[Keshan disease--a review from the aspect of history and etiology].
[Keshan disease--a review from the aspect of history and etiology].
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DOI：
10.1265/jjh.56.641
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发表时间：
2002-01
期刊：
影响因子：
--
通讯作者：
Yunbao Liu;M. Chiba;Y. Inaba;M. Kondo
中科院分区：
文献类型：
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作者：
Yunbao Liu;M. Chiba;Y. Inaba;M. Kondo
目的克山病是中国东北克山地区的一种地方性心肌病。1935年发现了第一个病人。该病以血液循环障碍、内皮细胞异常和心肌坏死为特征。我国科学家认为硒缺乏是一个主要因素。然而，确切的病因至今尚未明确。政府决定将亚硒酸钠应用于种植作物，疾病的发病率急剧下降。然而，少数病例仍以慢性或潜伏型发生。本文从历史和现状两个方面对克山病进行了回顾。方法通过文献调查，对克山病的病因、病理变化、临床表现等观点进行总结。结果目前流行病学调查显示，克山病在我国14个省、自治区均有大面积发生，主要集中在农村。临床和病理研究证实，克山病是一种独立的地方性心肌病，由生物学和地质学因素共同作用而引起。发病率最高的年龄是15岁以下的男孩和育龄妇女。有几种假设：急性一氧化碳中毒、病毒感染、营养不良或缺硒。第一个目前不被认为是原因。有人指出：1961年，中国科学院克山病研究所对克山病流行区的饮食与克山病关系进行了研究，发现克山病流行区居民饮食习惯比较单一，所谓“偏食”（食物种类有限）可能与克山病的发病有关。1973年在全国克山病病区进行了大规模的自然环境调查。结果表明，克山病的发病与病区特殊的自然环境有关，克山病的病因受到营养、生物、地质和化学（缺硒）因素的有力支持。另一方面，1981年发现克山病患者血清中抗科萨基病毒的抗体水平高于正常人。这一事实推测克山病的病因与病毒感染有关。但克山病的临床和病理表现为何与其他疾病如特发性心肌病相似，目前尚难以解释。克山病的病因有待进一步研究。
OBJECTIVE Keshan disease is an endemic cardiomyopathy found in Keshan, north-east China. The first patient was identified in 1935. This disease is characterized by a blood circulation disorder, endocardium abnormality and myocardium necrosis. Selenium (Se) deficiency is thought to be a major factor by Chinese scientists. However, the exact etiology has not been clarified up to now. The government decided to apply sodium selenite to growing crops, and the incidence of the disease decreased dramatically. However, a few cases still occur as chronic or latent types. This paper reviews Keshan disease from a historical aspect and also the present situation. METHODS We made a reference survey and summarised the etiology, pathological changes, clinical manifestation, and other views of Keshan disease. RESULT So far, epidemiological surveys have shown that Keshan disease occurs in large areas in 14 provinces in China, mainly in the countryside. It has been confirmed by clinical and pathological studies that Keshan disease is an independent endemic myocardial disease caused by biological and geological factors. The largest prevalence age rates are boys under 15 years old and women of childbearing age. There are several hypotheses; acute carbon monoxide poisoning, virus infection, malnutrition, or selenium deficiency. The first is not currently believed to be the cause. The following was pointed out; studies on the relationship between diet and the endemic areas of Keshan disease in 1961, where the food custom of the local residents was relatively simple and a so-called "one-sided diet" (eating a limited variety of food) might be related to the incidence of Keshan disease. In 1973, large-scale investigations on the natural environments were performed in the endemic areas of Keshan disease in the whole country. As a result, it was reported that there was a relationship between the incidence of Keshan disease and the special natural environment in the endemic areas and the cause of Keshan disease was strongly supported by nutritional, biological, geological and chemical (selenium deficiency) factors. In 1981, on the other hand, it was found that the levels of antibodies against Coxsackie virus were higher in the serum of Keshan disease patients than of normal subjects. This fact supposed that the cause of Keshan disease was related to a virus infection. However, it is difficult to explain why the clinical and pathological manifestations of Keshan disease are similar to those of other diseases, e.g. idiopathic dilatational myocardial disease. Further research should be performed on Keshan disease to clarify the etiology.