2008～2012年重庆市克山病监测结果分析

Analysis of the monitoring results of Keshan disease from 2008 to 2012 in Chongqing city

目的掌握重庆市克山病病情现状,为今后的防治工作提供科学依据。方法选择重庆市梁平、石柱、丰都、垫江、万州5个克山病病区县开展病例搜索,从县级医疗机构及病区乡镇卫生院近3年登记在册的全部心肌疾病病例中搜集克山病病例;选择以上5个病区县的29个克山病病村为监测点,进行克山病重点监测,对调查对象进行问卷调查、体格检查、12导联心电图描记,对疑似克山病者拍摄2 m后前位胸部正位X线片,依据《克山病诊断标准》判断。调查点采集15~20份居民枕部发样和10~15份主食大米进行硒含量测定。结果共搜索144个医疗机构,检出心肌病2 647例,确诊慢型克山病43例。共调查了29个病村,14 201人,检出潜在型和慢型克山病58例,总检出率为0.41%,其中潜在型、慢型克山病检出率分别为0.11%、0.30%。病例搜索和重点监测均未发现急型和亚急型克山病病例。以县为单位,梁平、石柱、丰都、垫江、万州的总检出率分别为0.47%、0.51%、0.35%、0.12%、0.00%。以村为单位,有19个村（65.52%）检出克山病病例,检出率在0.20%~1.25%之间波动。共描记心电图14 201份,异常心电图2 792份,异常率为19.66%;共拍摄X线胸片287份,心胸比例有增大者占50.17%。16个病村采集大米190份,硒含量平均为0.023 g/kg;22个病村采集发样391份,硒含量平均为0.311 g/kg。结论重庆市克山病病情处于较低水平,但各个地区差异较大。

Objective To understand the current situation of Keshan disease in Chongqing city so as to provide scientific basis for future prevention and control. Methods The Liangping, Shizhu, Fengdu and Dianjiang endemic counties and endemic Wanzhou district of Chongqing city were chosen for the study. Keshan cases were searched from all registered cases of myocardial patients of the past three years at county-level medical institutions and township hospitals. 29 villages of 5 counties were selected as monitoring sites to carry out intensified investigation. The residents of the village were surveyed by questionnaire, clinical examination, and 12-lead electrocardiogram （EGG）. Suspected Keshan patients had chest X-ray examination. Keshan patients were diagnosed according to the criteria of ＂diagnosis of Keshan disease＂. 15- 20 hair samples and 10-15 rice samples were collected for detecting selenium content. Results 144 medical institutions were searched.43 out of 2 647 cardiac cases from medical institutes were confirmed had chronic Keshan disease.29 villages were investigated and 14 201 people were surveyed by questionnaire and clinical examination. 58 Keshan patients were found and the total detection rate was 0.41%. The detection rates of potential Keshan disease and chronic Keshan were 0.11% and 0.30%, respectively. No acute and sub acute Keshan case was found in the survey. At county level, the total detection rates of Liangping, Shizhu, Fengdu, and Dianjiang counties and Wanzhou district were 0.47%, 0.51%, 0.35%, 0.12%, and 0.00%, respectively. At village level, 19 of 29 villages （65.52%） had Keshan cases and the detection rate was between 0.20% and 1.25%. The numbers of subjects with normal and abnormal EGG were 11 409 and 2 792, respectively. The abnormal rate of EGG was 19.66%. 144 of 287 people （50.17%） checked by X-ray showed enlargement changes. Selenium content was detected in 190 rice samples of 16 villages and 391 hair samples of 22 villages. The average selenium content of rice and hair samples were 0.023 and 0.311 mg/kg, respectively. Conclusions The detected rate of Keshan disease is low and varies in different investigation sites in Chongqing city.