2011年甘肃省克山病病情调查

Keshan disease condition in Gansu Province in 2011

目的：调查甘肃省克山病病情，为科学指导克山病预防控制提供流行病学依据。方法2011年，依据《全国克山病监测方案（试行）》，甘肃省在开展克山病病例搜索的基础上，从6个县的12个乡镇中选择12个村作为监测点。对每个监测点内全部常住人口进行临床检查，描记12导联心电图，克山病疑似病例拍摄2 m距离后前位X 线胸片，同时调查居民经济收入及主食结构等情况。克山病诊断依据为《克山病诊断标准》（WS/T 210-2011）。结果共调查5484人，心电图异常845人，异常率为15.41%；拍摄X 线胸片196例，心脏增大61例，其中轻度增大22例，中度增大21例，重度增大18例；检出克山病患者243例，总检出率为4.43%，其中慢型克山病31例，检出率为0.56%；潜在型克山病212例，检出率为3.87%。30岁以下病例47例，占19.34%，其中潜在型克山病46例，慢型克山病1例。克山病病例心电图异常以 ST-T 改变多见，占22.68%（71/313）；完全性右束支传导阻滞占16.29%（51/313）；低电压占12.46%（39/313）；左前分支阻滞占6.71%（21/313）。病区居民人均年收入1763元；主食中面粉占87%，大米占5%。结论甘肃省克山病以潜在型克山病为主，患者有相当部分是30岁以下，今后的工作重点是加强对小年龄段的克山病的监测。

Objective To observe the condition of Keshan disease （KSD） in Gansu Province in order to provide a scientific basis for prevention and control of the disease. Methods In 2011, according to “The national Keshan Disease Monitoring Program （trial edition）”, based on searching of KSD cases, 12 villages of 12 towns in 6 counties of Gansu Province, were selected as surveillance sites. All the residents in surveillance sites were clinically examined and given 12-lead ECG tracings; suspected cases were taken anterior chest X-rays in the distance of 2 meters, while staple food and life conditions of the residents were surveyed. Diagnosis of KSD was based on“Keshan Disease Diagnostic Criteria”（WS/T 210-2011）. Results Among investigated 5 484 residents, the incidence of abnormal electrocardiogram was 15.41%. Of the 196 X-ray films, 61 cases had enlarged heart（in which 22 of mild, 21 of moderate and 18 of severe）. Two hundred and forty-three cases of KSD were detected, the general detection rate was 4.43%, in which 31 cases of chronic, the detection rate was 0.56%; 212 cases of potential, the detection rate was 3.87%. In all cases, 47 cases were under the age of 30, including 46 cases of potential and 1 case of chronic. The major abnormal electrocardiogram change of KSD cases was ST-T changes[22.68%（71/313）], followed by complete right bundle branch block[16.29%（51/313）], low voltage[12.46%（39/313）], and left anterior fascicular block[6.71%（21/313）]. Per-capita annual income in surveillance site was 1 763 Yuan;and the major staple food was flour, accounted for 87%, and the staple food rice accounted for 5%. Conclusion The detection rate of KSD in Gansu Province is mainly to potential, and there is a cosiderable portion of patients under the age of 30;monitoring and investigation should also be strengthened in the younger age of KSD cases detected village.