Department of Epidemiology Public Health College of Harbin Medical University哈哈Department of Epidemiology Public Health College of Harbin Medical University第一节第一节 概述概述 (Introduction)第二节第二节 地方性碘缺乏病地方性碘缺乏病(Endemiciodinedeficiencydiseases)Department of Epidemiology Public Health College of Harbin Medical University第一节第一节 概概 述述Introduction地方病概念地方病概念地方病的判断依据及分类地方病的判断依据及分类我国主要的地方病我国主要的地方病几种主要地方病的流行特征几种主要地方病的流行特征预防策略与措施预防策略与措施Concept of endemic diseases CriteriaandclassificationofendemicdiseasesThemajorendemicdiseasesinChinaPrevalencecharacteristicsofseveralmajorendemicdiseasesPreventionstrategiesandmeasuresDepartment of Epidemiology Public Health College of Harbin Medical University一、地方病的概念一、地方病的概念Conceptofendemicdiseases地方病概念地方病概念p地方病也称地方性疾病。地方病也称地方性疾病。指在某些特定地区相对稳指在某些特定地区相对稳定并经常发生、不需从外定并经常发生、不需从外地输入的疾病。地输入的疾病。Whatwereendemicdiseases?FEndemicdiseaseshavebeendefinedas“aclassofdiseasesthatconstantlypresentinpeoplelivinginparticularareaswithoutimportedcasesfromexternalsources”Department of Epidemiology Public Health College of Harbin Medical University二、地方病的判断依据及分类二、地方病的判断依据及分类Criteriaandclassificationofendemicdiseases地方病的判断依据地方病的判断依据 该地区的居民任何民族其发该地区的居民任何民族其发病率病率 其他地区居住的相似人群，其他地区居住的相似人群，该病的发病频率该病的发病频率 ，甚至不，甚至不发病发病 CriteriaofendemicdiseaseFincidenceofthediseaseinanyethnicmayincreaseintheresidentsintheareaFsimilarresidentslivedinotherareashavethelowerincidence,orevennotoccurthediseaseDepartment of Epidemiology Public Health College of Harbin Medical University二、地方病的判断依据及分类二、地方病的判断依据及分类Criteriaandclassificationofendemicdiseases地方病的判断依据地方病的判断依据 迁入该地区的人经一段时间迁入该地区的人经一段时间后，其发病率和当地居民一后，其发病率和当地居民一致致人群迁出该地区后，发病率人群迁出该地区后，发病率 或患病症状减轻或自愈或患病症状减轻或自愈除人之外，当地的易感动物除人之外，当地的易感动物也可发生同样的疾病也可发生同样的疾病CriteriaofendemicdiseaseFwhoimmigratetheareaoveraperiodoftime,itsincidenceapproachesthatinlocalpopulationFthepeopleemigratethearea,theincidencewouldreduce,orsymptomsalleviateorself-healingFinaddition,thelocalanimalsarealsosusceptibletothesamediseaseDepartment of Epidemiology Public Health College of Harbin Medical University 地球化学性地方病地球化学性地方病 自然疫源性地方病自然疫源性地方病 与特定生产生活方式有与特定生产生活方式有 关地方病关地方病 病因未明地方病病因未明地方病 地方病的分类地方病的分类地方病的分类地方病的分类 ( (Classification of endemic diseases)GeochemistryendemicdiseasesNaturalfociendemicdiseaseparticularproductionandLifestyle-relatedendemicdiseasesEndemicdiseaseofunknownetiologyDepartment of Epidemiology Public Health College of Harbin Medical University地球化学性地方病地球化学性地方病 碘缺乏病碘缺乏病 饮水型地方饮水型地方性氟中毒性氟中毒 砷中毒砷中毒自然疫源性地方病自然疫源性地方病 血吸虫病血吸虫病 鼠疫鼠疫 布氏布氏杆菌病杆菌病GeochemistryendemicdiseasesIodinedeficiencydisease;drinkingwatertypefluorosisandarsenicpoisoningNaturalfociendemicdiseaseSchistosomiasis;plague;BrucellosisDepartment of Epidemiology Public Health College of Harbin Medical University与特定生产生活方式有与特定生产生活方式有关地方病关地方病 燃煤污染型氟中毒燃煤污染型氟中毒 饮茶型氟中毒饮茶型氟中毒 燃煤污染型砷中毒燃煤污染型砷中毒病因未明地方病病因未明地方病 克山病克山病 大骨节病大骨节病 趴子病趴子病 乌脚病乌脚病Particularproductionandlifestyle-relatedendemicdiseasesBurningcoalpollutedtypefluorosisDrinkingteatypefluorosisBurningcoalpollutedtypearsenicpoisoningEndemicdiseaseofunknownetiologyKeshandisease;Kaschin-Beckdisease;Pazhidisease;blackfootdiseaseDepartment of Epidemiology Public Health College of Harbin Medical University三、我国主要的地方病三、我国主要的地方病 纳入重点防治的地方病：纳入重点防治的地方病： 碘缺乏病碘缺乏病 地方性氟中毒地方性氟中毒 地方性砷中毒地方性砷中毒 克山病克山病 大骨节病大骨节病 鼠疫鼠疫 布鲁氏杆菌病布鲁氏杆菌病 血吸虫病血吸虫病Focusedendemicdiseasesofpreventionandcontrolincludes:IDDEndemicfluorosisEndemicarsenicpoisoningKeshandiseaseKaschin-BeckdiseasePlagueBrucellosisdiseaseSchistosomiasisdiseaseThemajorendemicdiseasesinChinaDepartment of Epidemiology Public Health College of Harbin Medical University表表28-1 28-1 全国全国8 8种主要地方病病区范围及病例数种主要地方病病区范围及病例数 Department of Epidemiology Public Health College of Harbin Medical University四、几种主要地方病的流行特征四、几种主要地方病的流行特征 地方性氟中毒地方性氟中毒 大骨节病大骨节病 克山病克山病 地方性砷中毒地方性砷中毒PrevalentcharacteristicsofseveralmajorendemicdiseasesEndemicfluorosisKaschin-BeckdiseaseKeshandiseaseEndemicarsenicpoisoningDepartment of Epidemiology Public Health College of Harbin Medical University( (一一) )地方性氟中毒地方性氟中毒( (地氟病地氟病) ) （Endemicfluorosis） 主要临床表现主要临床表现(The main clinical manifestations)(The main clinical manifestations)氟斑牙（氟斑牙（dentalfluorosis）氟骨症（氟骨症（skeletalflurosis） 定义定义 在特定的地理环境中发生的一种地球化学性疾病，在特定的地理环境中发生的一种地球化学性疾病，人体长期摄入过量氟而导致的全身慢性蓄积性中毒。人体长期摄入过量氟而导致的全身慢性蓄积性中毒。Ageochemicaldiseaseoccurredinaparticulargeographicalenvironment,forchronicsystemicaccumulatedpoisoningcausedbylong-termintakeofexcessivefluorideinhumanDepartment of Epidemiology Public Health College of Harbin Medical University氟斑牙氟斑牙 牙釉质形成期摄入高氟引起牙釉质形成期摄入高氟引起的的 表现为牙釉质白垩、着色或表现为牙釉质白垩、着色或缺损改变缺损改变 一旦形成，残留终生一旦形成，残留终生Dentalfluorosiscausedbyhighfluorideintaketheperformanceofenamelischalk,coloring,ordefectOnceformed,enamelformationwouldbeleftoverthefulllifeDepartment of Epidemiology Public Health College of Harbin Medical University氟斑牙氟斑牙DentalfluorosisDepartment of Epidemiology Public Health College of Harbin Medical University氟骨症氟骨症 SkeletalfluorosisDepartment of Epidemiology Public Health College of Harbin Medical University氟氟骨骨症症SkeletalfluorosisDepartment of Epidemiology Public Health College of Harbin Medical University 按氟的来源不同分为按氟的来源不同分为 饮水型饮水型 燃煤型燃煤型 饮茶型饮茶型 Dividedaccordingtodifferentsourcesoffluorine:DrinkingwatertypeBurningcoaltypeDrinkingteaType( (一一) )地方性氟中毒地方性氟中毒( (地氟病地氟病) ) （Endemicfluorosis）Department of Epidemiology Public Health College of Harbin Medical University地区分布地区分布 (Regionaldistribution)世界广世界广泛泛分布分布: : 中国、印度最为严重中国、印度最为严重国内国内 Distributioninworldwide:ChinaandIndiaarethemostseriousDomesticDepartment of Epidemiology Public Health College of Harbin Medical University饮饮茶茶型型氟氟中中毒毒病病区区分分布布Department of Epidemiology Public Health College of Harbin Medical University 该病的发生与季节年份无该病的发生与季节年份无明显相关明显相关 Theoccurrenceofthediseasehasnosignificantcorrelationwiththeseasonalandyear时间分布时间分布 (Timedistribution)氟斑牙氟斑牙 无明显的性别、种族差异无明显的性别、种族差异 婴幼儿症状较轻，主要表婴幼儿症状较轻，主要表现为白垩样改变现为白垩样改变DentalfluorosisNosignificantgenderandethnicdifferencesInfantsandyoungchildrensufferingfrommoderate,mainlyforthechalk-likechange人群分布人群分布 (Populationdistribution)Department of Epidemiology Public Health College of Harbin Medical University 氟斑牙（白垩样改变）氟斑牙（白垩样改变）Dentalfluorosis(chalk-likechange)Department of Epidemiology Public Health College of Harbin Medical University氟骨症氟骨症 主要发生在成年主要发生在成年1616岁以后，岁以后，特别是特别是3030岁以后岁以后 年龄年龄 患病率患病率 病情通常女性比男性严重病情通常女性比男性严重SkeletalfluorosisMainlyoccurredinadultsafter16yearsold,andespeciallyaftertheageof30,andtheprevalenceincreaseswiththeincreasedageConditionofillnessisusuallysevereinwomenthaninmen.人群分布人群分布 (Populationdistribution)Department of Epidemiology Public Health College of Harbin Medical University（二）大骨节病（二）大骨节病 （Kashin-Beckdisease） 一种地方性、多发性、变一种地方性、多发性、变形性骨关节病形性骨关节病主要病变是发育期儿童的主要病变是发育期儿童的关节透明软骨变性、坏死关节透明软骨变性、坏死及继发的骨关节炎，严重及继发的骨关节炎，严重者可导致矮小畸形，终生者可导致矮小畸形，终生残疾残疾 Itisaendemic,multiple,deformationosteoarthropathy.Primarylesiontochildreninadevelopmentalstagesisthearticularhyalinecartilagedegeneration,necrosisandsecondarybonearthritis,severecasescanleadtoshortstaturedeformities,permanentdisability.Department of Epidemiology Public Health College of Harbin Medical University大骨节病大骨节病Kashin-Beck disease变形性骨关节病变形性骨关节病Deformation osteoarthropathyDepartment of Epidemiology Public Health College of Harbin Medical University大骨节病大骨节病矮小畸形矮小畸形 Kashin-BeckdiseaseDwarfdeformityDepartment of Epidemiology Public Health College of Harbin Medical University大骨节病地区分布大骨节病地区分布ThegeographicaldistributionofKashin-BeckdiseaseDepartment of Epidemiology Public Health College of Harbin Medical University1.1.霜期早、秋雨大、粮食水霜期早、秋雨大、粮食水分高的次年多是大骨节病分高的次年多是大骨节病的高发年的高发年2.2.各病区多发季节有所不同，各病区多发季节有所不同，一般春季多发一般春季多发3.3.致病因子活跃的地方，四致病因子活跃的地方，四季都有新发病人季都有新发病人时间分布时间分布 (Time distribution)(Time distribution)1.Theearlyfrostyperiod,autumnlargeraininautumnwithhighmoistureoverthenextyearisahighincidenceofKashin-Beckdiseaseinyears2.Theseasonisdifferentfrommanywards,andthegeneralspring-prone.3.Incausativeagentactivearea,theincidenceofthisdiseasewillcouldbeseeninthefourseasons.Department of Epidemiology Public Health College of Harbin Medical University1.1.多发生于儿童和少年，多发生于儿童和少年，成人中新发病例极少成人中新发病例极少 2.2.未见明显的性别差异未见明显的性别差异3.3.民族间患病率差异取决民族间患病率差异取决于主食的粮食种类和生于主食的粮食种类和生活方式活方式1.Mostlyoccursinchildrenandadolescents,andveryfewnewcasesinadults,2.Nosignificantgenderdifferences3.Differencesintheprevalenceamongnationalitydependsoncategoriesofstaplefoodandlifestyle人群分布人群分布 (Population distribution)(Population distribution)Department of Epidemiology Public Health College of Harbin Medical University一种病因未明的、以心肌坏死为主要病理改变的一种病因未明的、以心肌坏死为主要病理改变的地方性心肌病。地方性心肌病。 （三）克山病（地方性心肌病）（三）克山病（地方性心肌病） （keshandisease）Akindofunknownetiology,endemiccardiomyopathythatthemainpathologicalchangesinheartisnecrosis.Department of Epidemiology Public Health College of Harbin Medical University克山病的克山病的病因学病因学地球化学说地球化学说生物病因学说生物病因学说TheetiologyofKeshandiseaseTheoryofgeochemicalhypothesisTheoryofbiologicalcausesDepartment of Epidemiology Public Health College of Harbin Medical University地区分布地区分布（Regionaldistribution）Department of Epidemiology Public Health College of Harbin Medical University年度多发年度多发 季节性高发季节性高发AnnualMulti-placeAhighincidenceofseasonal时间分布时间分布 (Time distribution)(Time distribution)Department of Epidemiology Public Health College of Harbin Medical University年龄年龄 生育期妇女和儿童为高生育期妇女和儿童为高发人群发人群性别性别 北方急型克山病女性发北方急型克山病女性发病比同龄男性多病比同龄男性多1 12 2倍以倍以上，高时可达上，高时可达4 47 7倍倍Age:womenofchildbearingageandchildrenarethehigh-riskpopulation.Gender:NorthKeshandiseaseincidenceinwomenisage12timeshigherthanitinmenwiththesameage,upto47times.人群分布人群分布 (Population distribution)(Population distribution)Department of Epidemiology Public Health College of Harbin Medical University职业职业 绝大多数是自产自给的农业人口绝大多数是自产自给的农业人口家庭集聚性家庭集聚性 克山病有家庭多发现象克山病有家庭多发现象民族民族 民族混居地区，若其生产、生活方式无相似则发病无明显差异民族混居地区，若其生产、生活方式无相似则发病无明显差异Occupation:Mostself-summary-grownagriculturalpopulation.Familyclustering:Keshandiseasehavethephenomenonofmultiple.National:iftheirproductionandwayoflifehavenosimilar,andtherearenosignificantdifferenceintheincidenceofthisdiseaseinethnicallymixedareas.人群分布人群分布 (Population distribution)(Population distribution)Department of Epidemiology Public Health College of Harbin Medical University居住在特定地理条件下居住在特定地理条件下的居民，通过饮水、空气和的居民，通过饮水、空气和食物长期摄入过量的砷而引食物长期摄入过量的砷而引起的以皮肤色素脱失、着色、起的以皮肤色素脱失、着色、角化及癌变为主的全身性慢角化及癌变为主的全身性慢性中毒性疾病。性中毒性疾病。 （四）地方性砷中毒（四）地方性砷中毒（地砷病）（地砷病）EndemicarsenicpoisoningTheresidentslivesinaspecificgeographicalconditions,throughdrinkingwater,airandlong-termintakeoffood,intakeanexcessiveamountofarsenic,causedtheskinpigmentationchange,keratosis,andcancer-basedsystemicchronictoxicillnesses.（四）地方性砷中毒（四）地方性砷中毒（地砷病）（地砷病）EndemicarsenicpoisoningDepartment of Epidemiology Public Health College of Harbin Medical University皮肤角化皮肤角化色素沉着色素沉着Skin KeratosisHyperpigmentationDepartment of Epidemiology Public Health College of Harbin Medical University地砷病的危害地砷病的危害手手/ /趾掌角化趾掌角化花肚皮花肚皮- -腹部色素沉着与脱失腹部色素沉着与脱失The hazard of endemic arsenicosisHand / toe palm keratosisFlower belly- abdominal pigmentation changeDepartment of Epidemiology Public Health College of Harbin Medical University皮肤癌皮肤癌Skin cancerDepartment of Epidemiology Public Health College of Harbin Medical University地区分布地区分布（Regional distributionRegional distribution）Department of Epidemiology Public Health College of Harbin Medical University该病没有多发季节和多发年该病没有多发季节和多发年 Thereisnotmultipleseasonsandmultipleyearstothisdisease.时间分布时间分布 (Time distribution)(Time distribution)Department of Epidemiology Public Health College of Harbin Medical University年龄分布年龄分布 任何年龄摄入过多的砷均可任何年龄摄入过多的砷均可患病患病 年龄年龄 该病的检出率该病的检出率 性别分布性别分布 调查结果不相一致，多数为调查结果不相一致，多数为男性男性 女性女性 Age distributionExcessive intake of arsenic at any age may be sick.The detection rate of the disease increases with the increased ageGender distributionSurvey results are not consistent, and the number of male beyond the Female In most cases.人群分布人群分布 (Population distribution)(Population distribution)Department of Epidemiology Public Health College of Harbin Medical University五、预防策略与措施五、预防策略与措施 预防策略与措施预防策略与措施 防治机构防治机构 监监 测测PreventionstrategiesandmeasuresPreventionstrategiesandmeasuresInstitutionsofpreventionandcontrolSurveillanceDepartment of Epidemiology Public Health College of Harbin Medical University（一）预防策略与措施（一）预防策略与措施地方病的预防与控制原则：地方病的预防与控制原则： 预防为主，兼顾救治预防为主，兼顾救治 政府领导、部门配合，政府领导、部门配合， 群众参与群众参与 可持续性可持续性PreventionstrategiesandmeasuresEndemicdiseasepreventionandcontrolprinciples:Focusingonpreventionandalsogiveconsiderationtoremedy.Governmentleading,departmentco-participatingandmassparticipation.SustainabilityDepartment of Epidemiology Public Health College of Harbin Medical University 碘缺乏病碘缺乏病 “ “全民食盐加碘全民食盐加碘” 克山病克山病 “ “采用综合性采用综合性措措施施”不同疾病防治措施不同疾病防治措施PreventivemeasuresfordifferentdiseasesFLodinedeficiencydiseaseNationalsaltiodizationFKeshandisease AdoptingintegratedmeasureaccordingtoetiologicalfactorDepartment of Epidemiology Public Health College of Harbin Medical University大骨节病大骨节病 “ “换粮、补硒、移民、换粮、补硒、移民、退耕还林还草退耕还林还草” ” 地方性氟中毒和地方性砷地方性氟中毒和地方性砷中毒中毒 “ “改水、改灶改水、改灶”不同疾病防治措施不同疾病防治措施PreventivemeasuresfordifferentdiseasesFKashin-Beckdisease“changinggrain,intakingSe,immigration,returningfarmlandtoforestandgrassFEndemicfluorosisandendemicarsenicpoisoningreformingwaterandchangingcookingstovesDepartment of Epidemiology Public Health College of Harbin Medical University （二）防治机构（二）防治机构Theinstitutionsofpreventionandcontrol地区地区国家国家省省县县NationalProvinceAreaCounty （二）防治机构（二）防治机构TheinstitutionsofpreventionandcontrolDepartment of Epidemiology Public Health College of Harbin Medical University卫生部卫生部国家国家中国疾控地方病控制中心中国疾控地方病控制中心全国鼠疫布病防治基地全国鼠疫布病防治基地寄生虫病预防控制所寄生虫病预防控制所EndemicDiseaseControlcenterofChineseCenterforDiseaseControlandPreventionNationalbaseforthepreventionandcontrolofBrucellosisandPlagueInstituteforthepreventionandcontrolofparasiticdiseasesNationalTheMinistryofHealth （二）防治机构（二）防治机构Theinstitutionsofpreventionandcontrol （二）防治机构（二）防治机构TheinstitutionsofpreventionandcontrolDepartment of Epidemiology Public Health College of Harbin Medical University省（区、市）省（区、市）地方病防治所地方病防治所省、市疾病控制中心地方病防治科省、市疾病控制中心地方病防治科Provinces(regionsandmunicipalities)InstituteforthepreventionandcontrolofendemicdiseaseEndemicdiseasedepartmentofprovincialandmunicipalCenterforDiseaseControlandprevention （二）防治机构（二）防治机构Theinstitutionsofpreventionandcontrol （二）防治机构（二）防治机构TheinstitutionsofpreventionandcontrolDepartment of Epidemiology Public Health College of Harbin Medical University县县乡乡 镇镇 县（旗）疾控中心地方病科县（旗）疾控中心地方病科乡镇卫生院乡镇卫生院County Countryside TownCounties (banners) CDC endemic DivisionTownship hospitals （二）防治机构（二）防治机构TheinstitutionsofpreventionandcontrolDepartment of Epidemiology Public Health College of Harbin Medical University病区地方病发病、患病区地方病发病、患病情况病情况 病区外环境状况病区外环境状况 防治措施落实情况防治措施落实情况 ThemorbidityandprevalenceofEndemicendemicdiseaseThestateoftheenvironmentoutsideendemicdeseaseTheimplementationofpreventionandcontrolmeasures（三）监测（三）监测 （surveillance）Department of Epidemiology Public Health College of Harbin Medical University52病因学病因学流行特征流行特征预防策略与措施预防策略与措施地方性甲状腺肿的分型、地方性甲状腺肿的分型、分度及诊断标准分度及诊断标准EtiologyEpidemiologicfeatureStrategiesandmeasuresTypes、degreesanddiagnosticstandardforendemicgoiter第二节第二节 地方性碘缺乏病地方性碘缺乏病IodinedeficiencydisordersDepartment of Epidemiology Public Health College of Harbin Medical University53碘缺乏病是由于自然环境碘缺碘缺乏病是由于自然环境碘缺乏造成机体甲状腺激素不足所乏造成机体甲状腺激素不足所表现的一组地方病的总称。包表现的一组地方病的总称。包括括 地方性甲状腺肿地方性甲状腺肿( (地甲肿地甲肿) )、地方性克汀病地方性克汀病( (地克病地克病) )、地方地方性亚临床克汀病性亚临床克汀病( (亚克汀亚克汀) )、由、由于碘缺乏引起的胎儿流产、早于碘缺乏引起的胎儿流产、早产、死产、先天畸形等。产、死产、先天畸形等。Iodinedeficiencydisordersareageneraltermforagroupofendemicdiseasesduetoenvironmentaliodinedeficiencyleadingtotheinsufficiencyofthyroidhormoneinthebody.Include:endemicgoiter,endemiccretinism,subclinicalcretinism,abortions,pretermbirth,stillbirths,andcongenitalanomaliesbecauseofiodinedeficiency.Department of Epidemiology Public Health College of Harbin Medical University54Iodinedeficiencydisorders地方性甲状腺肿地方性甲状腺肿EndemicgoiterDepartment of Epidemiology Public Health College of Harbin Medical University55Iodinedeficiencydisorders地方性甲状腺肿地方性甲状腺肿Endemicgoiter正正位位Department of Epidemiology Public Health College of Harbin Medical University56地方性克汀病地方性克汀病EndemiccretinismDepartment of Epidemiology Public Health College of Harbin Medical University57克克汀汀病病患患者者的的傻傻笑笑Cretinismpatientgiggle一代甲、二代一代甲、二代傻、三代四代傻、三代四代断根芽断根芽FirstgenerationFirstgenerationgoiter,goiter,secondgenerationsecondgenerationidiot,thirdandidiot,thirdandfourthenerationfourthenerationnooffspring.nooffspring.Department of Epidemiology Public Health College of Harbin Medical University58碘缺乏碘缺乏碘缺乏病的影响因素碘缺乏病的影响因素致甲状腺肿物质致甲状腺肿物质 营养因素营养因素 环境污染环境污染遗传因素遗传因素 IodinedeficiencyRiskfactorsforIDDGoitrogenoussubstanceNutritionalfactorsEnvironmentalpollutionHereditaryfactor一、病因学一、病因学 (Etiology)Department of Epidemiology Public Health College of Harbin Medical University59 地区分布地区分布 时间分布时间分布 人群分布人群分布GeographicaldistributionTemporaldistributionPopulationdistribution二、流行特征二、流行特征 EpidemiologyfeatureDepartment of Epidemiology Public Health College of Harbin Medical University60IDD是世界上分布最广、是世界上分布最广、受威胁人口最多的一种受威胁人口最多的一种地方病地方病IDD is the worldsmostwidelydistributedendemicdisease,andthelargest population areunderitsthreat.地区分布地区分布（Regionaldistribution）Department of Epidemiology Public Health College of Harbin Medical University61流行较重流行较重 亚洲的喜马拉雅山区亚洲的喜马拉雅山区 欧洲的阿尔卑斯和比里牛斯山欧洲的阿尔卑斯和比里牛斯山区区 南美的安第斯山区南美的安第斯山区 非洲的刚果河流域非洲的刚果河流域 大洋洲的巴布亚新几内亚大洋洲的巴布亚新几内亚 北美洲的五大湖盆地北美洲的五大湖盆地EpidemicseriouslyHimalayanregionsinAsiaAlpsandPyreneesinEuropeAndesinSouthAmericaCongoRiverBasininAfricaPapuaNewGuineainOceaniaGreatLakesinNorthAmerica地区分布地区分布（Regionaldistribution）Department of Epidemiology Public Health College of Harbin Medical University 全球共有全球共有2222亿人口（占全世界人口的亿人口（占全世界人口的38%38%）生活在缺碘地区）生活在缺碘地区Atotalof220millionpeopleworldwide(accountingfor38%oftheworldspopulation)liveiniodine-deficientregions. 我国是世界上我国是世界上IDD分布广泛、病情严重的国家之一分布广泛、病情严重的国家之一, ,主要流行主要流行 特征是山区多于平原，内陆多于沿海，乡村多于城市特征是山区多于平原，内陆多于沿海，乡村多于城市 ChinaisoneofthecountrieswhereIDDhavebeenwidelydistributedandseverelyprevalent,themainepidemiologicfeatureisthatmountainsaremorethanplains,inlandmorethancoastal,ruralmorethanurban.地区分布地区分布（Regionaldistribution）Department of Epidemiology Public Health College of Harbin Medical University图图28-2 28-2 世界碘缺乏病波及的国家世界碘缺乏病波及的国家Department of Epidemiology Public Health College of Harbin Medical University表表28-2 199428-2 1994、20002000年度中国碘缺乏病范围例数年度中国碘缺乏病范围例数Table28-2ScopeandcasesofIDDinChinafor1994and2000时间分布时间分布 (Time distribution)(Time distribution)Department of Epidemiology Public Health College of Harbin Medical University流行地区的人群任何年龄均可发病流行地区的人群任何年龄均可发病Peopleofanyageinendemicareascanbeill.5 5岁以下儿童发病较少，一般在青春发育期开始发岁以下儿童发病较少，一般在青春发育期开始发病，随着年龄病，随着年龄 患病率患病率 ， 4040岁以后逐渐岁以后逐渐Childrenunder5yearsofagehavealowincidenceofIDD,generallybeginningatpuberty.Prevalenceincreaseswithage,butprevalencedecreasesafter40yearsofagewithage.人群分布人群分布 (Population distribution)(Population distribution)Department of Epidemiology Public Health College of Harbin Medical University愈是病情严重的地区，甲状腺肿发病的年龄愈早愈是病情严重的地区，甲状腺肿发病的年龄愈早Themoreseriousconditionofthearea,theearliertheageofgoiter.1010岁以前男女患病率无显著差异岁以前男女患病率无显著差异 Thereisnosignificantdifferenceintheprevalencebetweenboysandgirlsbeforetheageof10.成人患病率女性成人患病率女性 男性男性, ,但重病区患病率性别差异小但重病区患病率性别差异小 Adultprevalencerateofwomenismorethanmen,butgenderdifferencesintheprevalenceofseriousIDDareaaresmall.人群分布人群分布 (Population distribution)(Population distribution)Department of Epidemiology Public Health College of Harbin Medical University监测监测掌握流行强度、流行趋势掌握流行强度、流行趋势评价干预措施的效果评价干预措施的效果为制定新的防治策略与措为制定新的防治策略与措施提供依据施提供依据 现况调查现况调查碘盐调查碘盐调查 病情调查病情调查 SurveillanceTomastertheepidemicstrength,epidemictendencyToevaluatetheeffectivenessofinterventionsToprovideabasisfornewcontrolandpreventionstrategiesandmeasuresCross-sectionalinvestigationdiodizedsaltsurveydiseasesurvey三、预防的策略与措施三、预防的策略与措施StrategiesandmeasuresDepartment of Epidemiology Public Health College of Harbin Medical University不加碘食盐不加碘食盐Non-iodized salt 加碘食盐加碘食盐iodized saltDepartment of Epidemiology Public Health College of Harbin Medical University碘盐调查碘盐调查以县为单位进行 合格碘盐的碘含量标准: 35 15mg/kg IodizedsaltsurveyThecountyasaunitQualifyingstandardsforiodinecontentofiodizedsalt:3515mg/kgDepartment of Epidemiology Public Health College of Harbin Medical University常用的统计学指标为常用的统计学指标为CommonlyusedstatisticalindicatorsCoverage rate of iodized saltThe qualified iodized salt rateDepartment of Epidemiology Public Health College of Harbin Medical UniversityDepartment of Epidemiology Public Health College of Harbin Medical UniversityGotier prevalenceGotier rateDepartment of Epidemiology Public Health College of Harbin Medical UniversityTypes、degreesanddiagnosticstandardforendemicgoiter 分型标准分型标准 分度标准分度标准 诊断标准诊断标准TypesstandardDegreesstandardDiagnosticstandard四、地方性甲状腺肿的分型、四、地方性甲状腺肿的分型、分度及诊断标准分度及诊断标准谢谢 谢谢 ！