目的 观察山东省克山病病情,掌握克山病的发病情况,科学指导防治工作的开展.方法 按照山东省克山病监测方案的要求,在7个克山病县(市、区)进行了病例搜索,在其中有代表性的3个县(市)中选择6个自然村进行了病情重点监测,每个监测点对420名左右居民进行详细询问病史、临床查体和心电图描记,可疑心脏异常者拍摄后前位X线胸片,同时采集部分居民头发和粮食检测内外环境硒水平,并收集居民经济收入及人均占有粮食等基本情况.结果 ①共搜索医疗单位259个,心肌疾病患者1132例,确定疑似克山病638例,诊断慢型克山病142例.②6个监测点调查居民2538人,检出克山病患者91例(其中潜在型77例,慢型14例),检出率为3.58％.描记心电图2127例,异常心电图检出率为24.5％(521/2127),以ST-T改变、T波改变、窦性心动过缓、窦性心律不齐、窦性心动过速、房性早搏等多见.拍摄X线胸片75例,39例增大(其中轻度增大21例,中度增大13例,重度增大5例).③采集头发、粮食等样品406份,病区居民发硒水平接近硒适宜地区的水平,粮食硒水平仍处于较低水平；各监测点人均年收入为3000～ 5900元；居民主食以面粉为主.结论 山东省克山病病情处于稳定态势,但监测中仍有慢型、潜在型患者检出；内环境硒水平明显升高,与病区居民生活水平的提高和膳食营养的改善有关.%Objective To investigate the incidence of Keshan disease(KSD) in Shandong province and to supply evidence for scientific control of the disease.Methods According to the scheme of KSD monitoring in Shandong province,the KSD cases were searched in 7 counties,and representative 3 counties and 6 villages were selected as key monitoring sites.In each site,about 420 residents were checked by asking detailed disease history,physical examination,and electrocardiography (ECG) tracings.Suspected cardiac abnormalities were taken chest posteroanterior X-ray film.At the same time,residents hair and food samples were collected to detect selenium levels in internal and external environments,and residents' income and per capita share of grain and other basic information were collected.Results ①Two hundred and fifty-nine medical units were searched,1132 cases of myocardial disease were found out and 638 suspected cases were identified and 142 chronic KSD cases were diagnosed.②In the 6 monitoring sites,2538 residents were surveyed and 91 cases of KSD were detected(of which 77 cases of potential,14 cases of chronic),the detection rate was 3.58％.A total of 2127 residents were traced ECG and the incidence of abnormal ECG was 24.5％ (521/2127),of which ST-T changes,T-wave changes,sinus bradycardia,sinus arrhymia,sinus tachycardia,and atrial premature beats et al were more common.Of the 75 X-ray films,39 cases had enlarged heart(in which 21 of mild,13 of moderate,5 of severe).③A total of 406 hair and grain samples were collected,respectively,and the selenium content of hair was approaching the level of appropriate,and the selenium content of food was still low.The annual per capita incomes of each site were between 3000 - 5900 Yuan,and residents main staple food was flour.Conclusions KSD in Shandong province is in a relatively stable situation.But latent and chronic KSD cases can still be detected.The internal environment selenium levels are elevated since the local living standards and dietary nutrition are improved.
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