD area.②The serum selenium levels of Shandong,Sichuan and Inner Mongolia are different between KSD patients and healthy controls in the diseased areas.③The hair and serum selenium data of Shandong resident show an upward vend over the past 30 years.We suggest to continue the comprehensive measures of adding selenium in KSD areas.