Shi Guo-qing, Zhang Jian, Huang Wen-li, Yang Tao, Ye Shao-dong, Sun Xiao-dong, Li Zhao-xiang, Xie Xiao-hua, Li Fu-rong, Wang Yue-bing, Ren Jin-ma, Fontaine Robert E, Zeng Guang
Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2006 Feb;27(2):96-101.
To identify the epidemiological and clinical features of unexpected sudden cardiac deaths (SUD) in Yunnan.
Choosing the old SUD cases from Xiangyun, Heqing, Nanjian and Dayao counties and using the standardized verbal autopsy Form, we interviewed the family members of the cases, witnesses and doctors as well as reviewing their medical files to get relative information.
We identified 116 SUDs in 21 villages from 1984 to 2004. The village-specific annually standardized incidence rates were ranged from 0.2/1000 to 8.9/1000 (median = 0.8/1000). 66% and 29% of the SUDs occurred in July and August respectively. The incidence rates of SUD were higher (1.6/1000, chi(2) = 16, P < 0.01) in 10 - 39 year-olds, and higher in females than in males (RR = 1.6, 95% CI: 1.1 - 2.3). Seventy percent of SUD occurred in families having clustering nature and 60% of the additional cases in the family were occurred within 24 hours (median = 20 hours) after the first SUD identified in the family. SUD occurred in 23 families followed the first affected family in a village during the same season. In these 23 families, 61% of the first SUD occurred within 8 days after the first SUD in the first affected family. 68% and 66% of the SUDs did not have any complaints or signs during the last 3 weeks or from 3 weeks to 2 days prior to the onset of the disease. 63% of the SUDs had cardiac symptoms within the last 2 days prior to the onset with major symptoms as dizziness, nausea, faintness, unconsciousness, weakness and palpitation. The median duration from acute onset to death was 2 hours.
The extreme time-space clustering of SUD in families and in villages suggested that the risk factors occurred in specific time and location. Familial clustered SUD cases had common exposure pattern. Sudden onset of acute cardiac symptoms often followed by sudden death. Epidemiological study on new cases was necessary to identify risk factors and to develop hypothesis for causation. In July 2005, we instituted a special SUD surveillance system for all the affected counties together with 10 counties which had no reported cases.
确定云南意外心源性猝死（SUD）的流行病学和临床特征。
选取祥云、鹤庆、南涧和大姚县既往的SUD病例，使用标准化的死因推断表，对病例的家属、目击者及医生进行访谈，并查阅其病历以获取相关信息。
1984年至2004年期间，在21个村庄共识别出116例SUD。各村的年标准化发病率在0.2/1000至8.9/1000之间（中位数 = 0.8/1000）。66%和29%的SUD分别发生在7月和8月。10至39岁人群的SUD发病率较高（1.6/1000，χ² = 16，P < 0.01），女性发病率高于男性（RR = 1.6，95% CI：1.1 - 2.3）。70%的SUD发生在具有聚集性的家庭中，家庭中额外病例的60%在家庭中首例SUD确诊后的24小时内（中位数 = 20小时）发生。同一季节，23个家庭的SUD发生在一个村庄首例发病家庭之后。在这23个家庭中，61%的首例SUD发生在首例发病家庭首例SUD后的8天内。68%和66%的SUD在发病前3周内或发病前3周零2天内无任何不适或体征。63%的SUD在发病前2天内出现心脏症状，主要症状为头晕、恶心、乏力、意识丧失、虚弱和心悸。急性发病至死亡的中位持续时间为2小时。
SUD在家庭和村庄中的极端时空聚集表明危险因素发生在特定的时间和地点。家族聚集性SUD病例具有共同的暴露模式。急性心脏症状突然发作后常紧接着猝死。有必要对新病例进行流行病学研究以识别危险因素并建立病因假设。2005年7月，我们为所有受影响的县以及10个无报告病例的县建立了一个特殊的SUD监测系统。
