克山病病情和防控评估方法的研究

At present, the scope of the endemic areas where the epidemic of Keshan disease (KD) has basically been under control is still not very clear. It is very hard to apply the current national health standard of Keshan Disease Endemic Areas under Control at the level of county in evaluation of Keshan disease prevention and control. We urgently need to develop practical and feasible methodologies to evaluate Keshan disease prevention and control. To solve this problem, we propose, based on our work in recent years, to survey the prevalence and incidence of Keshan disease in the population of the Keshan disease endemic areas, the potential risks and the intervention being implemented. In the design, the ten attributives of disease surveillance systems, i.e., the necessity, representativeness, sensitivity, prediction and so on, are sufficiently considered. The methods, a combination of case searching and sentinel survey, are aimed at finding out the endemic villages with the highest or higher prevalence of Keshan disease. Since it is very hard to make differential diagnosis between chronic type of chronic Keshan disease and dilated cardiomyopathy, we also propose to survey the prevalence and incidence of dilated cardiomypathy in the non-endemic areas of Keshan disease in order to have a reference of the background level of dilated cardiomypathy in the endemic areas of Keshan disease. This proposal explores the new theory and methods of Keshan disease surveillance, translates the critical issues in the practice of Keshan disease surveillance, prevention and control into the new growth points of disease surveillance of epidemiological method, has original innovation, and the characteristics of China. The outcome of this proposal will be very important to surveillance and evaluation of prevention and control of Keshan disease, and for the development of the national health standard for elimination of Keshan disease, provide extremely important scientific value to the methodology of surveillance of other endemic diseases and non-communicable diseases epidemiology, and be beneficial for China to hold a seat for Keshan disease in cardiovascular diseases research in the world.

现今，我国达到控制水平的克山病病区范围仍不清楚，现有的《克山病病区控制》等标准难以应用到县级病情控制评估中,急需切实可行的评估方法。为解决这一问题，我们基于近年的工作，充分考虑了疾病监测系统的必要性、代表性、敏感性等要素的要求，计划以病区人群为对象，通过病例搜索结合近年监测结果的方法，找出病区县中病情最重或较重的乡和村，调查病情、可疑病因及防控措施等必要内容。由于慢型克山病与扩张型心肌病（DCM）临床上难以鉴别，故同时调查非病区DCM的病情，作为病区中DCM"本底值"的参照。本研究是对克山病监测、防控的新理论和新方法的探索，将克山病防控的实际问题转化成了疾病监测方法的生长点，具有源头性创新意义和我国特色。其产出对克山病病情的监测、防控效果的评估和消除标准的制订都具有极为重要的现实意义和科学价值，对其它地方病和慢性病监测也有重要参考价值，并有益于我国克山病在国际心血管病研究领域中占一席之地。

控制克山病是全国地方病防治规划的目标之一，但是现在全国达到控制水平的病区范围并不完全清楚，现有的标准也难以应用到乡级病区的控制评估中。本研究的目的在于探索以较小规模调查的结果评估乡级病区范围的克山病病情及其控制水平的方法。.选择历史重病区黑龙江省尚志市元宝镇作为调查点。通过村医、乡和县医院搜索慢型克山病疑似病例，对疑似病例进行诊断核实。选择慢型克山病病情最重的村作为重点调查人群，对调查点全体常住居民展开病情调查。采用氢化物原子荧光光谱法进行重点调查人群的头发硒含量检测。问卷调查病区范围、病区受威胁人口和防控措施。.此小规模调查的结果能够有效的评估一个乡级病区范围的克山病病情及防控水平。尚志市元宝镇克山病达到控制水平。低硒危险因素仍然存在，全国克山病监测需要继续。