2014、2015年山东省克山病病情重点调查评估

Current situation of Keshan disease in Shandong Province in 2014 and 2015

目的 掌握山东省克山病病情及发病相关因素，科学评估防治现状。方法 2014、2015年，根据2014年全国克山病监测方案要求，在山东省19个克山病县（市、区）的38个调查点对全体居民进行问卷调查、临床查体、心电图描记，疑似克山病病例拍摄胸部X线片或行心脏超声检查，同时采集居民头发、粮食和土壤，检测内外环境硒含量。依据《重点地方病控制和消除评价办法》（国卫疾控发［2014］79号）考核评估山东省克山病防治达标情况。结果 ①38个监测点共调查居民16 168人，检出克山病患者164例（潜在型149例、慢型15例），检出率为1.014%；②采集头发763份，小麦687份、玉米751份，土壤296份，共计2 497份，头发硒含量为（0.379 ± 0.120）mg／kg；小麦、玉米的硒含量分别为（0.025 ± 0.009）、（0.016 ± 0.007）mg／kg；土壤硒含量为（0.132 ± 0.046）mg／kg。③经考核评估，山东省6个克山病县（市、区）达到消除指标，13个县（市、区）处于控制水平，消除县所占比例为31.58%（6／19）。结论 ①山东省克山病病情处于稳定态势，内环境硒含量较高，与病区居民生活水平的提高和膳食营养的改善有关。②山东省克山病消除县的数量距离国家要求的“消除目标”还有一定差距，建议在继续加强防治队伍建设和加大经费投入力度的同时，建立克山病防治的长效工作机制。

Objective To investigate the current condition and risk factors of Keshan disease （KD） in Shandong Province, and to provide a scientific basis for prevention and control of KD. Methods Based on the 2014 scheme of KD surveillance, residents in 38 surveillance sites of 19 counties （cities, districts） were surveyed by questionnaire survey, physical examination, electrocardiograms （ECG）, X-ray or echocardiography. At the same time, some residents＇ hair, grain and soil samples were collected, and the content of selenium in the internal and external environment was tested. KD was evaluated in Shandong Province based on the ＂National Standard of Evaluation Method for Key Endemic Disease Control and Elimination＂. Results ①In 38 monitoring sites, 16 168 residents were surveyed and 164 cases of KD were detected （in which 149 cases of potential, 15 cases of chronic）, the detection rate was 1.014%. ② Totally 2 497 samples of hair （n = 763）, food （wheat： n = 687, corn： n = 751） and soil （n = 296） were collected and the selenium contents in hair was （0.379 ± 0.120） mg/kg, in wheat and corn were （0.025 ± 0.009） mg/kg and （0.016 ± 0.007） mg/kg, and in soil was （0.132 ± 0.046） mg/kg.③According to the national standard of evaluation content and decision criteria for KD, 6 counties achieved the elimination index and 13 counties were in the control level in Shandong Province, the county proportion of eliminating KD was 31.58% （6/19）. Conclusions ①The current condition of KD in Shandong Province remains relatively stable. Internal environment selenium content is increased significantly due to improvement of people＇s living standard and dietary nutrition. ②There is still a gap between the number of counties eliminated KD and the ＂elimination targets＂ required by the state in Shandong Province. It is recommended to continue to strengthen the team construction in prevention and control of KD and to enhance the investment of money, at the same time, to establish a long-term working mechanism in prevention and control of KD.