ABSTRACT
Objective To measure the serum selenium levels in patient with Keshan disease(KSD)and in healthy controls in Shandong,Sichuan and Inner Mongolia KSD areas,to monitor the long-term dynamic changes of hair and serum selenium levels in Shandong KSD areas,and to provide scientific basis for preventing KSD.Methods A cross-sectional survey was carried out in KSD areas of Shandong,Sichuan and Inner Mongolia in 2009.The research subjects which come from KSD areas were 77 cases and 63 healthy controls from Shandong;35 patients and 36 healthy controls from Sichuan;and 17 patients and 18 healthy controls from Inner Mongolia.Additional 33 healthy people from Jinan city were selected as controls of non-KSD areas.Blood and hair samples were collected and selenium levels were measured by 2,3-diaminonaphthalene fluorescence spectrometry.Retrospective method was used to analyze the hair and serum selenium data collected between 1976 and 2004 in Shandong KSD areas.and these data were eompard with the data of 2009 to observe the long-term dynamic changes.Results ① The serum selenium levels of KSD patients in Shandong and Inner Mongolia were significantly lower than that of healthy subjects of KSD areas[(0.0773±0.0113)vs(0.0895±0.0256),(0.0347±0.0107)vs(0.0469±0.0161),t=3.52,3.87,all P<0.01].No significant difference was found between KSD patients and healthy people in Sichuan[(0.0792±0.0162)vs(0.0774±0.0103),t=0.55,P>0.05].②The serum selenium levels of KSD patients in Shandong,Sichuan and Inner Mongolia KSD areas were lower than that of non-KSD area[(0.0988±0.0231)mg/L,q=6.74,5.83,19.47,all P<0.01].The serum selenium levels of healthy people in Sichuan and Inner Mongoha KSD areas were significantly lower than that of non-KSD area(q=6.68,16.36,all P<0.01).The serum selenium levels of healthy controls in Inner Mongolia were lower than that of in Shandong and Sichuan(q=13.63,14.74,13.62,1.46,all P<0.01).③From 1976 to 2009,the hair and serum selenium levels of Shandong resident were increased 1.68 times(0.343/0.128-1)for hair and 0.98 times(0.091/0.046-1)for serum,respectively.But there was no significant difference between the average growth rate of hair and serum selenium levels(χ2=1.38,P>0.05).Conclusions ①The hair and serum selenium levels of KSD patients are lower than that of healthy controls in non-KSD area.②The serum selenium levels of Shandong,Sichuan and Inner Mongolia are different between KSD patients and healthy controls in the diseased areas.③The hair and serum selenium data of Shandong resident show an upward vend over the past 30 years.We suggest to continue the comprehensive measures of adding selenium in KSD areas.
ABSTRACT
Objective To observe the incidence and clinical characteristics of chronic Keshan disease in recent years, and to provide evidence for diagnosis of the disease. Methods From March to August 2009, 163 patients with chronic Keshan disease were chosen from Shandong, Sichuan, Inner Mongolia and Cansu. Of these patients, 62 cases were from Shandong, 34 cases from Sichuan, 37 cases from Inner Mongolia, and 30 cases from Gansu. All of the subjects underwent detailed natural history of the disease, careful physical examination and electrocardiogram (ECG), X-ray chest radiography and cardiac ultrasound examination. The incidence and clinical features were analyzed. Results Adults accounted for 98.8%(161/163) and children for 1.2%(2/163) in 163 cases of chronic Keshan disease, with an average age of 45.8 years. Slow onset accounted for 62.6%(102/163), other types that evolved into chronic-type accounted for 37.4%(61/163). Low blood pressure( 116.5/72.4 mmHg),often with cardiac function grade Ⅱ accounted for 65.6%(107/163). Common symptoms were: palpitation[86.5%(141/163)], asthma [76.7% (125/163)], fatigue[76.1%(124/163)], precordial discomfort [54.6% (89/163)], dizziness[50.3%(82/163)], edema of lower limbs[44.8%(73/163)], and anorexia[38.0%(62/163)]. Common signs were: low-weak first heart sound[66.9%(109/163)], heart enlargement[64.4%(105/163)], apical pulse dispersion[42.3%(69/163)], arrhythmia[40.5%(66/163)], hepatomegalia[39.3%(64/163)], systolic murmur [25.2%(41/163)], and edema[20.9%(34/163)]. Abnormal ECG detection rate was 93.9%(153/163), with common types followed by ST-T changes[ST-T changes, ST segment changes, Tchange, 36.2%(59/163)], ventricular premature [occasional and frequent ventricular premature, 26.4% (43/163)], complete right bundle branch block [25.8% (42/163)], atrial fibrillation[19.0%(31/163)], and atrioventricular conduction block[8.6%( 14/163)]. X-ray results showed that significant and moderate heart enlargement were common, accounting for 73.4%( 105/143), followed by mild enlargement of 25.2%(36/143). Color doppler ultrasound examination results showed that the atrio-ventricular cavity diameter increased, followed by left ventricular end-systolic diameter increased[81.3%(52/64)], left ventricular end-diastolic diameter increased[65.6%(42/64)], left atrial enlargement[51.6%(33/64)], right atrial enlargement [43.8%(28/64)], and right ventricular enlargement[32.8%(21/64)]. Left ventricular wall and interventricular septum thinning accounted for 15.6%( 10/64) and 7.8%(5/64), respectively. Conclusions In recent years, most cases of chronic Keshan disease occur as natural chronic type, and at older age at onset with low blood pressure.Main clinical features of the disease are cardiac enlargement, inadequate tissue perfusion, and venous stasis performance caused by cardiac decompensation. Correct diagnosis of chronic Keshan disease can be made based on these clinical features.