摘要目的 调查影响四川省阿坝州大骨节病病情的相关因素,寻找有效防控措施.方法 采用病例对照研究的方法,选取2009、2010年金川、马尔康县大骨节病监测点8～ 15岁儿童右手X线正位片阳性者作为病例组,同时以X线正位片阴性且与病例组人员同性别、同年龄、同村庄、同学校1∶1配对儿童作为对照组,通过问卷方式调查相关防控措施落实情况.采集调查对象发样,用氢化物原子荧光光谱法检测发硒,统计分析影响大骨节病病情的相关因素.结果 共调查64人,病例组和对照组各32人.所在学校主食结构(每周食用米饭次数)比较,差异无统计学意义(Z=-0.695,P＞0.05),副食结构比较,差异无统计学意义(肉类:Z=-1.270,P＞0.05；奶品:Z=-0.300,P＞0.05)；发硒水平比较,差异无统计学意义[(0.27±0.09)、(0.26±0.10)mg/kg,x2=0.094,P＞0.05]；所在家庭人均年收入比较,差异无统计学意义(Z=-1.079,P＞ 0.05)；所在家庭主食结构(大米:x2=1.024；面食x2=1.636)、副食结构(肉类:Z=-1.231;奶品:Z=-0.603)比较,差异无统计学意义(P均＞ 0.05).病例组中骨端阳性者主食面食的家庭比例(84.6％,11/13)高于对照组(59.4％,19/32,x2=8.477,P＜ 0.05),而主食大米的家庭比例(61.5％,8/13)明显低于对照组(81.3％,26/32,x2=5.529,P＜0.05).结论 补硒未能显示防病作用,彻底换粮可能是消除大骨节病危害的有效途径.

abstractsObjective To investigate relevant factors to Kaschin-Beck disease(KBD),and to find out effective countermeasures to the disease.Methods Children aged 7-16 whose right hands X-ray films were positive or negative examined in the year 2009 and 2010 from KBD monitoring stations of Jinchuan and Maerkang Counties were selected.A case-control study was applied; questionnaires were used to investigate the implementing effectiveness of controlling measures,and relevant factors to controlling of KBD were analyzed.Results A total of 64 students were recruited in this research,and both the case and control groups consist of 32 students,respectively.The students staple structure (number of times of weekly consumption of rice,Z =-0.695,P ＞ 0.05),non-staple food structure (Meat:Z =-1.270,P ＞ 0.05; Milk:Z =-0.300,P ＞ 0.05),hair selenium levels [(0.27 ± 0.09),(0.26 ± 0.10)mg/kg,x2 =0.094,P ＞ 0.05] were not significantly different.Where the per capita household income,the difference was not.statistically significant (Z =-1.079,P ＞ 0.05); staple food structure (Rice:x2=1.024,P＞ 0.05; Pasta:x2=1.636,P＞ 0.05) and non-staple food structure(Meet:Z=-1.231,P＞ 0.05; Milk:Z =-0.603,P ＞ 0.05).In bone-end-positive group,the proportion of families who often took homegrown pasta as main foods (84.6％,11/13) was higher than that of control group (59.4％,19/32,x2 =8.477,P ＜ 0.05),however the proportion of families who often took rice as main foods was significantly lower than that of the control group (bone-end-positive group:61.5％,8/13 ; control group:81.3％,26/32,x2 =5.529,P ＜ 0.05).Conclusions Selenium has failed to show the effect of preventing KBD,thoroughly replacing homegrown-grain may be an effective way of eliminating KBD.