2005-2012年全国慢型克山病治疗项目病例构成情况分析

Analysis of cases from China national treatment program for patients with chronic Keshan disease 2005-2012

目的 通过对全国慢型克山病治疗项目累计上报数据的阶段性评估,分析已往纳入治疗全部病例存在的主要问题,以期进一步提高项目管理质量与效能.方法 核查并汇总2005-2012年项目省份上报的数据,对患者的整体构成进行统计分析,指标包括患者性别与年龄分布、慢型克山病诊断依据（心电图、X线心胸比、NYHA心功分级）和多次治疗患者比例.结果 ①参与治疗的“慢型克山病”患者总计2 649人,其中男性1115人,占42.1％（1 115/2 649）,女性1 534人,占57.9％（1 534/2 649）;年龄主要集中在41 ～ 70岁,而10岁以下患者有24人,占0.9％（24/2 649）.②慢型克山病诊断证据充分的有2 313人次,占81.9％（2 313/2 823）,诊断分类错误的有121人次,占4.3％（121/2 823）.③接受2次及以上治疗患者881人,占治疗总人数的38.3％（881/2 301）.结论 ①诊断问题仍较突出,应对慢型克山病患者逐个建立病案,由省级专家统一会诊确定.多次治疗患者的比例较低,不利于患者的治疗.②建议项目治疗周期至少1年,并争取将慢型克山病纳入新农合全额报销范畴.

Objective In this paper,major issues for all those who have been selected in China national treatment program for patients with chronic Keshan disease （CNTP-CKD） were uncovered through evaluation of the annually reported data from participating provinces,in order to improve the performance quality of the program.Methods The datasets 2005-2012 were merged after cleaning them,and the composition of the treated patients was statistically analyzed,including gender and age distribution,diagnosis evidence for chronic Keshan disease （ECG,cardiothoracic ratio by X-ray,heart function grade of NYHA）,and proportion of cases who had received treatment more than once.Results ①A total of 2 649 patients participated in the treatment,of them 1 115 patients were males accounting for 42.1% （1 115/2 649）,1 534 patients were females accounting for 57.9% （1 534/2 649）.Age of the patients were mainly distributed in 41 to 70 years old,and 24 CKD patients under 10 years accounting for 0.9% （24/2 649）.②2 313 cases of the involved patients were diagnosed with sufficient evidence,accounting for 81.9% （2 313/2 823） and 121 cases with full misdiagnosis,accounting for 18.1% （121/2 823）.③There were 881 patients been treated for more than once,accounting for 38.3% （881/2 301） of the number of treatment.Conclusions ① Diagnosis for CKD remains a key problem,suggesting that medical record for each patient diagnosed by province-level doctors＇ needs to be built up as early as possible.The rate of patient treatment for more than once is low which is not beneficial to the patients.② Treatment period for CKD patients is highly recommended to expand to at least one year,and the disease should be enrolled in the free cost list of the new rural cooperative medical system （NCMS）.