Latent Keshan Disease Research Articles

Spatial Epidemiological Analysis of Keshan Disease in China.

Objectives:Few researchers have studied the national prevalence of Keshan disease (KD) in China using spatial epidemiological methods. This study aimed to provide geographically precise and visualized evidence for the strategies for KD prevention and control.Methods:We surveyed and analyzed 237,000 people in 280 out of 328 KD-endemic counties (85.4%) in mainland China using a design of key investigation based on case-searching in 2015–2016. ArcGIS version 9.0 was used for spatial autocorrelation analysis, spatial interpolation analysis and spatial regression analysis.Results:Global autocorrelation analysis showed that global clustering of latent Keshan disease (LKD) prevalence was noted (Moran’s I = 0.22, Z = 7.06, and P < 0.0001), no global clustering of chronic Keshan disease (CKD) prevalence (Moran’s I = 0.03, Z = 1.10, and P = 0.27) was observed. Spatial regression analysis showed that LKD prevalence was negatively correlated with per capita disposable income (t = –4.36, P < 0.0001). Local autocorrelation analysis at the county level effectively identified the cluster areas of LKD prevalence in the provinces of Shaanxi, Gansu, Shanxi, Inner Mongolia, and Jilin. The high-high cluster areas should be given priority for precision prevention and control of Keshan disease.Conclusions:This spatial epidemiological study revealed that LKD prevention and control should be strengthened in areas with high values of clustering. Our findings provided spatially, geographically precise and visualized evidence for prioritizing KD prevention and control.

Preliminary quantitative proteomics analysis in chronic and latent Keshan disease by iTRAQ labeling approach.

Keshan disease is a congestive cardiomyopathy. Dietary selenium deficiency combined with additional stressors are recognized to cause the cardiomyopathies. In this study, clinical condition of individuals with different subtypes including chronic and latent were analyzed. ECG abnormalities, chest radiography, echocardiography and blood selenium concentration were assessed. Subsequently, in effort to uncover proteins that were reliably changed in patients, isobaric tags for absolute and relative quantitation technology was applied. Bioinformatics analysis of the differentially expressed proteins were performed by means of Gene Ontology classification, KEGG pathway, and Ingenuity Pathway Analysis. ELISA experiment was used to detect the interesting proteins. As a result, chronic patients showed more EGC abnormalities compared to Latent. All patients had low blood selenium level. Proteomics data revealed 28 differentially expressed proteins. By ELISA variation, LGALS3BP was increased in chronic patients. PZP was elevated specially in latent patients. The above results might be beneficial for further biomarkers discovery and Keshan disease pathological mechanism study.

An approach to assessment of Keshan disease elimination at the township level

The aim of this study was to pilot a method of a small-scale survey for the assessment of Keshan disease (KD) elimination at township level. The prevalence of chronic KD was obtained by case-searching the whole population. The endemic village with the highest prevalence of chronic KD was selected as the key village for the survey of latent KD prevalence rate among permanent residents. The selenium levels in the head hair of individuals in the key village was measured. The professionals of the department of endemic disease control, the township and village doctors were surveyed by pre-designed questionnaire survey for KD interventions. We conducted this study in 2013. Yuanbao township had a population of 16 487 people and 14 862 permanent residents. There were no acute or subacute KD cases in the previous 5 years. The prevalence rate of chronic KD and natural chronic KD were 6.7/10 000 and 3.4/10 000 respectively. The prevalence rate of latent KD was 250.6/10 000, higher than the elimination criterion. The head hair selenium levels were 0.23±0.18 mg/kg. The small-scale survey methodology for assessing KD elimination at township level was feasible. KD among the people living in Yuanbao township has not been eliminated.

An investigation of current prevalence situation of dilated cardiomyopathy in non-keshan disease areas of Yunnan Province in 2011

Objective In order to master the current prevalence situation of dilated cardiomyopathy in Yunnan Province.Methods An investigation of dilated cardiomyopathy was carried out in 17 counties from August to December in 2011 in non-Keshan disease areas.Two townships (towns) that similar to Keshan disease areas in natural environment,pattern of production and lifestyle in non-Keshan disease areas were selected in each project county,and 1 village was selected as surveillance site in each selected township(town).The number of resident in each village no less than 500 people was appropriate and deficiency was supplemented from neighboring villages.The sampling rate was no less than 80％.Clinical examination and electrocardiographic tracings were carried out.The patients with suspected dilated cardiomyopathy and latent Keshan disease were taken anteroposterior chest X-ray in accordance with the Non-Keshan Disease Area Dilated Cardiomyopathy Condition Survey Program.The surveillance was carried out based on National Investigation Scheme of Dilated Cardiomyopathy in Non-Keshan Disease Areas.Cases were diagnosed based on the diagnostic standard of dilated cardiomyopathy and suspected latent Keshan disease.Results In the 34 villages of 17 selected counties,14 545 people were investigated.Twenty-six cases of latent dilated cardiomyopathy and suspected latent Keshan disease were detected,and the total detection rate was 17.88/million.One case was dilated cardiomyopathy,and 25 cases were suspected latent Keshan disease,detection rates were 0.69/million and 17.19/million,respectively.Male and female cases were 15 and 11,respectively.The ratio of people aged 65 and older accounted for 42.31％(11/26),among them suspected latent Keshan disease accounted for 44.00％(11/25),and 1 case of dilated cardiomyopathy was in the 45 to 54 years old group.Electrocardiographic examination of 14 519 people,the abnormal rate was 8.13％(1 180/14 519).Among 112 chest X-ray films,104 cases had a cardiothoracic ratio less than or equal to 0.50,4 cases from 0.51 to 0.55,3 cases from 0.56 to 0.60,and 1 case more than or equal to 0.61.Conclusion The detection rate of dilated cardiomyopathy cases is lower in non-Keshan disease area of Yunnan Province,but suspected latent Keshan disease is detected. Key words: Dilated cardiomyopathy; Keshan disease; Investigation of situation

Long-term prognostic value of major and minor ECG abnormalities in latent Keshan disease with suspect chronic Keshan disease.

ObjectiveThis study aims to determine whether baseline electrocardiography (ECG) abnormalities, the appearance of new ECG abnormalities, or other clinical characteristics are associated with increased rates of progression to chronic Keshan disease (KD) among patients with latent KD.MethodsFour hundred and fourteen new latent KD patients from a monitored population in China were diagnosed and then followed for 10 years. Baseline and 10-year ECG abnormalities were classified according to the Minnesota Code as major and minor. Using Cox proportional hazards regression models, the addition of ECG abnormalities to traditional risk factors were examined to predict chronic KD events.ResultsIn 414 latent KD patients with ECG abnormalities, 220 (53.1%) had minor and 194 (46.9%) had major ECG abnormalities. During the follow-up, 92 (22.2%) patients experienced chronic KD events; 32 (14.5%) and 60 (30.9%) of these chronic KD events occurred in the minor and major ECG abnormalities groups, respectively. After adjustment for baseline potential confounders, the hazard ratios and 95% confidence intervals (CIs) for progression to chronic KD in latent KD patients with major ECG abnormalities versus those with minor ECG abnormalities was 2.43 (95% CI 1.58–3.93).ConclusionsMajor ECG abnormalities and new ventricular premature complex abnormalities that occurred during the follow-up were both associated with an increased risk of progression to chronic KD. Atrial fibrillation and right bundle branch block with left anterior hemiblock are the most strongly predictive components of major ECG abnormalities. Depending on the model, adding ECG abnormalities to traditional risk factors was associated with improved risk prediction in latent KD.

The prevalence of Keshan disease in China

Sentinel surveillance of Keshan disease (KD) is limited by unable to give the prevalence rates and their estimates. This study was to find the national KD prevalence and the estimated patient numbers to provide evidence toward modifying the policy of KD prevention and control. Using a probability proportional to population size, randomized, multistage, and cluster sampling, we surveyed 101,127, measured grain selenium levels; and surveyed household income with pre-designed questionnaires. The national prevalence rates of KD, chronic KD and latent KD were 2.21%, 0.50%, and 1.71% respectively. Chronic KD patients are mainly in the provinces where KD had been seriously epidemic. The KD prevalence rate was higher in females (2.20%) than in males (1.98%). These were also higher in older age groups. The cases younger than 30 years accounted for 13.6%, indicating the possibility that KD is still occurring. Nationally, the estimated numbers of KD and chronic KD patients are 1,675,500 (95% CI, 1,608,500-1,747,300) and 379,800 (95% CI, 346,700-412,800) respectively. Multiple logistic regression analysis indicated that family income was a significant dependent variable (OR: -0.258, 95% CI: -0.332 to -0.185, p<0.001). More than 2000 chronic KD patients found in the study were treated in 2009-2011. The limitation of this study was that sampling size was determined at national level. KD is still a public health issue among the people of the historically severe endemic areas. Selenium supplementation, self-management program for chronic KD patients and translation epidemiology of KD surveillance should be strengthened.

Suboptimal Selenium Supply—A Continuing Problem in Keshan Disease Areas in Heilongjiang Province

This study explores whether the declining prevalence of Keshan disease is associated with increasing selenium levels in Keshan disease areas in Heilongjiang province. Six counties endemic with Keshan disease and three non-endemic counties were selected as study areas. In each county, two townships and in each township one village were chosen in which to survey ten families about head hair, grain, and soil samples and to obtain demographic information. Selenium was measured with hydride generation-atomic fluorescence spectrometry. In each county endemic with Keshan disease, one of the villages was chosen to investigate the prevalence of the disease. We collected 534 head hair samples, 446 staple food samples, and 180 soil samples. The selenium levels of head hair and corn in the endemic counties were significantly lower than those in non-endemic counties. Family demographic information was homologous except for the composition of staple food. More residents in Keshan disease areas preferred flour and corn. The detection rate for latent Keshan disease had a significantly negative correlation with the corn selenium level in six counties endemic with Keshan disease. As the population in this region is still at risk for Keshan disease, selenium surveillance measures should be intensified.

Circulating adhesion molecules in patients with Keshan disease and their relationship with Coxsackie B virus infection

This study determined the levels of serum soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecular-1 (sVCAM-1) in patients with different types of Keshan disease (KD), examined the relationship between Coxsackie B virus-specific IgM antibody (CBV-IgM) and sICAM-1 or sVCAM-1 in KD patients, and investigated the role of these adhesion molecules in the pathogenesis of KD and their clinical implications. The levels of serum sICAM-1, sVCAM-1 and CBV-IgM were measured by using enzyme-linked immunosorbent assay in 22 patients with chronic Keshan disease (CKD), 27 with latent Keshan disease (LKD) and 28 healthy controls. The subjects in different groups were adjusted for sex and age. Echocardiography was adopted to determine left ventricular ejection fraction (LVEF) in 22 patients with CKD. The results showed that CKD patients had significantly higher levels of sICAM-1 and sVCAM-1 than LKD patients and healthy controls (P<0.01 for all). And there was significant difference in the levels of the 2 adhesion molecules between LKD patients and healthy controls (P<0.05). A negative correlation was found between LVEF and sICAM-1 or sVCAM-1 in CKD patients. The percentage of CBV-specific IgM positive individuals in KD patients was significantly higher than that of healthy controls. In CVB-specific IgM positive patients, the levels of serum sICAM-1 and sVCAM-1 were significantly greater than those in CBV-specific IgM negative counterpart. It was concluded that the increase in the levels of sICAM-1 and sVCAM-1 suggests the progression of inflammation in KD. sICAM-1 and sVCAM-1 can promote the development of myocardial pathology and lead to poor myocardial function. The increased serum sICAM-1 and sVCAM-1 in KD patients may be related to CBV infection.

The analysis of Keshan disease surveillance results in Yongjin Village, Fuyu County, Heilongjiang Province in 2007

Objective To investigate the prevalence and incidence of Keshan disease (KD) and the selenium concentration of food and hair in residents of Yongjin Village, Fuyu County, Heilongjiang Province, national monitoring site, in 2007. Methods According to the Standard of Keshan Disease Surveillance and the Standard of Diagnosis of Keshan Disease(GB 17021-1997), the residents living in the monitoring site were surveyed by clinical examination and electrocardiography. For individuals whose hearts showed abnormalities, a chest X-ray photograph was taken. The selenium concentrations of the residents' food (flour) and hair were assayed by flowing injection hydride generation atomic fluoremetric method(FI-HG-AFM). Results Nineteen KD patients were found from 282 residents in 2007 KD surveillance. The prevalence of KD, latent KD and chronic KD were 6.7%(19/282), 2.8%(8/282) and 3.9%(11/282), respectively. Five of the 8 latent KD cases were newly found. In addition, there were 5 the suspected KD cases, including 2 suspected chronic KD cases. No acute KD or sub-acute KD patients were found in Yongjin Village at this monitoring site this year. The average selenium concentration of children hair and residents food were (0.3197±0.0586)mg/kg and (0.0210±0.0062)mg/kg, respectively. Conclusions New cases of KD continued to emerge, indicating that etiological factors still exist. Therefore, the emphasis of monitoring KD in furore is founding the consummate report of infectious disease system and training the personnel to increase the reliability of monitoring. Key words: Keshan disease; Population surveillance; Prevalence

Measurement and analysis of blood plasma brain matriuretic peptide in Keshan disease patients

Objective To investigate the relationship and clinical significance of blood plasma brain natriuretic peptide (BNP) and Keshan Disease (KD). Methods Seventy KD patients and 30 healthy volunteers in endemic area were investigated with Doppler Echocardiography for the measurement of left ventricular end-diastolic diameter(LVEDD) and left ventricular ejection fraction (LVEF), and the plasma BNP levels were determined with microparticle enzyme immunoassay. Results The BNP levels in plasma in KD patients [(444.61±102.31), (87.21±23.15)ng/L] were significantly higher than that of healthy volunteers [(34.91±15.21)ng/L],the differencesbeing statistical significant (q=39.74,5.82,P<0.01). The BNP levels in chronic KD patients were higher than that of latent KD patients (q=37.62,P<0.01). The plasma BNP levels in KD patients with LVEDD 60 nun [(928.80±134.27)ng/L] were significantly higher than those of patients with LVEDD 55～60 mm [(89.24±52.31)ng/L] and LVEDD<55 nun [(67.14±6.92)ng/L],the differencesbeing statistical significant (q=44.30,48.16, P<0.01), The plasma BNP levels in KD patients with LVEF<35%[(1654.21±421.35) ng/L] were significantly higher than those of patients with 35% ~ 50%[(421.54±112.32)ng/L] and50% [ (81.21±72.85 ng/L)], the differencesbeing statistical significant(q=24.91,72.66, P<0.01), The BNP levels in LVEF 35%～50% were higher than that of 50% (q=11.84,P<0.01). Conclusion The plasma BNP levels were important for the diagnosis, grouping, therapeutic effect and prognostic evaluation of KD. Key words: Keshan disease; Natriuretic poptide, brain; Stroke volume

Surveillance on Keshan Disease in Huangling County, Shaanxi Province in 2004

Objective To monitor the prevalence of Keshan disease in Huangling County, Shaanxi Previnee in 2007. Methods All local residents in surveinance area of Keshan disease in Diantou and Yaoping Township of Huangling County, were surveyed and given overall examinations by electrocardiography. The patients of latent and chronic Keshan disease were examined by X-ray. The selenium contents in blood and hair were monitored by fluorospectrophotometry in surveillance and non-surveillance areas. Results No new ease of acute or sub-acute patient was found. Latent and chronic patients detected accounted for 3.92% (35/893). Only 1 ease of new latent Keshan disease was newly found. Major feature of electrocardiographic abnormality was ST-T change. By X-ray, there were 27 eases with a normal heart, 20 eases with mild enlargement, 20 eases with medium enlargement, and 16 eases with marked enlargement. Serological selenium eoncentrations were (38.67±19.58), (48.55±22.36), (67.29±17.32)μg/L, respectively in patients, internal and external eontrols(F=16.291 ,P<0.01). Selenium contents of children's hair were (0.376±0.101), (0.372±0.085), (0.436±0.085)μg/L, respectively(F= 17.032, P<0.01). Conclusions Cases of diagnosed Keshan disease were decreased compared with the previous years. There were new eases of latent Keshan disease in Huangling County, Shaanxi Province. Key words: Keshan disease; Electrocardiography; X-rays; Selenium; Surveillance