克山病的病因与流行机制  

Causes of Keshan disease and prevailing mechanism

作　　者：杨建伯[1] 

机构地区：[1]哈尔滨医科大学中国疾病预防控制中心地方病控制中心大骨节病防治研究所,150001

出　　处：《中国地方病学杂志》2004年第4期293-296,共4页Chinese Jouranl of Endemiology

基　　金：国家自然科学基金资助项目(30271151)

摘　　要：目的报告关于克山病病因的研究结果。方法病因流行病学方法;病理学和实验病理方法;文献学方法。结果克山病病因流行病学研究所见克山病的病因是特定自然、社会、生活条件下形成的黄绿青霉毒素(citreoviridin,CIT)中毒;传播途径是病区产的粮食与饮水无关;玉米、小米等粮食传病,小麦不传或少传;粮食在湿冷环境中被青霉菌污染并产生CIT毒素。克山病的病理、病理化学、实验病理研究所见从亚急型克山病以及解剖可见,心肌的早期病理改变是线粒体功能与结构的破坏。ATPases同琥珀酸脱氢酶等系列心肌酶的活性被明显抑制、改变、比例失衡,同时线粒体的结构也出现了相应的改变。心肌线粒体肿胀,嵴膜破坏,线粒体膜融合、消失。CIT毒素对心肌线粒体的作用机制CIT是ATP的类似物,可与ATPases相作用而降低其活性。由此开始,逐步发展、变化,最终导致克山病特异的心肌坏死。结论上述的3个方面基本是相互独立的各自发现,但可紧密的相互认证,相互支持,支持克山病的致病因子可能是青霉菌污染粮食产生的黄绿青霉毒素。Objective To report the studies on the cause of Keshan disease. Methods Epidemiologic pathologic and experiment pathologic methods and literaturologic method were used to find out some new related facts from other scientific fields. Results The epidemiologic finds-the cause of Keshan disease was CIT intoxication happened in some local areas with specific natural, social and life style conditions; the route of transmission was cereals produced in endemic areas and no relationship with drinking water was found maize and wheat had the ability to transfer the cause of CIT, but rice did not. Under the wet-cold condition, cereals infected by penicillums may produce citreoviridin in great quantity. The pathologic characters, detected by the observation of sub acute Keshan diseases, were mitochondrial damages in the cells of myocardium. Some results published in magazines of agricultrue and chemical species reported that the CIT toxin is a factor potently affect ATPases ctivity of myocardium cells. All these facts mentioned above had been found in 1970s by different authors indepedently in different country.Conclusions Based on the facts the author think that the cause of Keshan diseases is CIT intoxication, if no oppositiona facts can be find in future studies.

关 键 词：克山病 病因 流行机制 流行病学 病理学 青霉菌污染 CIT毒素 

分 类 号：R542.3[医药卫生—心血管疾病]