第一章 大骨节病流行特征 Chapter 1 Epidemiological characteristics of Kashin-Beck disease
【本章摘要】 大骨节病是一种地方性、多发性、变形性骨关节病。基本病变是发育过程中儿童四肢骺软骨、骺板软骨和关节软骨的变性与坏死以及继发性骨关节炎，严重者可致身材矮小畸形、终生残疾。大骨节病具有明显的局限性地域特征，仅分布在我国的黑龙江、吉林、辽宁、北京、河北、山东、河南、内蒙古、山西、陕西、甘肃、四川、青海和西藏等14 个省(直辖市、自治区)，延伸至俄罗斯贝加尔地区乌洛夫流域和朝鲜北部山区，世界其他地方没有大骨节病。大骨节病病区以自然村为单位呈灶状分布，病区村屯与非病区村屯相邻或相间。沟壑地带、浅山丘陵、河谷甸子、山间谷地等低洼潮湿地段的村屯发病最重，平原亦有发病，但相对较轻。20 世纪60～80 年代，大骨节病在时间分布上具有明显的年度波浪性，20 世纪90 年代后，大骨节病发病率逐年降低，只有轻微的“年度波动”, 2015 年全国临床检出率降至0.01%。大骨节病的人群特征是以病区所产小麦、玉米为主食的人群，若主食大米，即不患病。发病年龄主要在儿童、少年，成人中新发病例甚少。在重病区，发病年龄提前，两三岁即可发病，在轻病区发病年龄延后，可迟至十岁以后。大骨节病发病初期，只有X线改变，临床检查看不到明显体征，如不脱离病因，病情将逐渐加重，一两年后有的可出现干骺早期闭合，骨端严重破坏等改变。成年之后，不论当地人还是迁入者，因骨骺发育已经完成，不再出现短指畸形或侏儒体态。所以，临床病例都是幼年发病的后遗症。大骨节病没有种族易感性。
【Abstractofthischapter】Kashin-Beckdiseaseisregardedasanendemic, multiple and deformed osteoarthrosis disease.The basic pathological changes of KBD in growing children is the degeneration and necrosis of epiphysis cartilage, epiphyseal plate cartilage, articular cartilage as well as the secondary osteoarthritis, and most serious reaction can cause short stature, physicalmalformationandlife-timedisability.KBDwithevidentregionalcharacteristics,is only distributed in 14 provinces(autonomous regions and municipalities)in our country including Heilongjiang, Jilin, Liaoning, Beijing, Hebei, Shandong, Henan, Inner Mongolia,shanxi, Shannxi, Gansu, Sichuan, Qinghai and Tibet, and Extend to Transbaikal regions in Urov Valley in Russia and northern Korea mountains, while the other parts of the world do not have KBD.KBD is distributed in focal type and a natural village is a basic regional unit.Disease areas were located adjacent or interphase with non-disease areas.The incidence is higher in lowlying districts ranging over gully, hilly area, valley and basin, while the incidence is lower in plain area.The time distribution of KBD has changed wave upon wave annually from the 1960s to the 1980s, after the 1980s , the incidence of the disease showed a declining trend year by year, only a slight fluctuation of the year.The national clinical detection rate of KBD has declined to 0.01% in 2015.People in disease areas who use wheat and corn as the staple food have KBD, while people who eat rice mostly do not have KBD.Disease occurred mostly in children and teenagers, while adults almost do not have the disease.In serious disease areas,the disease occurred early in 2 or 3 years old, while in light disease areas, the disease occurred later after 10 years old.At the beginning of Kashin Beck disease, only the X-ray changes can be found and no obvious signs can be found through clinical examination.If the cause continues to exist, the disease condition will gradually increase.One or two years later early closing of the metaphyseal bone end and severe damage of bone end may appear on some patients.After adulthood, whether local people or immigrants, because the development of e-piphysis has been completed, could no longer suffer from brachydactylia or dwarf-like physical appearance.There is no racial susceptibility of KBD.
大骨节病是一种地方性、多发性、变形性骨关节病。其基本病变是发育过程中儿童四肢骺软骨、骺板软骨和关节软骨的变性与坏死及继发性骨关节炎，严重者可致身材矮小畸形、终生残疾。