甘肃省现存地方性克汀病流行病学分布

摘要

目的 初步建立地方性克汀病(地克病)资料库,了解甘肃省现存地克病分布情况,为碘缺乏病防治提供建议.方法 2011年,按照村-乡-县逐级查阅历史地克病病例资料,对甘肃省1985年普查的历史病例进行核实和登记,同时按照《中央转移支付碘缺乏病防治项目的高危地区监测方案》和《地方性克汀病和地方性亚临床克汀病诊断》(WS 104-1999),搜索和诊断历史地克病病区和碘缺乏病高危地区1985-2011年的地克病患者,建立甘肃省现存地克病数据库,分析现存地克病的分布情况.结果 1985年甘肃省地克病县(区)为53个,地克病病例为19 696例;2011年甘肃省地克病县(区)为41个,地克病病例4 715例,其中1985年前出生的地克病病例4 690例,1985-1997年出生的地克病18例,1997后出生(新发)地克病7例.在4 708例历史病例中,神经型、黏肿型和混合型地克病的比例分别为58.8％(2 766/4 708)、9.8％(461/4 708)和31.4％(1 481/4708),男性和女性地克病的比例分别为69.3％(3 261/4708)和30.7％(1 447/4 708),45岁以上病例占73.2％(3444/4 708);新发7例地克病均为神经型,5例分布在少数民族地区.结论 甘肃省目前还存在碘缺乏病高危地区,有发生地克病的潜在危险.甘肃省神经型地克病居多,主要是由于母体怀孕早期碘摄入不足所造成的,适时向高危地区的孕妇和哺乳期妇女提供应急补碘强化措施是防止地克病新发的关键.%Objective To build a case database of endemic cretinism,investigate the distribution of existing cretinism,and provide suggestions for prevention of iodine deficiency disorders.Methods In 2011,an existing endemic cretinism case database was established in Gansu Province by verifying and registering the historical cases before 1985,and searching and diagnosing the cases between 1985-2011 in history cretinism areas and IDD high-risk areas according to "endemic cretinism and endemic sub-clinical cretinism diagnosis (WS 104-104)" and "the IDD monitoring program of the central transfer fund" at the same time,and analysis the distribution of existing cretinism.Results In 1985 and 2011,cretinism areas were 53 and 41 in Gansu Province,and the endemic cretinism cases werel9 696 and 4 715,respectively;18 cases of endemic cretinism were born between 1985 to1997,7 new cases were born after 1997;nerve cretinism,myxedematous and mixed types among existing cases were 58.8％ (2 766/4 708),9.8％ (461/4 708) and 31.4％ (1 481/4 708),males and females were 69.3％ (3 261/4 708)and 30.7％ (1 481/4 708),respectively.Cases older than 45 accounted for 73.2％ (3 444/4 708);the 7 new cases were all nerve cretinism and 5 cases distributed in ethnic minority areas.Conclusions There are potential dangers of endemic cretinism in the high-risk areas of iodine deficiency disorders due to multiple factors in Gansu Province;the nervous cretinism is the majority which is caused by insufficient iodine intake in early maternal pregnancy.To prevent new endemic cretinism,it is necessary to strengthen measures of emergency iodine supplementation for pregnant women and nursing mothers in the high-risk areas.