2011年山东省克山病病情监测结果分析

Analysis of condition monitoring of Keshan disease in Shandong Province, 2011

目的观察山东省克山病病情，掌握克山病的发病情况，科学指导防治工作的开展。方法按照山东省克山病监测方案的要求，在7个克山病县（市、区）进行了病例搜索，选择有代表性的3个县（市）6个自然村进行了病情重点监测，每个监测点对420名居民详细询问病史、临床查体和心电图描记，可疑心脏异常者拍摄后前位x线胸片，同时采集部分居民头发和粮食检测内外环境硒含量，并收集居民经济收入及人均占有粮食等基本情况。结果共搜索医疗单位246个，心肌疾病病例831例，确定疑似克山病128例，诊断慢型克山病26例；6个监测点调查居民2527人，检出克山病患者32例（其中潜在型21例，慢型11例），检出率为1．27％，描记心电图2527例，异常心电图检出率为20．34％，以ST-T改变、T波改变、窦性心动过缓、窦性心律不齐、窦性心动过速、房性早搏等多见，拍摄x线胸片108张，16例心脏增大（其中轻度增大13例，中度增大3例），异常检出率为14．8％；采集头发、粮食等样品418份，病区居民发硒含量接近硒适宜地区的水平，粮食硒含量仍处于较低水平，各监测点人均年收入2400～7200元，居民主食以面粉为主。结论山东省克山病病情处于稳定态势，但监测中仍有慢型、潜在型患者检出；内环境硒含量明显升高，与病区居民生活水平的提高和膳食营养的改善有关。

Objective To observe condition and control the incidence of Keshan disease （KSD） in Shandong Province and supply evidence for scientific control and study. Methods According to the scheme of KSD monitoring in Shandong Province, KSD cases were searched in 7 counties, and 6 villages of 3 representative counties were selected. At each point, about 420 natural populations were checked by asking detailed history, physical examination, and electrocardiography （ECG） tracings. The suspicious people were taken chest X-ray film. At the same time, the inside and outside environment selenium was detected and the income of food, life condition of inhabitants and other basic information were collected. Results At 6 monitoring points, 2 527 residents were surveyed and 32 cases of Keshan disease were detected （in which 21 cases of the potential, 11 cases of the chronic）, with the detection rate of 1.27%. 2 527 residents were traced ECG and the incidence of ab- normal ECG was 20.34%, mainly presented ST-T changes, T-wave changes, sinus bradycardia, sinus arrhymia, sinus tachy- cardia, atrial premature beats, etc. Of the 108 X-ray films, 16 cases displayed enlarged heart （in which 13 of the mild, 3 of the moderate） wtih the abnormal detection rate of 14.8%. 418 samples of hair and grain were collected, and the selenium content of hair closed to the level of the appropriate areas, and the selenium content in food was still lower. The capita income of resi- dents at each point was between 2 400-7 200 yuan RMB, and residents＇ main staple food was made of flour. Conclusions The current condition of KSD in Shandong Province remains relatively stable. But the potential and chronic KSD cases are still detected. The selenium levels in internal environment are high because of the improvement of local living standards and dietary nutrition.