2012—2017年陕西宝鸡市大骨节病病情监测评价

Evaluation on Kashin-beck disease monitoring in Baoji City,Shaanxi Province(2012-2017)

目的分析陕西省宝鸡市大骨节病病区硒盐供应停止后大骨节病病情消长趋势,为科学防控提供依据。方法 2012—2017年宝鸡市在所辖12个县(区)开展了大骨节病病情监测,每年在监测县(区)随机抽取5个大骨节病病区镇,从监测镇抽取3个病区村(如辖区内少于5个病区镇则全选,所选镇少于3个病区村则全查)作为监测点,对监测点的全部7~12岁儿童进行临床和右手X线摄片检查,同时调查防控措施等情况。2012年和2014年先后在宝鸡市麟游县和其地理位置相邻的岐山县按东、西、南、北4个方位分别选取4个大骨节病病区村和非病区村作为监测点,调查人群发硒含量。每个监测点抽取7~12岁儿童8人(男、女各半),16岁以上成人8人(男、女各半),采集后枕根部头发10g左右进行发硒含量检测。结果 7~12岁儿童临床和X线摄片检查共25 357名,检诊率96.56%(25 357/26 261),未检出Ⅰ度及以上大骨节病病例;X线摄片检出干骺端病变6例,骨骺、骨端及腕骨未检出病变。共采集发样264人(份),其中病区130人份(儿童66人,成人64人),非病区134份(儿童63人,成人71人)。病区人群硒营养达到或超过非病区水平,人群发硒含量总体处于硒水平中等或超过中等水平。调查的494个病区村居民主食以面粉为主,占67.00%~83.00%,外购粮、大米食用比例呈上升趋势,2013—2017年12县(区)大骨节病病区均未供应硒盐。结论宝鸡市大骨节病病区停止补硒后,病情平稳,表现出消退病区的特点,但宝鸡市外环境低硒等大骨节病致病因子依然存在,X线仍有检出病例,综合防病措施的落实可以逐步由群防转向精准化,尤其应加强病区人群发硒含量监测并常态化。

Objective To analyze the trend of Kashin-beck disease in the endemic area after ceasing the provision of selenium,and provide evidence for disease control. Methods Kashin-beck disease surveillance was performed in 12 counties/districts in Baoji City,5 Kashin-beck endemic townships were randomly selected in the surveillance county/district yearly,3 endemic villages were selected from the township,（ if there were less than 5 endemic townships,all the endemic townships would be selected,if there were less than 3 endemic villages,all the endemic villages would be selected）. Clinical and right hand X-ray radiography would be examined for all the 7 to 12 years old children. and prevention and control measures would be investigated as well. In 2012 and 2014,we successively selected Linyou County and its geographical location adjacent qishan county,according to the four directions（ east,west,south and north）,4 Kashin-beck endemic villages and 4 non-endemic villages as surveillance spots. The content of hair selenium of the population was investigated. In each surveillance spots,eight 7-12 years old children（ half male,half female）,eight 16 years old and above adults（ half male,half female） were selected to check the content of selenium in hair（ 10 gram occipital part hair）.Results A total of 25 357,7-12 years old children received clinical and X-ray examination,examination rate was 96. 56%（ 25 357/26 261）,no Kashin-beck disease of grade I or over was found. X-ray radiography detection showed 6 cases had stem epiphyseal end lesions,no pathological change was found in epiphysis,bone ends and carpal bones. 264 hair samples were collected,including 130 samples from endemic area（ 66 children,64 adults,）,134（ 63 children,71 adults） from non-endemic area. Selenium level of the population from endemic area reached or exceeded that of non-endemic area,Overall hair selenium content of the population was at medium or higher level. Resident staple food in the 494 endemic villages was mainly flour,accounting for 67. 00%-83. 00%,the proportion of the purchased food and rice showed an increasing trend. From 2013 to 2017,no selenium salt was provided to the above mentioned 12 endemic areas. Conclusions After ceasing the provision of selenium,the endemic of Kahin-beck disease was stable,and showed dissipated nature. However,the low-selenium environment of Baoji City and other pathogenic factors still existed,patients could be detected by X-ray. The implementation of comprehensive prevention measures could gradually turn from group prevention and treatment to more precise control,especially the surveillance for hair selenium should be strengthened and constantly carried out.