1、,地方病,Endemic Diseases,哈尔滨医科大学流行病学教研室 Department of epidemiology ，Harbin Medical University,目 录,第一节 概述 (Introduction) 第二节 地方性碘缺乏病 (Endemic iodine deficiency diseases),第一节 概 述 Introduction,地方病概念 地方病的判断依据及分类 我国主要的地方病 几种主要地方病的流行特征 预防策略与措施,Concept of endemic diseases Criteria and classification of endemi
2、c diseasesThe major endemic diseases in ChinaPrevalence characteristics of several major endemic diseasesPrevention strategies and measures,一、地方病的概念 Concept of endemic diseases,地方病概念 地方病也称地方性疾病。指在某些特定地区相对稳定并经常发生、不需从外地输入的疾病。,What were endemic diseases?Endemic diseases have been defined as “a class of
3、 diseases that constantly present in people living in particular areas without imported cases from external sources”,二、地方病的判断依据及分类 Criteria and classification of endemic diseases,地方病的判断依据 该地区的居民任何民族其发病率 其他地区居住的相似人群，该病的发病频率 ，甚至不发病,Criteria of endemic diseaseincidence of the disease in any ethnic may
4、increase in the residents in the area similar residents lived in other areas have the lower incidence, or even not occur the disease,二、地方病的判断依据及分类 Criteria and classification of endemic diseases,地方病的判断依据 迁入该地区的人经一段时间后，其发病率和当地居民一致 人群迁出该地区后，发病率 或患病症状减轻或自愈 除人之外，当地的易感动物也可发生同样的疾病,Criteria of endemic dise
5、ase who immigrate the area over a period of time, its incidence approaches that in local population the people emigrate the area, the incidence would reduce, or symptoms alleviate or self-healing in addition, the local animals are also susceptible to the same disease,地球化学性地方病自然疫源性地方病 与特定生产生活方式有 关地方病
6、 病因未明地方病,地方病的分类 (Classification of endemic diseases),Geochemistry endemic diseasesNatural foci endemic diseaseparticular production and Lifestyle-related endemic diseasesEndemic disease of unknown etiology,地球化学性地方病 碘缺乏病 饮水型地方性氟中毒 砷中毒 自然疫源性地方病 血吸虫病 鼠疫 布氏杆菌病,Geochemistry endemic diseasesIodine deficie
7、ncy disease; drinking water type fluorosis and arsenic poisoning Natural foci endemic diseaseSchistosomiasis; plague ; Brucellosis,与特定生产生活方式有关地方病 燃煤污染型氟中毒 饮茶型氟中毒燃煤污染型砷中毒 病因未明地方病 克山病 大骨节病 趴子病 乌脚病,Particular production and lifestyle-related endemic diseasesBurning coal polluted type fluorosisDrinking
8、tea type fluorosisBurning coal polluted type arsenic poisoning Endemic disease of unknown etiologyKeshan disease; Kaschin-Beck disease; Pazhi disease; black foot disease,三、我国主要的地方病,纳入重点防治的地方病：碘缺乏病 地方性氟中毒地方性砷中毒 克山病大骨节病 鼠疫布鲁氏杆菌病 血吸虫病,Focused endemic diseases of prevention and control includes: IDD End
9、emic fluorosis Endemic arsenic poisoning Keshan disease Kaschin-Beck disease Plague Brucellosis disease Schistosomiasis disease,The major endemic diseases in China,表28-1 全国8种主要地方病病区范围及病例数,四、几种主要地方病的流行特征,地方性氟中毒大骨节病克山病地方性砷中毒,Prevalent characteristics of several major endemic diseases,Endemic fluorosis
10、Kaschin-Beck diseaseKeshan diseaseEndemic arsenic poisoning,(一)地方性氟中毒(地氟病) （Endemic fluorosis）,主要临床表现(The main clinical manifestations) 氟斑牙（dental fluorosis） 氟骨症（skeletal flurosis）,定义 在特定的地理环境中发生的一种地球化学性疾病，人体长期摄入过量氟而导致的全身慢性蓄积性中毒。,A geochemical disease occurred in a particular geographical environmen
11、t , for chronic systemic accumulated poisoning caused by long-term intake of excessive fluoride in human,氟斑牙牙釉质形成期摄入高氟引起的表现为牙釉质白垩、着色或缺损改变一旦形成，残留终生,Dental fluorosis caused by high fluoride intakethe performance of enamel is chalk, coloring, or defect Once formed, enamel formation would be left over t
12、he full life,氟斑牙,Dental fluorosis,氟骨症,Skeletal fluorosis,氟骨症,Skeletal fluorosis,按氟的来源不同分为饮水型 燃煤型 饮茶型,Divided according to different sources of fluorine:Drinking water typeBurning coal typeDrinking tea Type,(一)地方性氟中毒(地氟病) （Endemic fluorosis）,地区分布 (Regional distribution),世界广泛分布:中国、印度最为严重 国内,Distributi
13、on in world wide : China and India are the most serious Domestic,饮茶型氟中毒病区分布,该病的发生与季节年份无明显相关,The occurrence of the disease has no significant correlation with the seasonal and year,时间分布 (Time distribution),氟斑牙 无明显的性别、种族差异 婴幼儿症状较轻，主要表现为白垩样改变,Dental fluorosisNo significant gender and ethnic differences
14、Infants and young children suffering from moderate, mainly for the chalk-like change,人群分布 (Population distribution),氟斑牙（白垩样改变）,Dental fluorosis (chalk-like change),氟骨症 主要发生在成年16岁以后，特别是30岁以后年龄 患病率病情通常女性比男性严重,Skeletal fluorosisMainly occurred in adults after 16 years old, and especially after the age
15、of 30, and the prevalence increases with the increased ageCondition of illness is usually severe in women than in men.,人群分布 (Population distribution),（二）大骨节病（Kashin-Beck disease）,一种地方性、多发性、变形性骨关节病 主要病变是发育期儿童的关节透明软骨变性、坏死及继发的骨关节炎，严重者可导致矮小畸形，终生残疾,It is a endemic, multiple, deformation osteoarthropathy.
16、Primary lesion to children in a developmental stages is the articular hyaline cartilage degeneration, necrosis and secondary bone arthritis, severe cases can lead to short stature deformities, permanent disability.,大骨节病 Kashin-Beck disease,变形性骨关节病 Deformation osteoarthropathy,大骨节病 矮小畸形,Kashin-Beck d
17、isease,Dwarf deformity,大骨节病地区分布,The geographical distribution of Kashin-Beck disease,1.霜期早、秋雨大、粮食水分高的次年多是大骨节病的高发年 2.各病区多发季节有所不同，一般春季多发 3.致病因子活跃的地方，四季都有新发病人,时间分布 (Time distribution),The early frosty period, autumn large rain in autumn with high moisture over the next year is a high incidence of Kashi
18、n-Beck disease in years The season is different from many wards, and the general spring-prone. In causative agent active area, the incidence of this disease will could be seen in the four seasons.,1.多发生于儿童和少年，成人中新发病例极少 2.未见明显的性别差异 3.民族间患病率差异取决于主食的粮食种类和生活方式,Mostly occurs in children and adolescents,
19、and very few new cases in adults, No significant gender differences Differences in the prevalence among nationality depends on categories of staple food and lifestyle,人群分布 (Population distribution),一种病因未明的、以心肌坏死为主要病理改变的地方性心肌病。,（三）克山病（地方性心肌病） （keshan disease）,A kind of unknown etiology, endemic cardi
20、omyopathy that the main pathological changes in heart is necrosis.,克山病的病因学,地球化学说 生物病因学说,The etiology of Keshan disease,Theory of geochemical hypothesisTheory of biological causes,地区分布（Regional distribution）,年度多发 季节性高发,Annual Multi-place A high incidence of seasonal,时间分布 (Time distribution),年龄 生育期妇女和
21、儿童为高发人群 性别 北方急型克山病女性发病比同龄男性多12倍以上，高时可达47倍,Age: women of childbearing age and children are the high-risk population. Gender: North Keshan disease incidence in women is age 1 2 times higher than it in men with the same age, up to 4 7 times.,人群分布 (Population distribution),职业 绝大多数是自产自给的农业人口 家庭集聚性 克山病有家庭
22、多发现象 民族 民族混居地区，若其生产、生活方式无相似则发病无明显差异,Occupation: Most self-summary-grown agricultural population. Family clustering: Keshan disease have the phenomenon of multiple. National: if their production and way of life have no similar, and there are no significant difference in the incidence of this disease
23、in ethnically mixed areas.,人群分布 (Population distribution),居住在特定地理条件下的居民，通过饮水、空气和食物长期摄入过量的砷而引起的以皮肤色素脱失、着色、角化及癌变为主的全身性慢性中毒性疾病。,（四）地方性砷中毒（地砷病）,Endemic arsenic poisoning,The residents lives in a specific geographical conditions, through drinking water, air and long-term intake of food, intake an excessi
24、ve amount of arsenic, caused the skin pigmentation change, keratosis, and cancer-based systemic chronic toxic illnesses.,（四）地方性砷中毒（地砷病）,Endemic arsenic poisoning,皮肤角化,色素沉着,Skin Keratosis,Hyperpigmentation,地砷病的危害,手/趾掌角化,花肚皮-腹部色素沉着与脱失,The hazard of endemic arsenicosis,Hand / toe palm keratosis,Flower
25、belly- abdominal pigmentation change,皮肤癌,Skin cancer,地区分布（Regional distribution）,该病没有多发季节和多发年,There is not multiple seasons and multiple years to this disease.,时间分布 (Time distribution),年龄分布 任何年龄摄入过多的砷均可患病年龄 该病的检出率 性别分布 调查结果不相一致，多数为男性女性,Age distribution,Excessive intake of arsenic at any age may be s
26、ick.,The detection rate of the disease increases with the increased age,Gender distribution,Survey results are not consistent, and the number of male beyond the Female In most cases.,人群分布 (Population distribution),五、预防策略与措施,预防策略与措施防治机构监 测,Prevention strategies and measures,Prevention strategies and
27、measuresInstitutions of prevention and controlSurveillance,（一）预防策略与措施,地方病的预防与控制原则：预防为主，兼顾救治政府领导、部门配合，群众参与可持续性,Prevention strategies and measures,Endemic disease prevention and control principles: Focusing on prevention and also give consideration to remedy.Government leading, department co-participa
28、ting and mass participation.Sustainability,碘缺乏病 “全民食盐加碘”克山病 “采用综合性措施”,不同疾病防治措施,Preventive measures for different diseases,Lodine deficiency disease “ National salt iodization “Keshan disease“ Adopting integrated measure according to etiological factor “,大骨节病 “换粮、补硒、移民、退耕还林还草” 地方性氟中毒和地方性砷中毒 “改水、改灶”,不
29、同疾病防治措施,Preventive measures for different diseases,Kashin-Beck disease “changing grain, intaking Se, immigration, returning farmland to forest and grass“Endemic fluorosis and endemic arsenic poisoning “reforming water and changing cooking stoves“,（二）防治机构,The institutions of prevention and control,（二
30、）防治机构,The institutions of prevention and control,卫生部,中国疾控地方病控制中心,全国鼠疫布病防治基地,寄生虫病预防控制所,Endemic Disease Control center of Chinese Center for Disease Control and Prevention,National base for the prevention and control of Brucellosis and Plague,Institute for the prevention and control of parasitic disea
31、ses,National,The Ministry of Health,（二）防治机构,The institutions of prevention and control,（二）防治机构,The institutions of prevention and control,省（区、市）,地方病防治所,省、市疾病控制中心地方病防治科,Provinces (regions and municipalities),Institute for the prevention and control of endemic disease,Endemic disease department of pro
32、vincial and municipal Center for Disease Control and prevention,（二）防治机构,The institutions of prevention and control,（二）防治机构,The institutions of prevention and control,县 乡 镇,县（旗）疾控中心地方病科,乡镇卫生院,County Countryside Town,Counties (banners) CDC endemic Division,Township hospitals,（二）防治机构,The institutions o
33、f prevention and control,病区地方病发病、患病情况 病区外环境状况 防治措施落实情况,The morbidity and prevalence of Endemic endemic disease The state of the environment outside endemic desease The implementation of prevention and control measures,（三）监测 （surveillance）,52,病因学 流行特征 预防策略与措施 地方性甲状腺肿的分型、分度及诊断标准,Etiology Epidemiologic
34、 feature Strategies and measures Types、degrees and diagnostic standard for endemic goiter,第二节 地方性碘缺乏病 Iodine deficiency disorders,53,碘缺乏病是由于自然环境碘缺乏造成机体甲状腺激素不足所表现的一组地方病的总称。包括 地方性甲状腺肿(地甲肿)、地方性克汀病(地克病)、地方性亚临床克汀病(亚克汀)、由于碘缺乏引起的胎儿流产、早产、死产、先天畸形等。,Iodine deficiency disorders are a general term for a group o
35、f endemic diseases due to environmental iodine deficiency leading to the insufficiency of thyroid hormone in the body. Include: endemic goiter, endemic cretinism , subclinical cretinism, abortions, preterm birth, stillbirths, and congenital anomalies because of iodine deficiency.,54,Iodine deficienc
36、y disorders,地方性甲状腺肿Endemic goiter,55,Iodine deficiency disorders,地方性甲状腺肿Endemic goiter,正位,56,地方性克汀病 Endemic cretinism,57,克汀病患者的傻笑 Cretinism patient giggle,一代甲、二代傻、三代四代断根芽First generation goiter, second generation idiot, third and fourth eneration no offspring.,58,碘缺乏 碘缺乏病的影响因素 致甲状腺肿物质 营养因素 环境污染 遗传因素
37、,Iodine deficiency Risk factors for IDD Goitrogenous substance Nutritional factors Environmental pollution Hereditary factor,一、病因学 (Etiology),59,地区分布时间分布人群分布,Geographical distributionTemporal distributionPopulation distribution,二、流行特征 Epidemiology feature,60,IDD是世界上分布最广、受威胁人口最多的一种地方病,IDD is the worl
38、ds most widely distributed endemic disease, and the largest population are under its threat.,地区分布（Regional distribution）,61,流行较重亚洲的喜马拉雅山区 欧洲的阿尔卑斯和比里牛斯山区南美的安第斯山区非洲的刚果河流域大洋洲的巴布亚新几内亚 北美洲的五大湖盆地,Epidemic seriously Himalayan regions in AsiaAlps and Pyrenees in EuropeAndes in South AmericaCongo River Basin
39、 in AfricaPapua New Guinea in OceaniaGreat Lakes in North America,地区分布（Regional distribution）,全球共有22亿人口（占全世界人口的38%）生活在缺碘地区A total of 220 million people worldwide (accounting for 38% of the worlds population) live in iodine-deficient regions.,我国是世界上IDD分布广泛、病情严重的国家之一,主要流行 特征是山区多于平原，内陆多于沿海，乡村多于城市 China
40、 is one of the countries where IDD have been widely distributed and severely prevalent, the main epidemiologic feature is that mountains are more than plains, inland more than coastal, rural more than urban.,地区分布（Regional distribution）,图28-2 世界碘缺乏病波及的国家,表28-2 1994、2000年度中国碘缺乏病范围例数 Table 28-2 Scope a
41、nd cases of IDD in China for1994 and 2000,时间分布 (Time distribution),流行地区的人群任何年龄均可发病People of any age in endemic areas can be ill. 5岁以下儿童发病较少，一般在青春发育期开始发病，随着年龄 患病率 ， 40岁以后逐渐Children under 5 years of age have a low incidence of IDD, generally beginning at puberty. Prevalence increases with age, but pre
42、valence decreases after 40 years of age with age.,人群分布 (Population distribution),愈是病情严重的地区，甲状腺肿发病的年龄愈早The more serious condition of the area, the earlier the age of goiter. 10岁以前男女患病率无显著差异There is no significant difference in the prevalence between boys and girls before the age of 10. 成人患病率女性男性,但重病区
43、患病率性别差异小Adult prevalence rate of women is more than men, but gender differences in the prevalence of serious IDD area are small.,人群分布 (Population distribution),监测 掌握流行强度、流行趋势 评价干预措施的效果 为制定新的防治策略与措施提供依据 现况调查 碘盐调查 病情调查,Surveillance To master the epidemic strength , epidemic tendency To evaluate the ef
44、fectiveness of interventions To provide a basis for new control and prevention strategies and measures Cross-sectional investigation diodized salt survey disease survey,三、预防的策略与措施 Strategies and measures,不加碘食盐 Non-iodized salt,加碘食盐iodized salt,碘盐调查 以县为单位进行 合格碘盐的碘含量标准: 35 15mg/kg,Iodized salt survey
45、The county as a unitQualifying standards for iodine content of iodized salt: 35 15mg/kg,常用的统计学指标为 Commonly used statistical indicators,Coverage rate of iodized salt,The qualified iodized salt rate,Gotier prevalence,Gotier rate,Types、degrees and diagnostic standard for endemic goiter,分型标准分度标准诊断标准,Types standard Degrees standard Diagnostic standard,四、地方性甲状腺肿的分型、分度及诊断标准,谢 谢 ！,
