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云南不明原因猝死重点病区人群心电图调查研究

ISSN号：1006-4028
期刊名称：《预防医学情报杂志》
时间：0
分类：R541[医药卫生—心血管疾病;医药卫生—临床医学;医药卫生—内科学] R181.23[医药卫生—流行病学;医药卫生—公共卫生与预防医学]
作者机构：[1]云南省地方病防治所,云南大理671000, [2]中国疾病预防控制中心中国现场流行病学培训项目,北京100050, [3]北京阜外心血管病医院,北京100037, [4]大姚县疾病预防控制中心,云南大姚675400, [5]鹤庆县疾病预防控制中心,云南鹤庆671500, [6]腾冲县疾病预防控制中心,云南腾冲679100, [7]云县疾病预防控制中心,云南云县675800
相关基金：云南省科技厅攻关项目（2004NG13）;卫生部科学研究基金项目（WKJ-2003-01-05）;科技部国家重大科技攻关资助项目（2003BA712A11-01）

作者：王跃兵[1], 申涛[2], 施国庆[2], 杨林[1], 赵溯[1], 陆步来[2], 李兆祥[1], 马琳[1], 张健[3], 陆荣安[4], 李灿彪[5], 李胜国[6], 宋科强[7], 黄文丽[1], 曾光[2]

关键词：云南不明原因猝死, 心电图, 心肌酶, Yunnan unexpected sudden death, Electrocardiogram （ECG）, Myocardial enzyme

中文摘要：

目的研究云南不明原因猝死重点病区人群的健康状况，探索其与云南不明原因猝死发病之间的关系，为病因学研究、制定有效的干预和临床救治措施提供科学依据。方法选择两个反复发病村、一个新发聚集性病例村和一个对照村作为调查点，连续观察测量研究对象的心电图、血液生化、血压、心率、呼吸频率、体温、身高和体重等健康指标，对比分析各类人群各项指标之间的差异。结果重点病区人群心电图以“U波异常、T波异常、传导阻滞、ST-T改变、Q-T间期延长”等心肌损伤型表现为主，其中“U波异常”检出率高达50．9％，明显区别于对照人群“窦性心律不齐、电轴左偏、低电压”等归属为“正常”的心电图改变类型；大部分相同类型的心电图检出率重点病区人群明显高于对照人群，重点病区人群的BMI超重和消度检出率低于对照人群。结论重点病区人群的心电图改变较为复杂和严重，存在较高的发生恶性心律失常的潜在风险，且反复发病村人群较新发聚集性病例村人群存在的心脏健康风险更高；“Q-T间期延长”可作为发生恶性心律失常的预警指标，心电图和心肌酶可联合作为云南不明原因猝死病区人群的特异性临床检查、检测指标，是制定病例定义和临床救治措施的重要参考指标。

英文摘要：

Objective To study health condition of crowds in focal epidemic area of Yunnan unexpected sudden death （YUSD）, search for the relationship between the condition and onset of YUSD, in order to offer effective intervention and cure measures. Methods Two villages with repeatedly occurred YUSD cases, one village with only once occurred YUSD case and one control village were selected as the survey sites, to carry out continuously survey of electrocardiogram （ECG）, blood biochemical indexes, blood pressure, heart rate, respiratory rate, temperature, height and weight of the key crowd and control crowd. Then, difference in each index among different crowds was analyzed comparatively. Results The ECG result of key crowd focused on myocardial damage types. There were abnormal U wave, abnormal T wave, con- duction block, ST-T alteration and Q-T interval prolongation. The detection rate of abnormal U wave reached up to 50.9%. On the contrary, to the control crowd those mainly were normal types of sinus arrhythmia, left axis deviation and low voltage. For most ECG types, the detection rate of key crowd obviously higher than that of the control crowd. And the detection rates of BMI obesity and thin were lower than those of the control crowd. Conclusions The ECG result of key crowd is more complex and serious than that of the control crowd, with potential risk of occurring malignant arrhythmia, and heart health risk in the crowd is higher in villages with repeatedly occurred YUSD cases than in villages with new aggregation cases. Q-T interval prolongation can be taken as the early-warning index of occurrence of malignant arrhythmia. ECG and myo- cardial enzyme should be considered as the specific clinical examination index to the crowds in YUSD areas, and also the important reference index for drawing up case definition and clinical treatment measures.

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