Objective To systematically review the differences of selenium levels in environment between endemic and normal regions and in patients with Kaschin-Beck disease and health people. Methods Such databases as PubMed, The Cochrane Library (Issue 8, 2013), EMbase, ISI Web of Knowledge, CNKI, CBM, VIP and WanFang Data were electronically searched to August 16th, 2013 for all observational studies about the differences of selenium levels in environment (including soil, water, and cereal) between endemic and normal regions, and in patients with Kaschin-Beck disease and health people (including blood, urine, and hair) were included. Meta-analysisi was performed using RevMan 5.2 software. Results Forty-six controlled studies were included. The results of meta-analysis showed that, selenium levels in water (SMD= –0.99, 95%CI –1.31 to –0.66), soil (SMD= –1.20, 95%CI –1.92 to –0.49), cereal (SMD= –1.94, 95%CI –2.63 to –1.26) and corn (SMD= –1.66, 95%CI –2.33 to –0.98) in endemic region were lower than those in normal region. The selenium in blood (SMD= –1.03, 95%CI –1.54 to –0.53), blood serum (SMD= –0.66, 95%CI –1.01 to –0.31), red blood cell (SMD= –2.75, 95%CI –4.13 to –1.37), urine (SMD= –0.99, 95%CI –1.43 to –0.55) and hair (SMD= –1.67, 95%CI –2.14 to –1.20) of Kaschin-Beck disease patients were lower than those in healthy people. The results of subgroup analysis also showed that significant differences were found between patients and healthy people in endemic region. The selenium in blood (SMD= –6.12, 95%CI –8.58 to –3.66), blood serum (SMD= –1.02, 95%CI –1.34 to –0.69), red blood cell (SMD= –3.37, 95%CI –5.38 to –1.35), urine (SMD= –1.94, 95%CI –2.54 to –1.34), and hair (SMD –3.49, 95%CI –5.32 to –1.66) of healthy people in endemic region were lower than those in normal region. After removing the specific studies on every pooling outcome with high risk of heterogeneity, the results of sensitivity analysis showed that the results were of robustness and the impact due to heterogenicity was fairly low. Conclusion Selenium levels in external environment in endemic region are significantly lower than those in normal region, and patients’ selenium levels in the body are also significantly lower than the healthy in endemic region. The selenium levels of the healthy in endemic region are also significantly lower than those of the healthy in normal region. Current evidence indicated that lack of selenium in external environment might be related to Kaschin-Beck disease.
Objective To primarily test the reliability and validity of the Kashin-Beck Disease (KBD) affected big joints function assessing system for adult Tibetans in Rangtang County. Method From June to July 2009, 142 KBD patients were investigated with the function assessing system in Rangtang County of Ngawa. Cronbach’s α coefficient was calculated to estimate internal consistency reliability. Pearson’s r for the correlation of the items with the total score of the scale was computed to test the internal validity. Principal component factor analysis with varimax rotation analysis was conducted to explore construct validity. Result Both the response and complete rates of the scale were 100%. The time for completing the scale was 7.8±3.4 minutes. Cronbach’s α was 0.857, which revealed satisfactory internal consistency reliability. Pearson correlation analysis revealed significant correlation between the scores of each item and the total score of the scale (Plt;0.05). Pearson’s r value of each item was more than 0.4, only except the items of “sitting with legs crossed” and “standing at attention”. The principal factor analysis extracted three latent factors explaining 68.1% of the variation together. The latent factors weights of the items were over 0.4 except the items of “standing at attention”, "taking food” and “wiping after defecation”. Conclusion The reliability and validity of KBD affected big joints function assessing system for adult Tibetans in Rangtang County was good in this primary test, the function assessing system has to be widely applied and further assessed among Tibetans suffered with KBD, in order to provide a standard evaluation criterion in KBD integrate control.
Objective To determine the thyroid hormone concentrations in preschool children in the Kasin-Beck disease (KBD) endemic area so as to explore the etiology of KBD. Methods Children of 1-6 years old in Naidang village,Jinchuan county, Sichuan Province, China were included. Physical examination was performed, personal history and medical history were collected, and blood samples were drawn for the determination of thyroid hormones. Results Blood samples were successfully collected from 14 children. Of them, 57.14% showed decreased TT3 levels, and 85.71% demonstrated decreased FT3 levels. All children showed significantly lower TT3 and FT3 average levels than the reference average value (P lt;0.000 01). The TT4, FT4and TSH levels were within the normal range. Conclusion Most children in the KBD endemic area showed lower T3 levels, which may act as a key factor for cartilage hypogenesis. It is suggested that a decreased TT3 level be one of the indicators for the assessment of KBD preventative effect, early monitoring and diagnosis of preclinical or subclinical stage of KBD.
Objective To explore the etiological mechanism of Kashin-Beck disease (KBD) and? the changes of bone on X-ray photography in preschool children in the KBD endemic area. Methods Children of 1-6 years old in Naidang village of Jinchuan county, Sichuan province, China were included; and their wrist and knee joints X-ray photos were collected. The photos were bl indly diagnosed. Results Of the 22 children aged 1-6 years old in the village, 17 were included and another 3 aged 6-8 years old asked for examination. All children showed changes in bone metaphysis around wrist or/and knee joints based on the results of X-ray examination. Conclusion The 20 children in mild type KBD area show common changes in bone metaphysis This result coincides with our hypothesis that hypoplastic cartilage should occur in the population of preschool children in the KBD endemic area.
目的 了解成人大骨节病（KBD）患者血清中硒和氟的含量及其与大骨节病分度的相关性。 方法 2008年8月－2009年10月，采集四川阿坝壤塘县大骨节病区成人KBD患者血清标本37例，四川非大骨节病区健康成人血清39例作为对照组。血清硒的含量采用石墨炉原子吸收分光光度法进行检测，氟采用氟离子选择电极法进行检测。统计学分析组间差异有无统计学意义，同时分析硒和氟的表达水平与大骨节病分度的相关性。 结果 大骨节病组患者血清硒的表达水平明显低于健康对照组（P＜0.05）；血清氟的表达水平虽略低于健康对照组，但无统计学意义（P＞0.05）。大骨节病组患者Ⅰ度和Ⅱ、Ⅲ度间硒和氟的表达水平无统计学差异（P＞0.05）。 结论 成人大骨节病患者血清中硒水平偏低，血清氟水平与健康人无统计学差异；血清硒和氟含量与大骨节病的分度并无明显相关性。
目的 总结早期大骨节病儿童的手部MRI表现，为早期大骨节病诊断提供参考依据。 方法 2009年11月－2011年12月对当地筛查出的18例6～12岁早期大骨节病患儿进行双手X线、MRI检查，并对比读片。 结果 所检18例大骨节病儿童的手部MRI异常主要表现为骺线不整、中断、变薄、信号改变、骺核信号改变等（29.0%）、干骺端先期钙化带与骨骺部分穿通（17.7%）等。按部位分手指近节（71.0%），中节（19.4%），远节（9.7%）；干骺端为异常集中处（53.2%），其次为骨骺（46.8%），骨端无异常发现。另外MRI还能显示X线片不能显示的骺线、骺核微小形态、信号改变以及干骺端由骺板伸入指骨的中高信号影像（17.7%）等更早期的软骨病变的征象。 结论 MRI较X线不仅能更清晰显示儿童大骨节病手指异常改变，而且能更早期发现更多的手指异常改变，但还需进一步随访观察。
ObjectivesTo systematically review the efficacy of intra-articular injection of sodium hyaluronate for kashin-beck disease. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2016), CBM, VIP, WanFang Data, and CNKI were electronically searched from inception to January 2016 to collect randomized controlled trials (RCTs) about sodium hyaluronate in the treatment of kashin-beck disease. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 6 RCTs involving 1 276 patients were included. The result of metaanalysis suggested that the sodium hyaluronate group was significantly superior to the control group in clinical effect (OR=5.89, 95% CI 4.10 to 8.47, P < 0.000 01) and the Lequesne index (SMD=-1.66, 95% CI-2.14 to-1.13, P < 0.000 01). ConclusionIntra-articular injection of sodium hyaluronate is helpful in the improvement of kashin-beck disease in clinical effect and the Lequesne index. Due to the limited quality and quantity of the included studies, more high quality studies are need to verify the above conclusion.
ObjectiveTo assess the comparative efficacy of all kinds of selenium supplementation in the treatment of patients with Kashin-Beck disease (KBD) by network meta-analysis. MethodsWe searched seven electronic databases including PubMed, EMbase, The Cochrane Library (Issue 7, 2016), CBM, VIP, WanFang Data and CNKI databases up to July 2016. All randomized controlled trials (RCTs) assessing the effect of selenium supplementation on KBD were included. Two reviewers independently screened literatures, extracted data and assessed the risk bias of included studies, and then meta-analysis was performed by using Stata13.1 software. ResultsA total of 16 RCTs involving 2 883 participants were included. Direct meta-analysis comparison showed that:Compared with placebo or blank group, sodium selenite (OR=5.00, 95%CI 3.21 to 7.78), selenium supplement salt (OR=7.60, 95%CI 2.34 to 24.67), and combination of sodium selenite and vitamin E (OR=11.05, 95%CI 2.61 to 46.80) had higher metaphysis X-ray improvement (P < 0.05). Ranking on efficacy indicated that combination of sodium selenite and vitamin E were highest, followed by selenium supplement salt, sodium selenite, sodium selenite plus vitamin C, vitamin C, and placebo/blank. ConclusionBased on the results of network meta-analysis, selenium supplement (sodium selenite, combination of sodium selenite and vitamin C, combination of sodium selenite and vitamin E, as well as selenium salt) is more effective than placebo or no treatment in promoting the repairement of metaphysis impairment. The effect of combination of sodium selenite and vitamin E are highest.