摘要
目的 调查2017年和2020年西藏自治区昌都市学龄儿童大骨节病X线阳性病例现况,为防治策略的制定提供流行病学依据.方法 选择西藏自治区昌都市大骨节病历史病情最严重的洛隆、边坝、八宿县作为目标地区,以7～12岁在校儿童作为研究对象,调查2017年和2020年西藏自治区昌都市学龄儿童大骨节病X线检出病例情况,对受试者摄右手正位X线片,依据大骨节病诊断标准(WS/T207-2010)进行X线诊断.由两位经验丰富的研究者分别独立阅片,通过加权Kappa值和百分比一致率评估组内及组间一致性.计算2017年和2020年大骨节病的X线检出率,采用二分类变量logistic回归分析构建大骨节病X线病例的危险因素预测模型.结果 2017年昌都市7～12岁儿童中接受基线横断面调查者5 711人(平均年龄9.2岁,女性占比48.0％),其中大骨节病X线阳性者28例,年龄性别标准化患病率为0.527％;2020年接受二次横断面调查的受试者共计6 771人(平均年龄9.3岁,女性占比49.5％),其中大骨节病X线阳性者9例,年龄性别标准化患病率为0.134％.Logistic回归分析结果表明较高的年龄[OR=2.439,95％CI(1.299,4.580),P=0.006]、女性[OR=8.157,95％CI(1.016,65.528),P=0.048]是大骨节病X线阳性的独立危险因素.而在西藏地区高海拔的大前提下,较高的居住地海拔是其保护因素[OR=0.995,95％CI(0.990,0.999),P=0.032].结论 西藏自治区昌都市学龄儿童的大骨节病X线检出阳性率处于极低水平并呈下降趋势,2020年已经达到了历史病区的标准.考虑到目前无阳性体征患儿,说明当地大骨节病已基本消除.
Abstract
Objective This study aimed to explore the status of radiological Kashin-Beck disease(KBD)among school-aged children in Chamdo City,Tibet,through a 3-year monitoring survey,providing epidemiological evidence for prevention and control strategies.Methods The target areas for this study were Luolong,Bianba,and Basu counties in Chamdo City,Tibet Au-tonomous Region,identified as having the most severe historical cases of KBD.Children aged 7-12 years attending school were en-rolled as study subjects.Anteroposterior X-ray films of the right-hand were taken,and radiological diagnoses were made based on the"Diagnosis of Kashin-Beck Disease"criteria(WS/T 207-2010).Two experienced researchers independently reviewed the X-rays,and intra-and inter-group consistency were assessed using weighted Kappa values and percentage agreement.Cross-section-al surveys were conducted in 2017 and 2020 to describe the X-ray detection rates of KBD,and logistic regression analysis was em-ployed to construct a predictive model of risk factors for radiological KBD cases.Results In 2017,a total of 5,711 children aged 7-12 years in Chamdo City,Tibet,participated in the baseline cross-sectional survey(average age 9.2 years,48.0％female),with 28 cases of radiological KBD.The age-and gender-standardized prevalence rate was 0.527％.In 2020,6,771 participants(average age 9.3 years,49.5％female)underwent a second cross-sectional survey,with 9 cases of radiological KBD and a standardized prev-alence rate of 0.134％.Logistic regression analysis indicated that older age[OR=2.439,95％CI(1.299,4.580),P=0.006]and fe-male gender[OR=8.157,95％CI(1.016,65.528),P=0.048]were independent risk factors for radiological KBD cases.Conversely,higher residential altitude,under the premise of Tibet's high altitude,was a protective factor[OR=0.995,95％CI(0.990,0.999),P=0.032).Conclusion The radiographically positive detection rate of KBD among school-aged children in Chamdo City,Tibet Au- tonomous Region,is at an extremely low level and showing a declining trend,reaching the historical standard in 2020.Considering the absence of positive signs in affected children,it suggests that local KBD has been effectively eliminated.
NETL
NSTL
维普
万方数据