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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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Objective To observe the electrocardiogram changes of threatened crowds in Keshan disease (KSD) endemic area in Shandong province. Methods In 2008,inhabitants from 21 villages of Zoucheng,Sishui,Tengzhou, Yishui, Pingyi, Wulian, Juxian and Qingzhou regions were selected as subjects undergoing electrocardiogram. No less than 100 people were chosen from each village and the examination rate was not lower than 85%. Results Among the 3378 inhabitants investigated,460 cases showed abnormal electrocardiogram and the total incidence of abnormal electrocardiogram was 13.62% (460/3378). The relatively high incidence was T-wave changes,QRS low voltage and ST-T changes,the detection rate being respectively 2.69% (91/3378), 1.92% (65/3378) and 1.72% (41/3378). The highest incidence of abnormal electrocardiogram (26.76%,55/213),the intermediate(21.50%,43/200) and the lowest(5.50%,12/218) was respectively found in Pingyi,Qingzhou and Sishui. Conclusions The threatened crowds in KSD endemic area in Shandong province are still in a state of high abnormal electrocardiogram detection,and electrocardiogram is of great value in the evaluation of KSD patients.
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Objective To observe the curative effect of captopril and metoprolol in the treatment of chronic Keshan disease (CKD). Methods One hundred and ninty-five patients with CKD chosen from Juxian, Wulian, Yishui, Pingyi, Sishui and Zoucheng in Shandong Province were randomly assigned to control group, captopril group and metoprolol group according to NYHA cardiac functional grading. All cases were given diuretics, digitalis and vasodilating agents as routine treatment. On this basis, captopril and metoprolol was administered in captopril group and metoprolol group respectively. After 12 months of follow-up visit, the causes of cardiac death, hospitalization status and the changes of heart size, electrocardiogram, blood pressure and heart rate were all observed. Results It was found that the mortality of captopril group and metoprolo] group was 4.76% (3/63), 5.00% (3/60) respectively, both lower than the control group 10.61%(7/66). But this difference had no statistically significance(P=0.39). Besides, the hospitalization days of each year in captopril group and metoprolol group was respectively (19.12± 20.35) and(18.86±21.52)days, much more reduced than in the control group[(21.45±21.74)days, q=3.17, 3.38, P<0.05]. The detection rate of cardiothoracic ratio decreased in captopril group and metoprolol group [45% (27/60) and 40.4% (23/57)] After treatment showed more pronounced amelioration than the control group [18.6% (11/59), χ2=9.51,6.59, all P<0.0125], still the detection rate of cardiomegaly and invariability had no significant difference among three groups (χ2=2.50,4.75, all P>0.05). The elimination coefficient of ectopic rhythm in metoprolol group [56.5% (13/23)] was pronounced higher than the control group and captopril group [23.8% (5/21), 22.7% (5/22)], but differences had no statistically significance(P=0.0358,0.0331, all P>0.0125). Significant differences were found in systolic blood pressure(SBP), diastolic blood pressure(DBP) and heart rate(HR) in three groups prior and post-treatment(F=47.51,44.23,80.66, all P<0.01). The interaction of therapy and treatment time had influence on SBP and HR (F=3.19,37.44, all P<0.05), but had no influence on DBP(F=2.21, P> 0.05). There was no difference in SBP, DBP or HR among three groups before treatment(F=0.28,0.57,1.80, all P>0.05). After treatment, SBP and DBP in captopril group, metoprolol group and the control group[(109.0±10.9), (112.2±12.8), (114.7±13.2)mm Hg, (69.3±7.2), (72.1±9.5), (73.3±9.3)mm Hg] were all lowered compared with pre-treatment[ (117.1±13.4), (119.0±14.4), (117.6±14.1)mm Hg and (74.2±10.2), (76.3±10.8), (75.4±11.1)mm Hg, t=4.79,4.47,2.08,5.12, 4.32,2.15, all P<0.05]. HR was reduced in metoprolol group, being [(66.2±7.7), (75.9±11.5)times/min] before and after treatment(t=10.81, P<0.01), while it remained unchanged in captopril group and control group[(70.6±8.0), (72.6±10.5) times/min and (71.9±10.4), (73.8± 12.2)times/min, t=1.77,1.74, all P>0.05]. After treatment, both SBP and DBP of captopril group were significantly lower than that in the control group (q=3.52,3.56, all P<0.05); HR was reduced in metoprolol group, lower than that in captopril group and control group(q=5.44,3.73, all P<0.01). Conclusions Having a tendency of depressing mortality, captopril and metoprolol can reverse or delay myocardial remodeling and reduce admission rate in a safe,reliable and economic way, and are worth to be widely used in the treatment of chronic Keshan disease.
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<p><b>OBJECTIVE</b>To observe the serial changes of condition and related factors of Keshan disease (KSD) and provide the scientific basis for disease control and further research.</p><p><b>METHODS</b>The villages in KSD epidemic area of Juxian, Yishui, Pingyi, Zoucheng counties were selected. Since 1990, every five-year was counted as a stage. For the first to third stage, 3-14 year-old residents and over 14 year-old suspicious patients were selected as surveillance subjects. And in the fourth stage, all residents were selected as surveillance subjects. The same group of surveillance subjects in each stage were observed consecutively for 5 years. Surveillance contents included physical checkup, electrocardiogram (ECG) and Xray. At the same time, the selenium (Se) concentration in hair, wheat, corn and sweet potato was measured. The economic income and grain availability were also investigated.</p><p><b>RESULTS</b>Totally, 14,510 cases were visited during 18 years. The incidence of KSD was 3.02% in the first stage, 2.31% in the second stage, 3.57% in the third stages and 3.65% in the fourth stage. Totally, 14,510 cases were examined by ECG, 809 cases showed the abnormal ECG and the total incidence of abnormal ECG was 5.49%. The incidence of abnormal ECG was 3.52% -5.24% from 1990 to 2004 but was 10.97%-10.91% from 2005 to 2007. 732 of hair samples, 701 of wheat samples, 615 of corn samples and 643 of sweet potato samples were collected and the Se concentration was determined by the fluorescent method. Se levels in hair samples had increased (P < 0.05) year by year but Se levels in food have not changed significantly. The economic income and grain availability had increased gradually from 535.8 yuan and 254.6 kg per person in 1990 to 2968.0 yuan and 602.0 kg per person in 2007.</p><p><b>CONCLUSION</b>The condition of KSD was in a stable situation in Shandong Province. Related factors improvement should be an important environmental condition.</p>
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Cardiomyopathies , Epidemiology , China , Epidemiology , Electrocardiography , Hair , Chemistry , Incidence , Nutritional Status , SeleniumABSTRACT
Objective To screen the arsenic content situation of drinking water in lower reaches of Yellow River and survey the amount of threatened people drinking high arsenic water and the condition of endemic arsenism.Methods Four counties of Yuncheng,Jiaxiang,Dongchangfu and Boxing were selected to colleft the water samples by CroOSS-sectional survey method.The water arsenic content wag determined by semi-quantitative rapid kit.All water samples having arsenic were re-determined by atomic fluorescence spectrometry.And the nurober of threatened people who drinking high arsenic water were investigated.Results In 4765 water wells screened,303 water samples had contained arsenic,arsenic content of 35 samples Was≥0.030 mg/L,12 samples were exceeding the international standard (arsenic content≥0.050 ms/L),they distributed in 3 counties of Dongchangfu,Yuncheng and Jiaxiang.The residents drinking water wells of arsenic content≥0.030 mg/L were surveyed by epidemiological investigation.And in the 28 villages 13 032 residents and 11 Bu8picious patient8 wlere checked out.Conclusion The wells with excesive water arsenic content are existing in the lower reaches of Yellow River and people suspicious of endemic arsenism need to be further identified.
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Objective To investigate the current condition of Keshan disease(KD), and inner and outer environmental selenium (Se) levels in Shandong Province, in order to provide scientific evidence for the research, prevention and control work. Methods Inhabitants from 20 villages of 8 counties in KD endemic areas were selected as subjects undergoing general physical examination and electrocardiogram (ECG). Suspicious cases were followed up by chest X-ray radiographs. Meanwhile the Se contents in hair, wheat, corn and sweet potato were measured. Results Ninety one patients with KD, including 82 with latent KD and 9 with chronic KD, were screened out of 2613 inhabitants. The total incidence of KD was 3.48% (91/2613), while the incidence of latent and chronic KD was 3.14%(82/2613) and 0.34%(9/2613) respectively. No new cases of acute or sub-acute KD were found. A total of 368 abnormal ECCs were discovered and the rate of abnormal ECG detected among surveyed population was 14.08% (368/2613). Out of 113 suspects who took X-ray, 57 cases had cardiomagaly. In 217 samples of hair, 228 samples of wheat, 214 samples of corn and 190 samples of sweet potato that were collected, the Se contents were determined by fluorescence. The average Se content in hair, wheat,corn and sweet potato were (0.406±0.090), (0.026±0.009), (0.023±0.010), (0.024±0.006)mg/kg respectively. Conclusions Current condition of KD in Shandong Province remains relatively stable. Se content was increased in the hair, nearly achieving the level in normal areas, but remains low in food.