摘要
目的 观察近年来发病的慢型克山病的流行与临床特点,为克山病诊断提供依据.方法 2009年3-8月在山东、四川、内蒙古及甘肃省（自治区）选择163例慢型克山病患者,其中山东省62例、四川省34例、内蒙古37例、甘肃省30例.对所有患者进行详细询问病史、仔细体格检查以及心电图（ECG）、X线及心脏超声检查,分析发病特点与临床特征.结果 163例慢型克山病患者中,成人占98.8%（161/163）,儿童占1.2%（2/163） 平均年龄45.8岁 男女之比为1：1.33.自然慢型占62.6%（102/163）,其他类型演变为慢型占37.4%（61/163）.血压偏低（116.5/72.4 mmHg）,多为心功能Ⅱ级,占65.6%（107/163）.常见症状依次为心慌[心慌及活动后心慌,86.5%（141/163）]、气喘[气喘及活动后气喘,76.7%（125/163）]、乏力[76.1%（124/163）]、心前区不适[54.6%（89/163）]、头晕[50.3%（82/163）]、下肢水肿[44.8%（73/163）]、食欲减退[38.0%（62/163）].常见体征依次为第一心音低弱[66.9%（109/163）]、心界增大[64.4%（105/163）]、心尖搏动弥散[42.3%（69/163）]、心律不齐[40.5%（66/163）]、肝肿大[39.3%（64/163）]、收缩期杂音[25.2%（41/163）]、水肿[下肢及全身水肿,20.9%（34/163）].异常ECG检出率为93.9%（153/163）,常见异常ECG依次为ST-T改变[ST-T改变、ST段改变及T波改变,36.2%（59/163）]、室性早搏[偶发及频发室性早搏,26.4%（43/163）]、完全性右束支传导阻滞[25.8%（42/163）]、心房颤动[19.0%（31/163）]、房室传导阻滞[8.6%（14/163）].X线胸片显示心脏重度及中度扩大占73.4%（105/143）,轻度扩大占25.2%（36/143）.彩色多普勒超声检查结果表明房室内径增大,检出率由高到低依次为左心室收缩末期内径增大[81.3%（52/64）]、左心室舒张末期内径增大[65.6%（42/64）]、左心房内径增大[51.6%（33/64）]、右心房内径增大[43.8%（28/64）]、右心室内径增大[32.8%（21/64）]、左心室壁变薄[15.6%（10/64）]、室间隔变薄[7.8%（5/64）].结论 近年来慢型克山病发病主要为自然慢型,发病年龄后移,血压偏低,临床特点主要为心脏增大及心功能失代偿引起的组织灌注不足和静脉淤血表现,此特点为慢型克山病诊断提供可靠依据.
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.
出处
《中国地方病学杂志》
CAS
CSCD
北大核心
2010年第4期446-451,共6页
Chinese Jouranl of Endemiology
基金
基金项目：国家自然科学基金（30872192）
山东省科技发展项目（2008GGlo002053）
