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目的观察克山病病情及发病相关因素的动态变化,为指导克山病防治研究提供科学依据。方法选择克山病病区莒县棋山和邹城城前村为监测点,自2005～2009年对常住人口克山病患病情况进行连续5年动态监测,第1、3、5年对观察者进行临床查体和心电图描记,可疑心脏增大者行心脏后前位X线摄片。同时调查受检者发硒、粮硒含量(小麦、玉米、地瓜干)及经济收入情况。结果棋山点观察545人,第3、5年分别复查444人、434人,克山病检出率为2.75%、2.93%、3.92%。城前点观察523人,第3、5年分别复查471人、424人,克山病检出率为4.21%、4.46%、5.90%。棋山点及城前点观察人群异常心电图检出率分别为11.0%、15.9%。居民发硒含量逐年升高,已达硒适宜地区水平,第1、3、5年棋山点依次为(mg/kg):0.275±0.056(44人)、0.408±0.048(35人)、0.437±0.072(35人),城前点依次为(mg/kg):0.319±0.070(45人)、0.390±0.056(40人)、0.426±0.146(33人)。粮食硒基本恒定。人均经济收入和人均占有粮食逐年增加。结论克山病病区居民病情处于稳定态势,居民经济收入增加及膳食明显改善使内环境硒水平升高是重要环境因素。
Objective To observe the dynamic changes of Keshan disease and related factors in order to provide a scientific basis for the study of prevention and treatment of Keshan disease. Methods The Keshan disease patients in Qixian County and Chengqian Village in Zoucheng were selected as the monitoring sites. From 2005 to 2009, the prevalence of Keshan disease in resident population was monitored continuously for 5 years. At the first, third and fifth years, Clinical examination and electrocardiogram tracing, suspicious heart enlargement after cardiac X-ray. At the same time investigated subjects selenium, grain selenium content (wheat, corn, dried sweet potatoes) and economic income. Results 546 were observed in Chess Hill, 444 and 434 in the third and fifth years respectively. The detection rates of Keshan disease were 2.75%, 2.93% and 3.92% respectively. 523 were observed in front of the city and 471 and 424 were reviewed in the third and fifth years respectively. The detection rates of Keshan disease were 4.21%, 4.46% and 5.90% respectively. Chess Hill and the city before the point of observation of abnormal ECG rate were 11.0%, 15.9%. Selenium content of residents increased year by year, reaching the level of selenium suitable for the region, the first, the third and the fifth year chess mountain sites were (mg / kg): 0.275 ± 0.056 (44 people), 0.408 ± 0.048 (35 people), 0.437 ± 0.072 (35 persons). The points in front of the city were (mg / kg): 0.319 ± 0.070 (45 persons), 0.390 ± 0.056 (40 persons) and 0.426 ± 0.146 (33 persons). Food selenium is basically constant. Per capita income and per capita food are increasing year by year. Conclusion The condition of residents in Keshan disease area is in a steady state. It is an important environmental factor to increase the selenium level in the internal environment by increasing the income of residents and improving the diet significantly.