中国地方病学杂志
中國地方病學雜誌
중국지방병학잡지
CHINESE JOURNAL OF ENDEMIOLOGY
2010年
4期
446-451
,共6页
相有章%王秀红%刘源%郭凤玖%蔡卫%廖永健%张文明%王静%刘蔚涛
相有章%王秀紅%劉源%郭鳳玖%蔡衛%廖永健%張文明%王靜%劉蔚濤
상유장%왕수홍%류원%곽봉구%채위%료영건%장문명%왕정%류위도
克山病%心电描记术%X线%超声心动描记术
剋山病%心電描記術%X線%超聲心動描記術
극산병%심전묘기술%X선%초성심동묘기술
Keshan disease%Electrocardiography%X-rays%Echocardiography
目的 观察近年来发病的慢型克山病的流行与临床特点,为克山病诊断提供依据.方法 2009年3-8月在山东、四川、内蒙古及甘肃省(自治区)选择163例慢型克山病患者,其中山东省62例、四川省34例、内蒙古37例、甘肃省30例.对所有患者进行详细询问病史、仔细体格检查以及心电图(ECG)、X线及心脏超声检查,分析发病特点与临床特征.结果 163例慢型克山病患者中,成人占98.8%(161/163),儿童占1.2%(2/163);平均年龄45.8岁;男女之比为1:1.33.自然慢型占62.6%(102/163),其他类型演变为慢型占37.4%(61/163).血压偏低(116.5/72.4 mmHg),多为心功能Ⅱ级,占65.6%(107/163).常见症状依次为心慌[心慌及活动后心慌,86.5%(141/163)]、气喘[气喘及活动后气喘,76.7%(125/163)]、乏力[76.1%(124/163)]、心前区不适[54.6%(89/163)]、头晕[50.3%(82/163)]、下肢水肿[44.8%(73/163)]、食欲减退[38.0%(62/163)].常见体征依次为第一心音低弱[66.9%(109/163)]、心界增大[64.4%(105/163)]、心尖搏动弥散[42.3%(69/163)]、心律不齐[40.5%(66/163)]、肝肿大[39.3%(64/163)]、收缩期杂音[25.2%(41/163)]、水肿[下肢及全身水肿,20.9%(34/163)].异常ECG检出率为93.9%(153/163),常见异常ECG依次为ST-T改变[ST-T改变、ST段改变及T波改变,36.2%(59/163)]、室性早搏[偶发及频发室性早搏,26.4%(43/163)]、完全性右束支传导阻滞[25.8%(42/163)]、心房颤动[19.0%(31/163)]、房室传导阻滞[8.6%(14/163)].X线胸片显示心脏重度及中度扩大占73.4%(105/143),轻度扩大占25.2%(36/143).彩色多普勒超声检查结果表明房室内径增大,检出率由高到低依次为左心室收缩末期内径增大[81.3%(52/64)]、左心室舒张末期内径增大[65.6%(42/64)]、左心房内径增大[51.6%(33/64)]、右心房内径增大[43.8%(28/64)]、右心室内径增大[32.8%(21/64)]、左心室壁变薄[15.6%(10/64)]、室间隔变薄[7.8%(5/64)].结论 近年来慢型克山病发病主要为自然慢型,发病年龄后移,血压偏低,临床特点主要为心脏增大及心功能失代偿引起的组织灌注不足和静脉淤血表现,此特点为慢型克山病诊断提供可靠依据.
目的 觀察近年來髮病的慢型剋山病的流行與臨床特點,為剋山病診斷提供依據.方法 2009年3-8月在山東、四川、內矇古及甘肅省(自治區)選擇163例慢型剋山病患者,其中山東省62例、四川省34例、內矇古37例、甘肅省30例.對所有患者進行詳細詢問病史、仔細體格檢查以及心電圖(ECG)、X線及心髒超聲檢查,分析髮病特點與臨床特徵.結果 163例慢型剋山病患者中,成人佔98.8%(161/163),兒童佔1.2%(2/163);平均年齡45.8歲;男女之比為1:1.33.自然慢型佔62.6%(102/163),其他類型縯變為慢型佔37.4%(61/163).血壓偏低(116.5/72.4 mmHg),多為心功能Ⅱ級,佔65.6%(107/163).常見癥狀依次為心慌[心慌及活動後心慌,86.5%(141/163)]、氣喘[氣喘及活動後氣喘,76.7%(125/163)]、乏力[76.1%(124/163)]、心前區不適[54.6%(89/163)]、頭暈[50.3%(82/163)]、下肢水腫[44.8%(73/163)]、食欲減退[38.0%(62/163)].常見體徵依次為第一心音低弱[66.9%(109/163)]、心界增大[64.4%(105/163)]、心尖搏動瀰散[42.3%(69/163)]、心律不齊[40.5%(66/163)]、肝腫大[39.3%(64/163)]、收縮期雜音[25.2%(41/163)]、水腫[下肢及全身水腫,20.9%(34/163)].異常ECG檢齣率為93.9%(153/163),常見異常ECG依次為ST-T改變[ST-T改變、ST段改變及T波改變,36.2%(59/163)]、室性早搏[偶髮及頻髮室性早搏,26.4%(43/163)]、完全性右束支傳導阻滯[25.8%(42/163)]、心房顫動[19.0%(31/163)]、房室傳導阻滯[8.6%(14/163)].X線胸片顯示心髒重度及中度擴大佔73.4%(105/143),輕度擴大佔25.2%(36/143).綵色多普勒超聲檢查結果錶明房室內徑增大,檢齣率由高到低依次為左心室收縮末期內徑增大[81.3%(52/64)]、左心室舒張末期內徑增大[65.6%(42/64)]、左心房內徑增大[51.6%(33/64)]、右心房內徑增大[43.8%(28/64)]、右心室內徑增大[32.8%(21/64)]、左心室壁變薄[15.6%(10/64)]、室間隔變薄[7.8%(5/64)].結論 近年來慢型剋山病髮病主要為自然慢型,髮病年齡後移,血壓偏低,臨床特點主要為心髒增大及心功能失代償引起的組織灌註不足和靜脈淤血錶現,此特點為慢型剋山病診斷提供可靠依據.
목적 관찰근년래발병적만형극산병적류행여림상특점,위극산병진단제공의거.방법 2009년3-8월재산동、사천、내몽고급감숙성(자치구)선택163례만형극산병환자,기중산동성62례、사천성34례、내몽고37례、감숙성30례.대소유환자진행상세순문병사、자세체격검사이급심전도(ECG)、X선급심장초성검사,분석발병특점여림상특정.결과 163례만형극산병환자중,성인점98.8%(161/163),인동점1.2%(2/163);평균년령45.8세;남녀지비위1:1.33.자연만형점62.6%(102/163),기타류형연변위만형점37.4%(61/163).혈압편저(116.5/72.4 mmHg),다위심공능Ⅱ급,점65.6%(107/163).상견증상의차위심황[심황급활동후심황,86.5%(141/163)]、기천[기천급활동후기천,76.7%(125/163)]、핍력[76.1%(124/163)]、심전구불괄[54.6%(89/163)]、두훈[50.3%(82/163)]、하지수종[44.8%(73/163)]、식욕감퇴[38.0%(62/163)].상견체정의차위제일심음저약[66.9%(109/163)]、심계증대[64.4%(105/163)]、심첨박동미산[42.3%(69/163)]、심률불제[40.5%(66/163)]、간종대[39.3%(64/163)]、수축기잡음[25.2%(41/163)]、수종[하지급전신수종,20.9%(34/163)].이상ECG검출솔위93.9%(153/163),상견이상ECG의차위ST-T개변[ST-T개변、ST단개변급T파개변,36.2%(59/163)]、실성조박[우발급빈발실성조박,26.4%(43/163)]、완전성우속지전도조체[25.8%(42/163)]、심방전동[19.0%(31/163)]、방실전도조체[8.6%(14/163)].X선흉편현시심장중도급중도확대점73.4%(105/143),경도확대점25.2%(36/143).채색다보륵초성검사결과표명방실내경증대,검출솔유고도저의차위좌심실수축말기내경증대[81.3%(52/64)]、좌심실서장말기내경증대[65.6%(42/64)]、좌심방내경증대[51.6%(33/64)]、우심방내경증대[43.8%(28/64)]、우심실내경증대[32.8%(21/64)]、좌심실벽변박[15.6%(10/64)]、실간격변박[7.8%(5/64)].결론 근년래만형극산병발병주요위자연만형,발병년령후이,혈압편저,림상특점주요위심장증대급심공능실대상인기적조직관주불족화정맥어혈표현,차특점위만형극산병진단제공가고의거.
Objective To observe the incidence and clinical characteristics of chronic Keshan disease in recent years, and to provide evidence for diagnosis of the disease. Methods From March to August 2009, 163 patients with chronic Keshan disease were chosen from Shandong, Sichuan, Inner Mongolia and Cansu. Of these patients, 62 cases were from Shandong, 34 cases from Sichuan, 37 cases from Inner Mongolia, and 30 cases from Gansu. All of the subjects underwent detailed natural history of the disease, careful physical examination and electrocardiogram (ECG), X-ray chest radiography and cardiac ultrasound examination. The incidence and clinical features were analyzed. Results Adults accounted for 98.8%(161/163) and children for 1.2%(2/163) in 163 cases of chronic Keshan disease, with an average age of 45.8 years. Slow onset accounted for 62.6%(102/163), other types that evolved into chronic-type accounted for 37.4%(61/163). Low blood pressure( 116.5/72.4 mmHg),often with cardiac function grade Ⅱ accounted for 65.6%(107/163). Common symptoms were: palpitation[86.5%(141/163)], asthma [76.7% (125/163)], fatigue[76.1%(124/163)], precordial discomfort [54.6% (89/163)], dizziness[50.3%(82/163)], edema of lower limbs[44.8%(73/163)], and anorexia[38.0%(62/163)]. Common signs were: low-weak first heart sound[66.9%(109/163)], heart enlargement[64.4%(105/163)], apical pulse dispersion[42.3%(69/163)], arrhythmia[40.5%(66/163)], hepatomegalia[39.3%(64/163)], systolic murmur [25.2%(41/163)], and edema[20.9%(34/163)]. Abnormal ECG detection rate was 93.9%(153/163), with common types followed by ST-T changes[ST-T changes, ST segment changes, Tchange, 36.2%(59/163)], ventricular premature [occasional and frequent ventricular premature, 26.4% (43/163)], complete right bundle branch block [25.8% (42/163)], atrial fibrillation[19.0%(31/163)], and atrioventricular conduction block[8.6%( 14/163)]. X-ray results showed that significant and moderate heart enlargement were common, accounting for 73.4%( 105/143), followed by mild enlargement of 25.2%(36/143). Color doppler ultrasound examination results showed that the atrio-ventricular cavity diameter increased, followed by left ventricular end-systolic diameter increased[81.3%(52/64)], left ventricular end-diastolic diameter increased[65.6%(42/64)], left atrial enlargement[51.6%(33/64)], right atrial enlargement [43.8%(28/64)], and right ventricular enlargement[32.8%(21/64)]. Left ventricular wall and interventricular septum thinning accounted for 15.6%( 10/64) and 7.8%(5/64), respectively. Conclusions In recent years, most cases of chronic Keshan disease occur as natural chronic type, and at older age at onset with low blood pressure.Main clinical features of the disease are cardiac enlargement, inadequate tissue perfusion, and venous stasis performance caused by cardiac decompensation. Correct diagnosis of chronic Keshan disease can be made based on these clinical features.
