Arthritis Clinic and Research Center, Peking University People's Hospital, No. 11 Xizhimen South Road, Xicheng District, Beijing, 100044, China.
Institution of Basic Science, Shandong First Medical University, Tai'an, China.
Clin Rheumatol. 2021 Sep;40(9):3717-3722. doi: 10.1007/s10067-021-05669-9. Epub 2021 Mar 5.
To estimate the prevalence of Kashin-Beck disease (KBD) among children in 2017 in Changdu of Tibet.
We adopted a four-step recruitment to include children aged 7-12 years from seven identified historically endemic counties in Changdu. Posterior-anterior radiographs of right hand and wrist were taken and were graded at four sites (metaphysis, epiphysis, and bony end of phalanges and metacarpal and carpal bones). Two trained researchers independently read the films. Inter-rater reliability was assessed using weighted Kappa and percentage agreement. We fitted logistic regression model to examine the association of age, sex, and altitude of residential village with prevalence of KBD. We examined association between site involvement and severity of KBD using chi-square test.
We recruited 13,573 children (mean age = 9.3 years, 48.40% girls) with a response rate of 95.81%. The overall prevalence of radiographic KBD was 0.26%. Luolong County had the highest prevalence (0.69%), followed by Bianba (0.26%), Basu (0.24%), Mangkang (0.14%), Zuogong (0.14%), Dingqing (0.07%), and Chaya (0.00%). A higher risk of radiographic KBD was associated with older age (P for trend <0.001) and girls (OR=1.86, 95% CI: 0.94, 3.70), but not the altitude of residential village (P for trend=0.957). Metaphysis was involved in all cases of KBD while lesions in epiphysis and bony end of phalanges and metacarpals were only observed in severe cases.
The prevalence of radiographic KBD among children aged 7-12 years was low in Changdu compared with previous census data, suggesting the effectiveness of preventative measures. Key Points • In this study, 13,573 Tibetan children were taken X-ray films of their hands and wrists. • The prevalence of radiographic KBD among children aged 7-12 years was low in Changdu of Tibet. • The preventative measures against KBD launched by Chinese government were effective in decreasing new onsets of KBD among Tibetan children.
本研究旨在评估 2017 年西藏昌都地区儿童的大骨节病（KBD）患病率。
采用四步抽样法，纳入来自昌都七个历史地方性流行县的 7-12 岁儿童。拍摄右手和腕关节的前后位 X 线片，并在四个部位（干骺端、骨骺端、指骨和掌骨的骨端以及腕骨和掌骨）进行分级。由两名经过培训的研究人员独立阅读 X 线片。采用加权 Kappa 和百分比一致性评估观察者间的可靠性。我们拟合逻辑回归模型来检验年龄、性别和居住村庄海拔与 KBD 患病率之间的关系。采用卡方检验来检验受累部位与 KBD 严重程度之间的关系。
我们共招募了 13573 名儿童（平均年龄=9.3 岁，48.40%为女孩），应答率为 95.81%。放射学 KBD 的总患病率为 0.26%。洛隆县患病率最高（0.69%），其次是边坝县（0.26%）、巴苏县（0.24%）、芒康县（0.14%）、左贡县（0.14%）、丁青县（0.07%）和察雅县（0.00%）。放射学 KBD 的风险随年龄增长而增加（趋势 P<0.001），女孩的患病风险高于男孩（OR=1.86，95%CI：0.94，3.70），但与居住村庄的海拔无关（趋势 P=0.957）。所有 KBD 病例均累及干骺端，而骨骺端和指骨、掌骨的骨端病变仅见于严重病例。
与既往普查数据相比，昌都地区 7-12 岁儿童的放射学 KBD 患病率较低，提示预防措施有效。关键点：• 在本研究中，对 13573 名藏族儿童进行了手部和腕部 X 线片检查。• 西藏昌都地区 7-12 岁儿童的放射学 KBD 患病率较低。• 中国政府针对 KBD 开展的预防措施在降低藏族儿童新发病例方面是有效的。
