2012年山东省大骨节病病情调查结果分析

Analysis of investigating results of Kashin-Beck disease in Shandong Province in 2012

目的：了解山东省大骨节病的病情和防控措施落实现状，为消除大骨节病考核验收工作提供科学依据。方法按照国家《2012年医改地方病防治项目实施方案》和《2012年山东省医改大骨节病防治项目技术实施方案》的要求，在青州市的4个病区乡镇中，每个乡镇抽取3个病区村作为调查点，了解大骨节病防控措施落实情况，包括调查点的人口、耕种、主食以及防控措施落实等情况。对每个调查村的全部7-12岁儿童进行临床和X线摄片检查，人数少于50人时，在调查村附近再增加1个病区村，并检查该村的全部7-12岁儿童。分别计算临床Ⅰ度、Ⅱ度、Ⅲ度检出例数及检出率；X线阳性检出率；干骺、骨骺、骨端、腕骨、三联征检出例数及检出率。临床和X线诊断依据《大骨节病诊断标准》（WS/T 207-2010）。结果共调查了14个病区村。近3年病区未实施补硒措施，也未实行搬迁和异地育人；病区农作物以小麦和玉米为主，居民主食以面粉为主，占80%以上，且购食外地粮仅占11%；退耕还林（草）面积占原有耕地的0.32%（36/11151）；改种经济作物面积占原有耕地的1.17%（131/11151）。临床和X线摄片检查7-12岁儿童共536名，临床检查未检出大骨节病患儿；X线摄片检查，检出阳性患儿6例，均为单纯干骺端改变，平均X线检出率为1.12%（6/536），未检出骨骺、骨端及腕骨阳性患儿。结论山东省大骨节病病情得到了有效控制，但由于大骨节病病因未明，仍需建立可持续控制大骨节病的长效机制，进一步完善监测体系，做好病情动态监测工作。

Objective To understand the status quo of the illness situation and the implementation of prevention and control measures on Kashin-Beck disease（ KBD ） in Shandong Province , and provide a scientific basis for assessment and acceptance of the work on eliminating KBD. Methods In accordance with the requirements of the national “Implementation Scheme for Endemic Disease Control in 2012” and the “Shandong Provincial Technical Scheme for KBD Control in 2012”. In four towns of Qingzhou, three epidemic villages were selected as the surveying villages in each town in order to understand the implementation of measures for prevention and control of KBD; information such as population of investigating villages, per capita income, farming, food and the implementation of control measures,etc were included. In each investigating village, 7 - 12 years old children were selected to receive clinical and X-ray examination. When fewer than 50 people in a investigating village , one additional endemic village was included near the investigating village , and all children aged 7 to 12 of the village were checked. The number of cases of clinical degree Ⅰ, Ⅱ, Ⅲand the detection rates, X-ray positive detection rate, the number of cases of metaphysis, epiphysis, distal end of phalanx, carpal bone, triad and the detection rates were calculated, respectively. Clinical and X-ray diagnosis were based on “The Diagnostic Criteria of Kaschin-Beck disease”（WS/T 207-2010）. Results A total of 14 epidemic villages were selected to survey in four towns of Qingzhou. In the recent three years in the epidemic areas, measures of supplying Se had not been implemented;measures of resettlement and off-site education had not been implemented either. In the epidemic areas , the main crops were wheat and corn; the staple food was flour which accounted for more than 80%, and the foreign food bought accounted for only 11%. The areas of returning farmland to forest （grass） accounted for 0.32%（36/11 151） of the original arable land, and the areas of replanting economic crops accounted for 1.17%（131/11 151） of the＆amp;nbsp;original farmland. A total of 536 children aged 7 to 12 were examined by clinical and X-rays. Patient of KBD was not detected clinically. Six positive patients with metaphyseal changes of KBD were detected by X-rays, and the average X-ray detection rate was 1.12%（6/536）. Patients with abnormal epiphysis, distal end of phalanx and carpal bone were not detected by X-rays. Conclusions KBD in Shandong Province has been effectively controlled. Since the cause of KBD is still unknown, it is necessary to build a sustainable long-term control mechanism of KBD;further improve the monitoring system and dynamic monitoring work still need to be strengthened.