卫生研究

综述了自1986年以来串珠镰刀菌素(MF)的克山病病因学说的研究进展,论证了 MF很可能是人类克山病致病因素的观点如下;(1)用 MF 饲喂小型猪产生的心肌病变和克山病病人心肌病变特点一致。(2)病区主粮玉米、小麦和大米中 MF 的污染率大都明显高于非病区同种粮。(3)发病特点与主粮中 MF 含量相关:MF 低含量的大米地区易感人群——儿童多发;剂量相对低的病型——亚急型多发。(4)粮食中自然污染 MF 的剂量低于动物急性中毒剂量近千分之一,可能是病区动物不发生克山病的原因,推测人类对 MF 的敏感性远比动物高。(5)流行病学调查观察到MF 与低硒同时存在的地区发生克山病。而粮中含 MF 的适硒地区北京和河北不发生克山病;四川南部低硒地区粮食中未检出 MF,该地区也不发生克山病。由此提出克山病病因假说为:非严格地区性特异因子(MF)+严格地区性条件因子(低硒)→地方性克山病的流行。

Keshan Disease is an endemic cardiomyopathy with unknown cause.It was prevalent in 17 provinces of China.The incidence of the disease used to be high up to 274 per 100000 per year in some endemic areas, and the death rate were 7.6%～34%.Moniliformin (MF) has been considered by some research workers as the main etiologic factor of Keshan Disease from the following points of view:(1) Animal models have been established successfully in mini-pigs.The characteristics of eardiomyopathy in the pigs were almost the same as that in Keshan Disease patients.(2) The rate of Moniliformin contamination of main cereals in Keshan Disease endemic areas were higher than the non-endemic areas.(3) MF contents in rice samples were lower than other ceresls.In the endemic areas where rice is the staple food,most patients (90%) were children and suffered from subacute type Keshan Disease.(4) MF content of cereals in the endemic areas were lower than one-thousandth of the acute poisoning doses for animals.This is the possibility that no Keshan Disease- like pathological changes observed in the local domestic animals and fowls.(5) The occurrence of Keshan Disease was associated with both MF and lower selenium content of cereals.The data from epidemiological studies showed that no patient was found in the areas where only one factor,either MF or low selenium,ex- isted.Based on the results mentioned above,it is considered that MF is probably the main factor and low se- lenium is the endemic conditioning factor for the occurrence of Keshan Disease.