地方病

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

2. 第一节 概述 (Introduction) 第二节 地方性碘缺乏病 (Endemic iodine deficiency diseases) 目 录

3. 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 endemic diseases • The major endemic diseases in China • Prevalence characteristics of several major endemic diseases • Prevention strategies and measures

4. 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 diseases that constantly present in people living in particular areas without imported cases from external sources”

5. 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 disease • incidence of the disease in any ethnic may increase in the residents in the area • similar residents lived in other areas have the lower incidence, or even not occur the disease

6. 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 disease • 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

7. 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 病因未明地方病 • 地方病的分类 (Classification of endemic diseases) • Geochemistry endemic diseases • Natural foci endemic disease • particular production and Lifestyle-related endemic diseases • Endemic disease of unknown etiology

8. 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 diseases • Iodine deficiency disease; drinking water type fluorosis and arsenic poisoning • Natural foci endemic disease • Schistosomiasis; plague ; Brucellosis

9. 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 diseases • Burning coal polluted type fluorosis • Drinking tea type fluorosis • Burning coal polluted type arsenic poisoning • Endemic disease of unknown etiology • Keshan disease; Kaschin-Beck disease; Pazhi disease; black foot disease

10. 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 The major endemic diseases in China Focused endemic diseases of prevention and control includes:  IDD        Endemic fluorosis        Endemic arsenic poisoning        Keshan disease         Kaschin-Beck disease        Plague        Brucellosis disease         Schistosomiasis disease

11. 表28-1 全国8种主要地方病病区范围及病例数

12. 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 • Kaschin-Beck disease • Keshan disease • Endemic arsenic poisoning

13. (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 environment , for chronic systemic accumulated poisoning caused by long-term intake of excessive fluoride in human

14. 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 intake • the performance of enamel is chalk, coloring, or defect • Once formed, enamel formation would be left over the full life

15. 氟斑牙 Dental fluorosis

16. 氟骨症 Skeletal fluorosis

17. Skeletal fluorosis 氟骨症

18. 按氟的来源不同分为 饮水型 燃煤型 饮茶型 (一)地方性氟中毒(地氟病)（Endemic fluorosis） • Divided according to different sources of fluorine: • Drinking water type • Burning coal type • Drinking tea Type

19. 世界广泛分布: 中国、印度最为严重 国内 地区分布 (Regional distribution) • Distribution in world wide : China and India are the most serious • Domestic

20. 饮茶型氟中毒病区分布

21. 时间分布 (Time distribution) The occurrence of the disease has no significant correlation with the seasonal and year 该病的发生与季节年份无明显相关 人群分布 (Population 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 fluorosis No significant gender and ethnic differences Infants and young children suffering from moderate, mainly for the chalk-like change

22. 氟斑牙（白垩样改变） Dental fluorosis (chalk-like change)

23. 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 人群分布 (Population distribution) Skeletal fluorosis Mainly occurred in adults after 16 years old, and especially after the age of 30, and the prevalence increases with the increased age Condition of illness is usually severe in women than in men.

24. （二）大骨节病 （Kashin-Beck disease） • It is a endemic, multiple, deformation osteoarthropathy. • 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. • 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

25. 大骨节病Kashin-Beck disease 变形性骨关节病 Deformation osteoarthropathy

26. 大骨节病 矮小畸形 Kashin-Beck disease Dwarf deformity

27. 大骨节病地区分布 The geographical distribution of Kashin-Beck disease

28. 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 Kashin-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.

29. 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 人群分布 (Population distribution) • Mostly occurs in children and adolescents, 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

30. 　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。　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 cardiomyopathy thatthe main pathological changes in heart is necrosis.

31. 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 hypothesis • Theory of biological causes

32. 地区分布（Regional distribution）

33. 　年度多发 　　 　季节性高发 时间分布 (Time distribution) • Annual Multi-place • A high incidence of seasonal

34. 年龄 生育期妇女和儿童为高发人群 性别 北方急型克山病女性发病比同龄男性多1～2倍以上，高时可达4～7倍 人群分布 (Population distribution) • 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.

35. 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 人群分布 (Population distribution) • 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 in ethnically mixed areas.

36. 　　　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。　　　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） （四）地方性砷中毒（地砷病） Endemic arsenic poisoning Endemic arsenic poisoning The residents lives in a specific geographical conditions, through drinking water, air and long-term intake of food, intake an excessive amount of arsenic, caused the skin pigmentation change, keratosis, and cancer-based systemic chronic toxic illnesses.

37. 色素沉着 皮肤角化 Hyperpigmentation Skin Keratosis

38. 地砷病的危害 The hazard of endemic arsenicosis 手/趾掌角化 Hand / toe palm keratosis 花肚皮-腹部色素沉着与脱失 Flower belly- abdominal pigmentation change

39. 皮肤癌 Skin cancer

40. 地区分布（Regional distribution）

41. 该病没有多发季节和多发年 时间分布 (Time distribution) • There is not multiple seasons and multiple years to this disease.

42. 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 人群分布 (Population distribution) Age distribution Excessive intake of arsenic at any age may be sick. 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.

43. 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 measures • Institutions of prevention and control • Surveillance

44. （一）预防策略与措施 Prevention strategies and measures • Endemic disease prevention and control principles: • Focusing on prevention and also give consideration to remedy. • Government leading, department co-participating and mass participation. • Sustainability • 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

45. 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 "

46. 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"

47. （二）防治机构 地区 县 国家 省 National Province Area County （二）防治机构 The institutions of prevention and control The institutions of prevention and control

48. 国家 （二）防治机构 （二）防治机构 The institutions of prevention and control The institutions of prevention and control 中国疾控地方病控制中心 Endemic Disease Control center of Chinese Center for Disease Control and Prevention 卫生部 全国鼠疫布病防治基地 National base for the prevention and control of Brucellosis and Plague National The Ministry of Health 寄生虫病预防控制所 Institute for the prevention and control of parasitic diseases

49. （二）防治机构 （二）防治机构 The institutions of prevention and control The institutions of prevention and control 地方病防治所 Institute for the prevention and control of endemic disease 省（区、市） Provinces (regions and municipalities) 省、市疾病控制中心地方病防治科 Endemic disease department of provincial and municipal Center for Disease Control and prevention

50. （二）防治机构 The institutions of prevention and control 县（旗）疾控中心地方病科 县 乡 镇 Counties (banners) CDC endemic Division 乡镇卫生院 County Countryside Town Township hospitals