西藏自治区昌都市学龄儿童大骨节病X线阳性病例的现况分析

Current status of radiological Kashin-Beck disease among school-aged children in Chamdo City,Tibet

目的调查2017年和2020年西藏自治区昌都市学龄儿童大骨节病X线阳性病例现况,为防治策略的制定提供流行病学依据。方法选择西藏自治区昌都市大骨节病历史病情最严重的洛隆、边坝、八宿县作为目标地区,以7~12岁在校儿童作为研究对象,调查2017年和2020年西藏自治区昌都市学龄儿童大骨节病X线检出病例情况,对受试者摄右手正位X线片,依据大骨节病诊断标准(WS/T 207-2010)进行X线诊断。由两位经验丰富的研究者分别独立阅片,通过加权Kappa值和百分比一致率评估组内及组间一致性。计算2017年和2020年大骨节病的X线检出率,采用二分类变量logistic回归分析构建大骨节病X线病例的危险因素预测模型。结果2017年昌都市7~12岁儿童中接受基线横断面调查者5711人(平均年龄9.2岁,女性占比48.0%),其中大骨节病X线阳性者28例,年龄性别标准化患病率为0.527%;2020年接受二次横断面调查的受试者共计6771人(平均年龄9.3岁,女性占比49.5%),其中大骨节病X线阳性者9例,年龄性别标准化患病率为0.134%。Logistic回归分析结果表明较高的年龄[OR=2.439,95%CI(1.299,4.580),P=0.006]、女性[OR=8.157,95%CI(1.016,65.528),P=0.048]是大骨节病X线阳性的独立危险因素。而在西藏地区高海拔的大前提下,较高的居住地海拔是其保护因素[OR=0.995,95%CI(0.990,0.999),P=0.032]。结论西藏自治区昌都市学龄儿童的大骨节病X线检出阳性率处于极低水平并呈下降趋势,2020年已经达到了历史病区的标准。考虑到目前无阳性体征患儿,说明当地大骨节病已基本消除。

Objective This study aimed to explore the status of radiological Kashin-Beck disease(KBD)among school-aged children in Chamdo City,Tibet,through a 3-year monitoring survey,providing epidemiological evidence for prevention and control strategies.Methods The target areas for this study were Luolong,Bianba,and Basu counties in Chamdo City,Tibet Autonomous Region,identified as having the most severe historical cases of KBD.Children aged 7-12 years attending school were enrolled as study subjects.Anteroposterior X-ray films of the right-hand were taken,and radiological diagnoses were made based on the"Diagnosis of Kashin-Beck Disease"criteria(WS/T 207-2010).Two experienced researchers independently reviewed the X-rays,and intra-and inter-group consistency were assessed using weighted Kappa values and percentage agreement.Cross-sectional surveys were conducted in 2017 and 2020 to describe the X-ray detection rates of KBD,and logistic regression analysis was employed to construct a predictive model of risk factors for radiological KBD cases.Results In 2017,a total of 5,711 children aged 7-12 years in Chamdo City,Tibet,participated in the baseline cross-sectional survey(average age 9.2 years,48.0% female),with 28 cases of radiological KBD.The age-and gender-standardized prevalence rate was 0.527%.In 2020,6,771 participants(average age 9.3 years,49.5% female)underwent a second cross-sectional survey,with 9 cases of radiological KBD and a standardized prevalence rate of 0.134%.Logistic regression analysis indicated that older age[OR=2.439,95%CI(1.299,4.580),P=0.006]and female gender[OR=8.157,95%CI(1.016,65.528),P=0.048]were independent risk factors for radiological KBD cases.Conversely,higher residential altitude,under the premise of Tibet's high altitude,was a protective factor[OR=0.995,95%CI(0.990,0.999),P=0.032].Conclusion The radiographically positive detection rate of KBD among school-aged children in Chamdo City,Tibet Autonomous Region,is at an extremely low level and showing a declining trend,reaching the historical standard in 2020.Considering the absence of positive signs in affected children,it suggests that local KBD has been effectively eliminated.