目的掌握云南省克山病病情现状和消长趋势,科学评估防控效果。方法在11个县(市、区)进行克山病病例搜索,由各监测县专业人员搜索县级医疗机构内科、儿科、急诊科近3年登记在册的全部心肌疾病病例,确定疑似克山病病例,按照《克山病诊断标准》对疑似病例进行诊断核实;每个监测县根据病例搜索结果,选取病例较多的2个病区乡(镇),在每个选中病区乡(镇)选取病例较多的1个病区村作为监测点,对监测点居民进行临床查体和心电图描记,可疑克山病患者拍摄胸部正位X线片和彩色超声心动图检查,按照《克山病诊断标准》进行诊断。结果在11个县(市、区)进行克山病病例搜索,共搜获心肌疾病病例8972例,疑似克山病35例,诊断慢型克山病5例。在搜索出的5例慢型克山病病例中,女性(4例)多于男性(1例),慢型克山病病人集中在55~64岁年龄段(3/5)。在11个县(市、区)22个村进行克山病重点监测,共监测9077人,检出克山病34人,总检出率为0.37%,其中检出慢型克山病3例,检出率0.03%,检出潜在型克山病31例,检出率0.34%,急型和亚急型未检出。在重点监测检出的34例克山病病例中,女性(22例)多于男性(12例)。潜在型克山病病例集中在45~54岁年龄段(9/31)及3~14岁年龄段(8/31),慢型克山病病例集中在35~44岁年龄段(1/3)、45~54岁年龄段(1/3)及55~64岁年龄段(1/3)。共检查心电图9077人,心电图异常1527人,异常率为16.8%。拍摄了40例2m后前位X线胸部正位片,心胸比例≤0.50的23例(23/40),0.51~0.55的8例(8/40),0.56~0.60的8例(8/40),≥0.61的1例(1/40)。结论克山病病例搜索结果表明,云南省克山病病区仍有慢型克山病病人存在,以中老年居多;克山病重点监测结果表明,云南省克山病病情处于平稳低发势态,克山病检出率较低,潜在型克山病主要以中年及儿童为主,慢型克山病主要以中老年为主。值得注意的是潜在型克山病检出率3~14岁年龄段占25.81%(8/31),说明克山病致病因子仍然活跃,对克山病病区儿童危害较大。 Objective To understand the status of Keshan disease in Yunnan Province and its trend of growth and decline, and to evaluate the effect of prevention and control by scientifically. Methods The Keshan disease cases were searched in 11 counties (cities and districts), and all the county specialists searched all the cases of myocardial diseases registered in the medical, internal medicine, pediatric and emergency departments of the county level for nearly 3 years to determine the suspected Keshan disease Cases, in accordance with the “Keshan disease diagnostic criteria” for the diagnosis and verification of suspected cases; each monitoring county based on case search results, select more cases of 2 ward townships (towns), in each selected ward township (town) Select one of the more cases of ward village as a monitoring point for the residents at the monitoring point for physical examination and electrocardiography, patients with suspected Keshan X-ray film and chest X-ray and color echocardiography, according to “Keshan disease Diagnostic criteria ”for diagnosis. Results Keshan disease cases were searched in 11 counties (cities and districts), 8972 cases of myocardial disease, 35 cases of suspected Keshan disease and 5 cases of chronic Keshan disease were detected. Among the 5 cases of chronic Keshan disease found in the study, there were more women (4 cases) than men (1 case) and patients with chronic Keshan disease (55-54 years) (3/5). In 11 counties (cities, districts) 22 villages Keshan disease focus monitoring, a total of 9077 people were detected, Keshan disease was detected 34 people, the total detection rate was 0.37%, of which 3 cases of chronic Keshan disease were detected , The detection rate was 0.03%, 31 cases of latent Keshan disease were detected, the detection rate was 0.34%, acute and sub-acute type were not detected. Among the 34 cases of Keshan disease detected by the key surveillance, women (22 cases) were more than men (12 cases). The cases of latent Keshan disease were concentrated in the age group of 45-54 years (9/31) and the age group of 3-14 years (8/31). The cases of chronic Keshan disease were concentrated in the age group of 35-44 (1/3 ), 45-54 years old (1/3) and 55-64 years old (1/3). A total of 9077 people checked electrocardiogram, electrocardiogram anomaly 1527 people, the abnormal rate was 16.8%. A total of 40 patients (23/40) with chest X-ray of less than 0.50 after 2 m, 8 patients (8/40) at 0.51-0.55 and 8 patients (0.5% ), One case of ≥0.61 (1/40). Conclusion The results of Keshan disease case search showed that there are still patients with chronic Keshan disease in Keshan disease area of ​​Yunnan province, most of them are middle-aged and elderly patients. The key surveillance results of Keshan disease indicate that the condition of Keshan disease in Yunnan province is in a state of steady and low- , Keshan disease detection rate is low, the underlying Keshan disease mainly middle-aged and children, chronic Keshan disease mainly in the elderly. It is worth noting that the detection rate of latent Keshan disease is 25.81% (8/31) in the age group of 3 to 14 years old, indicating that the pathogenic factor of Keshan disease is still active, which is harmful to children in Keshan disease area.