2007—2011年四川省阿坝州综合措施预防儿童大骨节病效果分析

Effects of comprehensive measures on prevention of children＇s Kashin-Beck disease in Aba state Sichuan province from 2007 to 2011

目的观察换粮、补硒、异地育人和搬迁综合措施对四川省阿坝州儿童大骨节病的预防效果。方法2007—2011年，在四川省阿坝州选择58个大骨节病病区村作为干预点，根据防控措施落实情况，将58个干预点分为异地育人＋换粮＋补硒组和搬迁＋异地育人＋换粮＋补硒组，选择甘孜州色达县歌乐沱乡作为对照组．每年对2个调查点的6—13岁儿童拍摄右手正位X线片（包括腕关节）。按照《大骨节病诊断标准》（GB16003—1995）进行大骨节病临床和X线诊断。通过比较预防控制措施实施前后儿童X线检出率的变化来评价预防控制措施效果。结果2007—2011年，干预点儿童平均X线阳性检出率分别为2．07％（66／3181）、2．72％（69／2540）、1．16％（35／3017）、0．56％（19／3397）和0．56％（24／4273），整体呈明显的下降趋势（X^2趋势=66．74，P〈0．01）；5年间，异地育人＋换粮＋补硒组儿童X线阳性检出率[1．60％（29／1809）、2．63％（39／1484）、1．29％（25／1941）、0．64％（15／2332）、0．42％（10／2379）]和搬迁＋异地育人＋换粮＋补硒组X线阳性检出率[2．70％（37／1372）、2．84％（30／1056）、0．93％（10／1076）、0．38％（4／1065）、0．74％（14／1894）]均呈下降趋势（X^2趋势=30．97、35．19，P均〈0．01）。对照组2007—2010年儿童X线阳性检出率均为0，2011年X线阳性检出率为1．61％（1／62），5年间X线阳性检出率比较，差异没有统计学意义（X^2趋势=1．88，P〉0．05）。干预组和对照组比较，2007年基线调查与2011年末次调查儿童X线阳性检出率差异均没有统计学意义（X^2=0．40、0．24、0．10、0．38，P均〉0．05）。结论在病情不活跃的病区采取换粮、补硒、异地育人和搬迁等综合措施预防儿童大骨节病效果不够显著。

Objective To observe the effects of comprehensive measures of changing grain, selenium supplementation, off-site education and resettlement on prevention of children＇s Kashin-Beck disease in Aba state. Methods Fifty eight villages in Aba Kashin-Beck disease areas were chosen as intervention points in Aba state Sichuan province from 2007 to 2011. Based on the implementation of prevention and control measures, the villages were divided into off-site education ＋ changing grain ＋ selenium supplementation group and resettlement ＋ off-site education ＋ changing grain ＋ selenium supplementation group, Geletuo town of Seda county, Ganzi state was selected as a control point, and right-hand anteroposterior X-ray examination（including the wrist） was carried out on children aged 6 - 13 from 2007 to 2011 annually. Clinical and X-ray diagnosis of Kashin-Beck disease was made in accordance with ＂the Diagnostic Criteria of Kaschin-Beck Disease＂ （GB 16003-1995）. The effects of prevention and control measures were evaluated by comparing the child X-ray detection rate before and after the implementation of the measures. Results The average X-ray positive detectable rate of children in the intervention points was 2.07% （66/3181） ,2.72% （69/2540）, 1.16% （35/3017）, 0.56% （19/3397） and 0.56% （24/4273）, respectively from 2007 to 2011, with a downward trend（x^2trend= 66.74, P 〈 0.01）. There was a downward trend in the average X-ray positive detectable rate of children in off-site education ＋ changing grain ＋ selenium supplementation group [ 1.60% （29/1809） ,2.63% （39/1484）, 1.29% （25/1941） ,0.64% （15/2332） ,0.42% （10/2379） 3 and resettlement ＋ off-site education ＋ changing grain ＋ selenium supplementation group [2.70% （37/1372）,2.84% （30/1056）,0.93% （10/1076） ,0.38% （4/I065） ,0.74% （14/1894） ] （X^2 = 30.97, 35.19, all P 〈 0.01）. The average X-ray positive detectable rate of children in the intervention group was 0 from 2007 to 2010, and was 1.61%（1/62） in 2011. The difference of X-ray positive detectable rate was not statistically significant in the control group in the 5 years from 2007 to 2011. The difference of children＇s X-ray positive detectable rate was not statistically significant between control group and intervention group. Conclusions The effect of taking changing grain, selenium supplementation, off-site education and resettlement comprehensive measures to prevent children＇s Kashin-Beck disease is not significant in those places where the state of Kaschin-Beck disease is not active.