CAJ | 학술논문

目的掌握宝鸡市克山病病情现状和消长趋势,为防治科研工作提供科学依据.方法选择凤县、千阳县、麟游县、陇县4个克山病病区县开展病例搜索,从县级医疗机构及乡(镇)卫生院近3年登记在册的全部心肌疾病病例中搜集克山病病例；选择千阳县、凤翔县、凤县、麟游县、陇县5个克山病病区县的13个克山病病村为监测点,进行克山病重点监测,对监测点所有调查对象进行全面临床体格检查和12导联心电图描记,依据《克山病诊断标准》判定.每个监测点(村)抽取10户居民家庭,采集1份主食小麦粮样和成人枕部发样进行硒水平测定.结果共搜索医疗机构32个,心肌病例746例,确诊慢型克山病17例.13个监测点共监测5723人,检出克山病患者65例,其中慢型克山病17例,潜在型克山病48例,总检出率为1.14％.发硒均值为0.420 mg/kg;小麦硒均值为0.079 mg/kg.结论宝鸡市克山病病情处于低发平稳态势,人群内环境硒水平已上升到非病区水平,但仍有克山病病例检出,应尽快建立病区人群内、外环境硒水平等克山病综合致病因素常态化监测机制.
목적 장악보계시극산병병정현상화소장추세,위방치과연공작제공과학의거.방법 선택봉현、천양현、린유현、롱현4개극산병병구현개전병례수색,종현급의료궤구급향(진)위생원근3년등기재책적전부심기질병병례중수집극산병병례；선택천양현、봉상현、봉현、린유현、롱현5개극산병병구현적13개극산병병촌위감측점,진행극산병중점감측,대감측점소유조사대상진행전면림상체격검사화12도련심전도묘기,의거《극산병진단표준》판정.매개감측점(촌)추취10호거민가정,채집1빈주식소맥량양화성인침부발양진행서수평측정.결과 공수색의료궤구32개,심기병례746례,학진만형극산병17례.13개감측점공감측5723인,검출극산병환자65례,기중만형극산병17례,잠재형극산병48례,총검출솔위1.14％.발서균치위0.420 mg/kg;소맥서균치위0.079 mg/kg.결론 보계시극산병병정처우저발평은태세,인군내배경서수평이상승도비병구수평,단잉유극산병병례검출,응진쾌건립병구인군내、외배경서수평등극산병종합치병인소상태화감측궤제.
Objective To learn the existing state of Keshan disease and its trend in Baoji City,and to provide a scientific basis for control of the disease.Methods Feng,Qianyang,Linyou and Long Counties,the Keshan disease affected areas were selected to carry out the case study,and Keshan cases were searched from all registered cases of myocardial patients of the past three years at county-level medical institutions and hospitals of townships(towns).Thirteen villages affected by Keshan disease in Qianyang,Fengxiang,Feng,Linyou and Long Counties were selected as monitoring points to carry out a intensified monitoring.All subjects were surveyed by comprehensive clinical physical examination and 12-lead ECG tracings,and they were diagnosed according to the Keshan disease diagnostic criteria.Ten households were selected randomly in each monitoring point(village),and self-produced wheat samples and adult subject's occipital hair samples were collected for detecting selenium levels.Results Seven hundred and forty-six cardiac cases which containing 17 cases of chronic Keshan disease were discovered in 32 medical institutions,and there were no acute and subacute type of Keshan disease patients.Five thousand seven hundred and twenty-three subjects were examined in the 13 monitoring sites,and 65 cases of Keshan disease were diagnosed which including 17 cases of slow and 48 cases of potential Keshan disease,and no acute or subacute case was found.The total detection rate was 1.14％,and the detection rate ranged from 0 to 2.86％.Hair selenium mean was 0.420 mg/kg; wheat selenium mean was 0.079 mg/kg.Conclusions The Keshan disease detection rate of Baoji City is at a low level.The selenium level of local residents has reached the level of non-endemic area.Constant detection of patient with Keshan disease means various control measures should be reinforced.The comprehensive monitoring program,such as monitoring people's in vivo and in vitro selenium level and others,should be established as soon as possible.