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目的 分析全国克山病病情,为调整防治策略提供科学的依据.方法 根据2009年克山病监测方案和《克山病诊断标准》(GB 17021-1997),在黑龙江、吉林、辽宁、内蒙古、河北、河南、山东、山西、重庆、四川、云南、陕西、甘肃、湖北和贵州,共15个省(市、自治区)的91个监测点,对全体居民进行问卷调查、临床查体、心电图描记,疑似病例拍摄胸部X线片或行心脏超声检查.每个监测点抽取12岁以下男童和成年男性各10名,采集发样,2,3-二氨基萘荧光法检测发硒含量.结果 共检诊53 414人,检出克山病1 081例,总检出率为202.4/万.其中慢型和潜在型克山病各为235、846例,检出率分别为44.0/万和158.4/万;男性检出率为158.8/万(337/23 743),女性为237.3/万(704/29 671);60～ 79岁人群克山病检出率较高(424.3/万);检出＜30岁的小年龄病例137例,占12.7％.共采集发样1 382份,平均发硒含量为(0.302±0.142)mg/kg.结论 克山病仍是不容忽视的公共卫生问题.在开展克山病监测时,应加强慢型克山病患者管理和重点地区的补硒工作.克山病监测方法需要加以改进,以满足不同时期克山病病情评估的需求.“,”Objective To investigate the national prevalence of Keshan disease (KD) in 2009,and to provide a scientific basis for adjustment of KD prevention strategies.Methods Based on the scheme of KD surveillance and the “Standard of Diagnosis of KD ”(GB 17021-1997),residents in 91 surveillance sites of 15 provinces including Heilongjiang,Jilin,Liaoning,Inner Mongolia,Hebei,Henan,Shandong,Shanxi,Chongqing,Sichuan,Yunnan,Shaanxi,Gansu,Hubei and Guizhou were surveyed by questionnaire survey,physical examination,electrocardiograms (ECG),X-ray or echocardiography.Ten boys under 12 years old and ten male adults were selected in each surveillance site,and their hair samples were collected for determination of selenium levels by fluorometric method and hydride atomic fluorescence spectrometry.Results A total of 1 081 KD patients were detected in 53 414 residents,and the detection rate was 202.4/10 000.The numbers of chronic and latent KD were 235 and 846,and the detection rates were 44.0/10 000 and 158.4/10 000,respectively.Detection rates of male and female were 158.8/10 000 (337/23 743) and 237.3/10 000 (704/29 671).The detection rate of KD was higher in the 60-79 years old population (424.3/10 000).Totally 137 KD cases less than 30 years old were found and the proportion was 12.7％.Totally 1 382 hair samples were collected,and the average hair selenium was (0.302 ± 0.142) mg/kg.Conclusions KD is still an endemic public health issue which cannot be ignored.When doing the national KD surveillance,management of chronic KD and selenium supplementation in key areas should be strengthened.Methods of surveillance should be improved to satisfy the need in control and assessment of KD.