青海省大骨节病病区换粮、补硒防治儿童大骨节病效果观察

Effect of changing grain and selenium supplementation on control of children＇s Kaschin-Beck disease in Qinghai province

目的 观察换粮、补硒对青海省儿童大骨节病的防治效果.方法 2008年对病区7～12岁儿童进行流行病学、临床及右手X线拍片检查,检出X线阳性患者,以村为单位分成3组,贵德县新建坪村为对照组、斜马浪村为换粮组,兴海县上、下鹿圈村为补硒组.防治前和防治后1年对每个观察对象拍摄右手X线片（包括腕骨）,同时采集儿童枕部发样,采用2,3-二氨基萘荧光法测定发硒.结果 经过1年防治,对照组X线检出率由4.88%（2/41）升至12.20%（5/41）,换粮组X线检出率由17.54%（10/57）降至5.26%（3/57）,补硒组X线检出率由13.51%（10/74）降至5.41%（4/74）.换粮组10例病人,有7例痊愈,2例稳定,1例进展,无新发病人;补硒组10例病人,有7例痊愈,3例稳定,1例干骺端新发病人;对照组除原有2例病人病情稳定外,有2例干骺端和1例骨端新发病人.换粮组、补硒组防治效果与对照组比较,差异有统计学意义（x2值分别为5.49、4.14,P均＜0.05）.对照组、换粮组发硒值防治前为（107.15±42.30）、（125.30±40.30）μg/kg,防治1年后为（108.32±35.67）、（135.38±65.24）μg/kg,升高不明显（t值分别为0.01、0.68,P均＞0.05）;补硒组发硒值由防治前的（95.62±43.42）μg/kg明显升高至防治1年后的（197.64±97.08）μg/kg（t=5.41,P＜0.05）.结论 换粮、补硒对防治儿童大骨节病有效.

Objective To observe the effect of changing grain and selenium supplementation for 1-year on control of children＇s Kaschin-Beck disease in Qinghai province. Methods Epidemiology, clinical and right-hand X-ray examination were carried out on children aged 7 - 12 years in 2008. Patients were diagnosed and divided into 3 groups by village, control group from Xinjianping village in Guide county, changing grain group from Xiemalang village in Guide county and supplying salt with selenium and iodine group from Shanglujuan and Xialujuan villages in Xinghai county. One year before and after the treatment, right-hand X-ray photograph （including carpal bones）was taken and child hair samples were collected, selenium was detected by 2,3-diaminonaphthalene fluorescence spectrophotometry. Results After 1 year prevention and control, the detectable rate of X-ray in control group was raised from 4.88%（2/41） to 12.20%（5/41） , the detection rate in changing grain group was declined from 17.54%（10/57） to 5.26%（3/57）, and from 13.51%（10/74） to 5.41%（4/74） in supplying salt with selenium and iodine group. In changing grain group, there were 10 patients, 7 cases were cured, 2 patients stable, 1 case progressed,no new case;in supplying salt with selenium and iodine group of 10 patients, 7 were cured, 3 patients stable, 1 new diagnosed case;in control group, 2 patients stable, 2 new diagnosed metaphysis cases, 1 new diagnosed metaphyseal case. Compared with control group, the difference was statistically significant between changing grain group and supplying salt with selenium and iodine group（x2 = 5.49,4.14, all P 〈 0.05）. After 1 year control and prevention,hair selenium contents in control group and changing grain group were increased from （107.15 ± 42.30）, （125.30 ±40.30）μg/kg to （108.32 ± 35.67）, （135.38 ± 65.24）μg/kg, the difference was statistically insignificant（t = 0.01,0.68, all P 〉 0.05）, and selenium contents in supplying salt with selenium and iodine group were obviously increased from （95.62 ± 43.42）μg/kg to （197.64 ± 97.08）μg/kg （t = 5.41, P 〈 0.05）. Conclusion Changing grain and supplying selenium can prevent and control children＇s Kaschin-Beck disease.