甘肃省地方性克汀病生态流行病学分布特征

Eco-epidemiology characteristic of endemic cretinism in Gansu

目的了解甘肃省不同生态类型区现存地方性克汀病（以下简称地克病）患者的生态流行病学分布特征。方法于2011年,村-乡-县逐级查阅历史地克病病例资料,对1985年普查的历史病例进行核实和登记,同时按照《中央转移支付碘缺乏病防治项目的高危地区监测方案》和WS 104—1999《地方性克汀病和地方性亚临床克汀病诊断》搜索和诊断历史克汀病病区及碘缺乏病高危地区1985年以后出生的地克病患者,建立甘肃省现存地克病数据库。结果 2011年全省现存地克病病例4 715例,地克病患病率为3.74/万;6个生态类型区中,荒漠区无地克病病例,秦岭中山峡谷区和黄土高原丘陵区地克病病例分别占总数的57.5%和33.2%。男、女地克病例的比例分别为70%和30%,不同生态区男性地克病病例比例均高于女性（P〈0.05）;新发地克病7例,其中甘南高原草原草甸区3例,其他生态区各1例;神经型、黏肿型和混合型三种病理类型的地克病病例分别占58.8%,9.8%和31.4%,河西走廊戈壁区和甘南高原草原草甸区100%为神经型,其他生态区神经型病例比例在40%～70%之间。结论甘肃省地克病病例在不同生态类型区分布特征不同,在实施全民食盐加碘防治碘缺乏病的同时,要考虑生态类型区其他因素对碘缺乏病防治的影响。

Objective To understand ecological epidemiology characteristic of existing endemic cretinism in different ecological type areas in Gansu. Methods In Gansu in 2011, the existing endemic cretinism cases database were established by verifying and registering the historical cases before 1985 and by searching and diagnosing the cases during 1985-2011 in history cretinism areas and IDD high-risk areas according to Endemic Cretinism and Endemic Sub-Clinical Cretinism Diagnosis（WS104-1999） and The IDD Monitoring Program of The Central Transfer Fund at the same time. Results Among Gansu 4 715 existing endemic cretinism cases in 2011, the prevalence was 3.74/10 000,57.5% and 33.2% cases were in Zhongshan Canyon of Qinling Mountains and loess plateau hilly land; The male and female cases accounted for 70.0% and 30.0% respectively, the proportion of male were higher than that in female in six ecological type areas（P〈0.05）; Among seven new cases of cretinism,three cases distributed in Gannan plateau grassland meadow area and one in each in the others; The nervous,myxedematous and mixed types of cretinism accounted for 58.8%, 9.8% and 31.4% respectively, 100% of nervous cases were in Hexi corridor gobi and Gannan plateau grassland meadow,and 40%-70% in the others. Conclusion The endemic cretinism cases distribution characteristic in Gansu is difference in six ecological type areas, the other ecological factors should be considered meanwhile the implementation of universal salt iodization for iodine deficiency disorders prevention and control.