中国6省（市）扩张型心肌病和类潜在型克山病患病率调查

Prevalence of dilated cardiomyopathy and quasi-latent Keshan disease in six provinces of China

目的了解我国6个克山病病区省（市）中的非克山病村扩张型心肌病和类潜在型克山病患病情况，为克山病病区建立消除标准提出本底参考值。方法在四川、陕西、河南和山东的非克山病病区，在重庆和云南的克山病病区，采用多阶段抽样方法，选取县、乡和村作为调查点。每个非病区县和病区县抽取2个乡，每个乡抽取1个村（非克山病村）。对调查点居民进行问卷调查、临床查体和心电图、心脏超声检查，对疑似病例拍胸部后前位X线片。扩张型心肌病诊断依据2006年世界卫生组织和国际心脏病联合会（WHO／ISFC）工作组制定的标准。结果共调查了126个村，对54139人进行了问卷调查和临床检查。共检出扩张型心肌病患者10例，其中男性7人，女性3人，总患病率为18．47／10万（10／54139），95％可信区间为18．11／10万-18．84／10万。共检出类潜在型克山病197例，总患病率为363．88／10万（197／54139），95％可信区间为362．27／10万～365．49／10万，其中男性患病率为353．34／10万（83／23490），女性患病率为372．07／10万（114／30639）。描记心电图54139例，其中正常心电图45222例，异常心电图8917例，异常率为16．47％。其中重庆心电图异常率最高为38．28％（1585／4141），云南心电图异常率最低为8．10％（1175／14507）。心电图异常改变中，T波和ST段改变检出率最高为4．67％（2528／54139）。在异常心电图指数中，河南、山东和重庆检出率较高。均〉10．0％。结论建议我国6个省（市）中的克山病病区扩张型心肌病和类潜在型克山病本底的参考值分别为18．47／10万和363．88／10万。

Objective To study the prevalence of dilated cardiomyopathy and the quasi-latent Keshan disease in villages of non-endemic areas of six Keshan disease endemic provinces in China, and to provide reference values for proposing a elimination standard of keshan disease. Methods County, township and village was selected as the study area by using multi-stage sampling in non-Keshan disease areas of Sichuan, Shanxi, Henan, Shandong and in Keshan disease areas of Chongqing and Yunnan. In each county two townships were selected and in each township one village was chosen. The residents of the villages sampled were surveyed by questionnaire, physical examination, electrocardiogram （ECG） and cardiac echocardiography. Suspected dilated cardiomyopathy patients had chest X-ray. Dilated eardiomyopathy patients were diagnosed according to the criteria proposed by 2006 World Health Organization/International Society and Federation of Cardiology （WHO/ISFC）. Results The number of investigated villages was 126 and 54 139 people were surveyed by questionnaire and clinical examination. Ten patients with dilated eardiomyoi3athy were found, the prevalence was 18.47/100 000（10/54 139）, and its 95% confidence interval was 18.11/100 000 - 18.84/100 000. A total of 197 patients with quasi-latent Keshan diseasewere found, the prevalence was 363.88/100 000 （197/54 139）, and its 95% confidence interval was 362.27/100 000 - 365.49/ 100 000. The prevalence of male quasi-latent Keshan disease was 353.34/100 000（83/23 490） and of female was 372.07/100 000（114/30 639）. The number of subjects with normal and abnormal ECG was 45 222 and 8917, respectively, and the rate of abnormal ECG was 16.47%. The highest rate of abnormal ECG was 38.28% （1585/4141） in Chongqing. The lowest rate of abnormal ECG was 8.10% （1175/14 507） in Yunnan. The highest detection rate of T wave and ST segment changes was 4.67% （2528/54 139）. In abnormal ECG indices, the detection rate of Henan, Shandong and Chongqing was higher, and all of them were higher than 10.0%. Conclusions We suggest that the reference baselines of dilated cardiomyopathy and quasi-latent Keshan disease in Keshan disease areas of the six provinces in the south of China be 18.47/100 000 and 363.88/100 000, respectively.