青藏高原地区大骨节病的流行特征及致病因素探究

Epidemiological trend and pathogenic factors of KBD in Qinghai-Tibet Plateau region

本文系统分析了青藏高原地区2001—2017年间大骨节病的时空流行特征,研究结果显示,青藏高原地区7—12周岁儿童大骨节病X线检出率整体下降趋势显著,随着换粮、补硒、改水、易地搬迁和退耕还林还草等防控措施的实施,大骨节病基本得到了控制.以2008年为转折点,大骨节病得到了质的改善,2017年大部分病区县已基本消除.青海省7—12周岁儿童大骨节病平均检出率最高,为10.6%,占平均总检出率的59%;其次是西藏自治区和阿坝州,平均检出率分别为5.3%和2.2%,占平均总检出率的29%和12%.其中,青海的兴海县和贵德县以及西藏的昌都市和山南市平均检出率占比较高,分别为32%、26%、8%和7%,应当引起重视.本文根据国内外相关研究,总结分析了大骨节病主要致病因素的研究进展,其中缺硒是重要因素之一,此外,粮食霉菌、饮水中过量的腐殖酸、强辐射和缺氧环境也会增加大骨节病的患病风险.目前青藏高原地区大部分病区依旧处于低硒环境,补硒换粮仍是最有效的控制手段,但是具体的致病因素还需要进一步的深入探究.本研究可为青藏高原地区大骨节病的防治提供参考和理论依据.

This paper systematically analyzed the temporal and spatial epidemiological characteristics of Kashin-Beck disease(KBD)in the Qinghai-Tibet Plateau from 2001 to 2017.The results showed that the Kashin-Beck X-ray detection rate of children aged 7 to 12 in the QinghaiTibet plateau area decline significantly.With the implementation of the prevention and control measures such as grain exchange,selenium supplementation,water improvement,relocation and returning farmland to forest and grassland,KBD has been basically under control.Transfer point in 2008,the prevalence of KBD has decreased significantly,and most affected areas and counties were eliminated in 2017.The mean detection rate of KBD in children aged 7—12 in Qinghai province was the highest with 10.6%,accounting for 59%of the total mean detection rate.Tibet Autonomous Region and Aba Prefecture had an average detection rate of 5.3%and 2.2%,respectively,comparing to 29%and 12%of the total average detection rate.In particular,Xinghai and Guide in Qinghai and Changdu and Shannan in Tibet make up higher average detection rates with 32%,26%,8%,and 7%,respectively,which should be taken seriously.The main pathogenic factors of KBD were summarized and analyzed based on relevant studies.Notably,selenium deficiency is the one of important factors.In addition,food mold,excessive humic acid in drinking water,intense radiation and the anoxic environment also increase the risk of KBD.At present,most of the disease areas in the Qinghai-Tibet Plateau are still in a low selenium environment,indicating that selenium supplement for food is still the most effective control method.However,the specific pathogenic factors need to be further evaluated.This study can further promote the relevant research and devote efforts to the prevention and treatment of KBD in the Qinghai-Tibet Plateau.