克山病消除评估的方法学研究

Elimination of Keshan disease is one of the goals of the national program of endemic disease prevention and control. We urgently need the method of assessment of Keshan disease elimination, which needs to draw conclusion for the minimum unit of the endemic areas. At macro level in this study, we plan to use a comprehensive method to survey the county hospitals, the township hospitals and the general practitioners at village clinics to emphasize its advantages of science and ensure the basic requirements of practice, in order to maximum ensure the accuracy and reliability of the data of the chronic patients and the population of the endemic areas. This is assisted with cross-sectional survey of latent Keshan disease patients by cluster sampling, etiological (hair selenium) survey, and intervention survey. Cardiac molecular imaging for latent Keshan disease patients may explore the myocardial injuries, which is the important indirect proof of the existence of the etiology at micro level, and the characteristics of the injuries are helpful for early diagnosis, and beneficial to have Keshan disease enclosed in the definitions and classifications of cardiomyopathies proposed by the major international organizations. Based on the national actual need for prevention and control of Keshan disease, this study has the theoretical and methodological innovations in both disease surveillance of epidemiology and assessment of Keshan disease elimination by emphasizing multidiscipline permeation, population-based study and focusing on solving the scientific issues to be solved in sore need in the practice of Keshan disease prevention and control, is special for this country, prospective, the translational public health of the practice of Keshan disease prevention and control, and beneficial to keep a space internationally for Keshan disease in the fields of cardiovascular diseases research.

基本消除克山病是我国地方病防治规划的目标之一，现急需克山病消除的评价方法对最小病区单位的病情作出结论。本研究在宏观水平拟通过调查县医院、乡卫生院和村医生的综合方法，突出所用方法中科学性的优点，保证其可行性的基本要求，从而最大限度地保证慢克病例数据和病区人口数据的准确可靠。同时，辅以潜克调查、病因调查和防控措施调查。本研究在微观水平拟通过分子影像学检查探测潜克患者心脏异常改变，间接证明致病因子的存在，从而有助于早期诊断，并为将克山病纳入到主要的国际心肌病分类中提供依据。本研究从我国克山病防控工作的实际需要出发，注重学科渗透，以人群为基础，拟解决克山病消除评估中迫切需要解决的关键科技问题，在流行病学疾病监测和克山病消除评估两个领域形成了新的生长点，具有我国特色和前瞻性，是理论和方法的源头性创新，是转化公共卫生学在克山病防控实践中的体现，有益于保持我国克山病在国际心血管疾病研究领域占有一席之地。

《全国地方病防治规划（2011-2015年）》中关于克山病的防治目标是，消除克山病的病区县达到90%以上。因此，我国急需克山病的消除评估方法。本研究拟从宏观和微观两个水平评估克山病消除。宏观水平评估的内容包括五个方面，分别是慢型克山病，潜在型克山病，病区村、乡、县的人口，病因及危险因素，地方病防控机构及措施。微观水平评估包括三个方面，分别是心脏分子影像学特征、心肌组织损伤标志物和心力衰竭标志物。本调查在尚志市未检出急型、亚急型克山病病例，共确诊慢型克山病病例27例，患病率为1.2/万，自然慢型克山病13例，患病率为0.6/万，低于克山病消除评估标准5/万。重点调查点共检出潜在型克山病10例，患病率为2.5%，低于3.0%的控制标准，高于克山病消除评估标准90/万。重点调查点共有自然慢型克山病患者5例，患病率为3.4/万（5/14,862），低于克山病消除评估标准5/万。这些结果显示，尚志市克山病病情已经达到控制水平，接近但未达到消除水平。本研究建立了调查规模小，可用于县级水平克山病消除评估的方法，使克山病防控的实际问题转化成病情评估方法的生长点，具有源头性创新意义和我国特色，探索了慢性非传染性疾病评估的新理论和新方法，对其它地方病和慢性病的病情评估也有重要科学参考价值，有益于保持我国克山病防治研究在国际心血管病的研究领域中占有一席之地。