南水北调供水前河北省地方性氟中毒环境因素调查

为探讨南水北调中线河北省供水区内地方性氟中毒与环境因素的关系，按南水北调中线供水区地方性氟中毒调查实施方案要求，在南水北调所途经的河北省供水区内的7个市106个县，在南水北调工程实施前对水氟含量大于1．0mg／L病区村，按轻、中、重分层，随机抽取51个村进行环境及流行病学重点调查，对采集的水及水中其它的化学成分、水总硬度、水总碱度以及其它环境样品中的氟含量进行测定分析。结果显示，南水北调中线供水区水是主要携氟介质，其它环境因素土壤、水碱度、水硬度等对供水区地方性氟中毒也有一定影响。说明南水北调中线供水区饮用高氟水是地方性氟中毒流行的主要因素，其它环境因素起辅助作用。     

南水北调中线工程的实施与河北省地方性氟中毒防治

目的调查掌握南水北调中线工程河北省供水区供水前地方性氟中毒的流行范围、危害程度及改水降氟现状,探讨南水北调中线工程的实施对河北省地方性氟中毒防治的影响.方法按南水北调中线供水区地方性氟中毒调查实施方案要求,对所途经的河北省7个地市106个县27 891个村的水氟含量和改水现状进行普查,对饮水含氟量超过1.0mg/L病区村按轻、中、重分层,随机抽取51个村进行重点调查,调查氟斑牙和氟骨症患病情况.结果地方性氟中毒在南水北调中线供水区流行分布广泛,一些地区改水降氟成效显著,但低氟水源难寻,改水难度大的地区,病情较为严重.结论南水北调中线工程实施后为河北省改水难度大的地区彻底改水降氟提供了可能.     

河北省南水北调中线工程供水区地方性氟中毒调查

目的 了解南水北调中线工程河北省供水区内地方性氟中毒（地氟病）现况。方法 普查河北省供水区内7个地级市27686个行政的水氟含量和改水现状。对饮水含氟量超过1．0mg/L病区村按轻、中、重分层,随机的51个村进行重点调查。结果 普查的27686个行政村中饮水氟含量超标率38．27％,4534眼改水井中仍有367％的井水氟超标,大部分传统改水降氟措施效果不佳。重点调查的51个村中,8－12岁在校生8183人氟斑牙患病率25．04％,16－65岁660人右前臂X线正位片氟骨症检出率3．94％,氟斑牙与氟骨症患病率随水氟浓度升高而升高,随饮水用氟水的增长而增高。结论 南水北调河北省供水区水氟含量超标严重;病区人民长期饮用高氟水是该地区饮水型氟中毒的主要原因。实施南水北调中线工程是控制该地区地氟病流行的根本措施。     

地氟病区低氟潜水开发利用的研究

作者调查了吉林省９个县的氖地氟病屯的潜水氟含量，对高氟和低氟地下水质进行分析，对居住在同一村屯饮用高氟水和低氟地下水的居民进行了流行病学调查。结果显示，在饮水型地氟病区，有近一半的井水氟含量低，水质好，水氟含量比较稳定，可用于地氟病的预防。作者认为，高氟区低氟潜水的开发利用有很大的价值。     

宁夏固原县地方性氟中毒病区水质监测分析

固原县是宁夏地方性氟中毒 (地氟病 )重病区县之一 ,氟病区有 15个乡(镇 ) ,2 8个行政村 ,10 2 2 9户、 51590人口。 1980年的流行病学调查中 ,固原县被确定为饮水型氟中毒病区 ,水氟含量 (3 .48± 2 .45) mg/ L。为了观察地氟病病区改水效果 ,掌握水质动态变化 ,科学指导防治工作 ,2 0 0 1年 11～ 12月对固原县改水病区居民生活饮用水水质、含氟量等指标进行监测 ,现将结果报告如下。1　材料与方法　　对全县地氟病病区的井水、泉水、屋檐集水进行随机采样 ,共采水样 60份。检测水样含氟量、p H值、总硬度。氟化物测定用茜素锆比色法 ,总…     

沧州市居民饮水氟含量调查结果分析

沧州市位于河北平原东部，东临渤海，是京津冀南水北调工程中线供水区内饮水型氟中毒重病区。据８０年代调查，水氟含量在３．５～７．０ｍｇ／Ｌ。多年来，政府和有关部门斥巨资改水降氟取得了一定成绩，部分改水区水氟含量比较明确，但是未改水区的水氟含量及其规律尚未见系统报道，本文对沧州市未改水区水氟含量及规律进行了调查。１ 材料和方法 水氟含量测定用离子选择电极法；各县（区）按人口比例概率随机抽样；饮用水按国家饮用水卫生标准。２ 结果２．１ 不同县（区）水氟含量 测定了沧州地区门个未改水县（区）的水氟含量，结果见…     

通榆县防氟改水现状调查分析

通榆县是饮水型地方性氟中毒（地氟病）流行区域。地氟病流行的原因系浅层地下水氟含量过高,地氟病病区自然村分布在28个乡（镇）166个行政村的707个自然村,有轻病区331个,中病区307个,重病区69个,病区村人口36万,氟骨症患者0.82万人,氟斑牙患者13.67万人。打深井改饮低氟水是本县预防地氟病发生、发展的根本措施,为了摸清本县地氟病病区防氟改水现状,掌握改水工程运行情况,为调整地氟病防治策略提供科学依据,2016年开展了防氟改水现况调查工作,结果报道如下。     

1998～2002年陕西省两个改水降氟村地氟病调查报告

为观察两监测点改水后水、尿氟含量变化，评估地氟病防治效果，连续4年用氟电极法测定水、尿氟含量，氟斑牙诊断用Dean's氏法，结果表明巴邑村水氟含量从2．5mg／L降至1．0mg／L(国家标准)以下，氟斑牙患病率从71．01％降至15.98％；吴坡村水氟含量从4．4mg／L降至1．12mg／L，氟斑牙患病率从81．3％降至39．77％，随水氟含量逐年下降，两监测点8～12岁儿童尿氟含量也逐年呈明显下降趋势；尿氟含量与氟斑牙患病之间，巴邑未出现明显的正相关关系(r=0．201)，吴坡呈非常显的正相关关系(r=0．876)，说明改水降氟对地氟病的防治效果是明显的，值得推广。     

已改水的地方性氟中毒病区用水管理与病情关系的现况调查

目的了解福建省漳州市已改水地方性氟中毒(地氟病)病区饮用水管理机制及地氟病病情现况。方法选择漳州市16个原地氟病病区,调查居民用水及管理现状和8￣12岁学生氟斑牙患病情况并测定学生尿氟。结果已改水病区人口中有17.65%重新饮用高氟水;病区8￣12岁学生氟斑牙检出率为14.32%,其中供水不正常病区8￣12岁学生氟斑牙患病率为22.4%,显著高于供水正常的病区的3.4%(P<0.01);因供水量不足兼有供水设备经常故障的病区8￣12岁学生氟斑牙检出率达到33.33%;按月高收费的用水管理类型病区,其饮用高氟水比例达48.2%,氟斑牙检出率为27.12%,高于其他水费管理类型病区。结论已改水病区有部分人群重新饮用高氟水,在改水后低氟水的供水量不足、供水设备经常发生故障、收费高、维护管理差的病区氟斑牙检出率显著增高。建议加强水源管理和养护,按吨因地制宜收费,减免低收入家庭的用水负担。     

高氟潜水病屯内存在的低氟潜水水质和水氟含量稳定性的研究

为探讨高氟潜水屯内存在的低氟潜水水质及水氟含量的稳定性，应用原子吸收等仪器对不同病情地氟病区，同屯高、低氟潜水混合样进行了３３项水质及化学成份分析。并对同眼低氟潜水间隔，连续三年作水氟含量动态观察。结果表明病屯内的低氟潜水水质基本上是良好的，绝大部分指标符合国家生活饮用水水质标准，有些人体必须元素虽超标，但对人体健康是无害的，水质化学特征与非氟区水质一致，水氟含量是稳定的、因此，该水源不仅可以预防地方性氟中毒并具有开发利用价值。     

河北省阳原县地方性氟中毒流行病学调查

目的掌握河北省阳原县地方性氟中毒流行现况。方法采用分层整群抽样法在非、轻、中、重病区分别抽取调查点,检测居民饮用水氟和儿童尿氟,检查儿童氟斑牙患病情况。结果共采集测定居民饮用水水样59份,水氟中位数为1.11mg/L;非、轻病区的水氟中位数在正常标准内;中、重病区的水氟中位数超过正常标准,所有水样的水氟均不合格。共采集并测定8～12岁儿童尿样405份,尿氟中位数为2.05mg/L,中、重病区儿童尿氟中位数明显高于非、轻病区。共检查8～12岁儿童1276名,氟斑牙检出率为37.7%,氟斑牙指数为0.69,非、轻、中、重病区的检出率差异有统计学意义(χ2=214.29,P<0.05);中、重病区的氟斑牙检出率和氟斑牙指数均较高,为轻微和中等流行。结论阳原县地方性氟中毒病情尚未完全得到控制;今后应进一步加大改水力度,有效地控制地方性氟中毒的发生。     

2009年西藏自治区饮水型氟中毒病情监测结果分析

目的 了解西藏饮水型地方性氟中毒的病情动态,评价防治措施的效果,为及时调整防治策略提供科学依据.方法 按照"2008年中央补助地方公共卫生专项资金西藏饮水型氟中毒防治项目"技术方案,于2009年9-10月选取日喀则谢通门和林芝察隅两县作为项目县,在每个项目县采用单纯随机抽样的方法选择3个项目村,以自然村为单位,对改水及改水工程运转情况、饮水含氟量、儿童氟斑牙和成人临床氟骨症进行调查.按照<生活饮用水标准检验方法非金属指标>(GB/T 5750.6-2006)测定水氟;尿中氟化物的测定采用离子选择电极法(WS/T 89-1996);氟斑牙诊断采用Dean法;成人氟骨症诊断按<地方性氟骨症临床诊断标准>(WS192-2008)进行.结果 已改水病区水氟均值在0.18～0.34 mg/L,未改水病区水氟均值在0.70～2.13 mg/L;已改水病区8～10岁儿童氟斑牙检出率为50.78%(65/128),氟斑牙指数为1.04,儿童尿氟均值为1.64 mg/L,未改水病区氟斑牙检出率为80.65%(25/31),氟斑牙指数为1.50,儿童尿氟均值为2.08;已改水病区成人氟骨症患病率为38.7%(104/269),尿氟为1.61 mg/L,未改水病区成人氟骨症患病率为15.4%(18/117),尿氟为3.54mg/L.结论 改水降氟使氟斑牙的检出率降低至控制水平,严重程度也在降低,改水病区尿氟低于未改水病区,说明改水仍对消除氟中毒的危害有重要意义,但氟骨症患病率出现了在改水病区反而高于未改水病区的现象.

Abstract：

Objective To find out the dynamics of drinking water borne endemic fluorosis in Tibet's, to evaluate the effect of control measures, and to provide a scientific basis for the timely adjustment of control strategies. Methods During september to october 2009, according to the "2008 Central Government Special Funds to Subsidize Local Public Health in Drinking Water Borne Fluorosis in Tibet", Xigaze Xietongmen and Nyingchi Zayu were selected as project counties, three project villages were selected with simple random sampling method in each county, the functioning of water improvement projects, drinking water fluoride content, children's dental fluorosis and adult skeletal fluorosis were investigated. Water fluoride was detected by the "standard examination methods for drinking water the non-metallic targets"(GB/T 5750.6-2006) determination of fluoride; urinary fluoride was tested by ion selective electrode (WS/T 89-1996); dental fluorosis was diagnosed using Deans method; adult skeletal fluorosis was diagnosed by "endemic skeletal fluorosis clinical diagnostic criteria" (WS 192-2008). Results Mean water fluoride was 0.18 - 0.34 mg/L in drinking water changed areas, and 0.70 - 2.13 mg/L in not changed areas; prevalence of dental fluorosis of children 8 - 10 was 50.78% (65/128), dental fluorosis index was 1.04,mean urinary fluoride was 1.64 mg/L in drinking water changed areas; prevalence of dental fluorosis of children 8 -10 years old was 80.65%(25/31 ) in not changed areas, dental fluorosis index was 1.50, mean urinary fluoride of children was 2.08; adult clinical skeletal fluorosis was 38.7%(104/269) in drinking water changed areas, the mean urinary fluoride was 1.61 mg/L, prevalence of skeletal fluorosis was 15.4% (18/117) in not changed areas, mean urinary fluoride was 3.54 mg/L. Conclusions The method of change the water to reduce fluoride decreases dental fluorosis to control levels, and severity is also reduced, urinary fluoride is decreased. However, the prevalence of skeletal fluorosis is higher than that of drinking water not changed areas.     

氟中毒和大骨节病区及两病并存病区的水质对比分析

本文报告了地方性氟中毒病区、大骨节病区、两病并存病区和非病区饮水中氟、钙、硒、锰、硅元素含量等21个项目的测试结果,对非病区与不同病区饮水中的有关元素的离子含量与离子总量的比值进行了对比分析,结果表明在地方性氟中毒和大骨节病并存的病区的饮水中,既有氟病的致病因素,又有大骨节病的致病因素,水质中低钙高氟与氟病区相一致,硒和离子总量的比值与大骨节病区相一致。二氧化硅的比值,氟病区低于非病区,而大骨节病区及两病并存病区却高于非病区,二氧化硅与氟病和大骨节病是否有关,有待进一步研究。     

少儿地方性氟骨症骨损害的X线表现及改水降氟后变化

目的了解少儿氟骨症骨损害X线表现、特点,与成人氟骨症X线改变的异同以及脱离高氟影响后的X线变化,为地方性氟骨症的诊断、防治效果评价及发病和转归机理研究提供参考。方法在水氟含量较高(4.3～16.0 mg/L)的地方性氟中毒病区,借助X线检查方法筛选出30例儿童氟骨症病例,对其出现的各种X线征象、特点进行观察和分析,追踪观察并统计了8例儿童氟骨症病例改水前、后X线表现及诊断结果的变化。结果 30名患者中,轻度22例,中度4例,重度4例。硬化型改变26例,软化型2例,混合型2例。所有患者都有骨纹X线征象异常,表现为骨小梁增多、增密(密集),粗大、模糊、紊乱、融合。严重紊乱和融合的骨纹使骨密度增高,骨质硬化。前臂、小腿、骨盆骨软化变形。与成人氟骨症不同,骨周软组织和关节无异常所见。结论少儿地方性氟骨症主要发生在氟含量更高的氟中毒病区,X线表现为骨质方面的损害,骨周软组织和关节不受波及。在改换水源降低饮水氟含量5年后,原有异常骨X线征象即可出现相当明显的逆转或恢复正常影像。部分改水前骨硬化患者在改水后出现了骨质疏松征象,机制有待研究。     

2009年河北省饮水型地方性氟中毒病情调查

目的 了解饮水型地方性氟中毒的病情动态和评价防治措施的落实效果,为及时调整防治策略提供科学依据.方法 2009年,采用单纯随机抽样的方法,在河北省饮水型氟中毒病区县中抽取38个县(市、区),采用系统抽样方法,将各病区县所有病区村分成轻、中、重3类,从每类病区村中各抽取1个病区村,对全部病区村进行水氟监测;调查病区村全部8～12岁儿童氟斑牙患病情况,从每个年龄段选择6人,检测尿氟;对各病区村全部16岁以上常住人口开展临床氟骨症检查,并检测20人份(男、女各半)尿氟.结果 共调查112个病区村,其中改水村66个,未改水村46个.采集改水工程水样236份,水氟范围为0.1～4.3 mg/L,有20个工程水氟＞1.2 mg/L,占总数的33.3%(20/60);采集未改水村水样230份,水氟范围为0.2～4.6 mg/L,水氟＞1.2 mg/L的水源数占总数的76.1%(35/46).共对5169名8～12岁儿童进行了氟斑牙患病情况调查,氟斑牙检出率为36.43%(1883/5169),氟斑牙指数为0.81.调查16岁以上成人71 497人,临床氟骨症检出率为4.81%(3438/71 497),中度以上临床氟骨症检出率为1.56%(1114/71 497).分别测定了2876和2021份儿童和成人尿氟,几何均数分别为2.30、3.32 mg/L.结论 水氟＜1.2 mg/L的已改水村儿童氟斑牙检出率均在30%以下,儿童氟斑牙检出率和成人临床氟骨症检出率随着改水时间的延长呈现逐渐下降的趋势.未改水病区,儿童氟斑牙检出率和成人临床氟骨症病情随水氟升高而上升.河北省饮水型氟中毒流行仍然较为严重,应该加快改水降氟进度并提高改水工程合格率.

Abstract：

Objective To understand the status of drinking-water-borne endemic fluorosis and the effect of preventive measure in Hebei province, so as to provide a basis to prevent and cure the disease. Methods Thirtyeight affected counties(cities, districts) with drinking-water-borne endemic fluorosis were sampled by random sampling in Hebei in 2009. All affected villages in every county were divided into mild, moderate and severe endemic fluorosis areas and a village was randomly selected from each category of the area to carry out the monitoring of endemic fluorosis. Dental fluorosis of children aged 8 - 12 were examined and 6 copies of urine samples were randomly collected in each age group in the above-mentioned villages. Clinical skeletal fluorosis was diagnosed among adults aged 16 and over and 20 copies of urine samples were tested for fluorosis in every village.Results A total of 112 affected villages were investigated, among which the drinking water quality of 66 villages were improved and 46 villages were not improved. A total of 236 copies of water samples from the 66 villages were measured and the fluoride content ranged from 0.1 to 4.3 mg/L, among which 20 copies of water samples exceeded the fluorine standard of 1.2 mg/L, accounting for 33.3%. A total of 230 copies of water samples were collected in the 46 villages and the fluoride content ranged from 0.2 to 4.6 mg/L, among which 76.1% (35/46) of the water samples exceeded the fluorine standard of 1.2 mg/L. A total of 5169 children aged 8 - 12 were examined of dental fluorosis, the dental fluorosis rate was 36.43%(1883/5169) and the dental fluorosis index was 0.81. A sum of 71 497 adults aged over 16 years were examined, and the rate of skeletal fluorosis was 4.81%(3438/71 497), moderate or severe clinical detection rate of skeletal fluorosis was 1.56%( 1114/71 497). A total of 2876 copies of children urine samples and 2021 copies of adult urine samples were tested and the geometric mean of fluoride content was 2.30,3.32 mg/L, respectively. Conclusions The prevalence of dental fluorosis of children in the areas with improved water is less than 30% and the rate of dental fluorosis and skeletal fluorosis decline gradually with time.The rate of dental fluorosis and skeletal fluorosis increases with the increase of water fluoride in the water quality not improved areas. The endemic fluorosis is still comparatively serious in Hebei. The progress of improving water quality in the areas with endemic fluorosis should be accelerated and the acceptability of improved water should be enhanced.     

饮水氟含量对高碘危害的影响研究

目的了解饮水氟含量对高碘危害是否有影响。方法应用全国高水碘地区调查和全国饮水型氟中毒病区水氟筛查结果,进行数据分析。结果当饮水氟含量〉1.0 mg/L时,高碘地区和高碘病区的8～10岁儿童甲肿率均随着饮水氟含量而增加,饮水氟含量在1～2 mg/L之间时,儿童甲肿率最低。在高碘地区,当饮水氟含量〉1.0 mg/L时,8～10岁儿童尿碘中位数有随着水氟值增加而减少的趋势,而在高碘病区,儿童尿碘中位数呈现出无规律的变化。结论高氟可以加强高碘危害的程度,二者具有协同作用,而且氟的水平也有最适范围,并非越低越好。饮水氟含量是否对尿碘水平存在影响还需进一步研究。     

山西省浑源县农村饮用水卫生状况及地方性氟中毒病情监测结果分析

目的 了解浑源县农村饮用水卫生状况,评价高氟区改水降氟效果,为今后农村饮水安全工作提供依据.方法 2008-2010年,按照<中央补助山西省公共卫生专项资金农村改水项目实施方案>,在浑源县共选择54个监测点,采集水样,检测感官性状、理化、微生物等19项指标.同时抽取全县17个乡(镇)40个改水村进行水氟监测.2009年6月在浑源县抽取3个高氟村,对3个村中所有8～12岁儿童进行氟斑牙诊断(Dean 法),并抽取儿童尿样,进行尿氟测定,并对3个村的饮用水氟进行测定.水氟、尿氟测定均采用离子选择电极法.结果 3年共检测水样188份,合格率仅为35.1%(66/188),主要超标指标为菌落总数(109项)、总大肠菌群(47项)、耐热大肠菌群(39项)和氟化物(21项).共检测40个村160份饮用水,水氟超标率为12.50%(20/160).共对522名8～12岁儿童进行了氟斑牙诊断,氟斑牙检出率为7.66%(40/522),氟斑牙指数为0.16;共对74名8～12岁儿童进行了尿氟测定,尿氟几何均数为1.17 mg/L,范围为0.31～3.92 mg/L.结论 浑源县农村改水工作取得成效,但卫生状况较差,今后应加强水质监测和管理,确保农村饮用水安全.

Abstract：

Objective To investigate the sanitary status of rural drinking water in Hunyuan county, evaluate the effect of water improvement project to reduce fluoride in high fluoride areas, and to provide the basis for rural drinking water safety. Methods Between 2008 and 2010, in accordance with the "Rural water supply project implementation plan entral grant special funds for public health in Shanxi province", in Hunyuan county, 54 monitoring sites were selected, collected water samples. Water sample sensory properties, chemical, microbiological and other 19 indicators were tested. Forty project villages from 17 townships in Hunyuan county were selected to test water fluoride. June 2009 in Hunyuan county 3 high fluoride villages were chosen, all children aged 8 to 12 in the villages were examined of dental fluorosis (Dean method), and children's urine samples were collected to measured urinary fluoride. Water fluoride of the 3 villages was determined. Water and urinary fluoride were measured by fluoride ion-selective electrode method. Results In three years, a total of 188 samples were detected,with a pass rate of 35.1%(66/188), the main indicators that exceeded the standard were colony count(109 items), total coliforms (47 items), heat-resistant coliform bacteria(39 items) and fluoride(21 items). A total of 160 water samples in the 40 villages from the 17 townships were tested, the water fluoride excessive rate was 12.50%(20/160). A total of 522 children aged 8 to 12 were examined dental fluorosis, dental fluorosis rate was 7.66%(40/522), dental fluorosis index was 0.16; a total of 74 urinary fluoride of children aged 8 to 12 were measured, geometric mean was 1.17 mg/L, urinary fluoride range was 0.31 - 3.92 mg/L. Conclusions The drinking water improvement project in Hunyuan county rural areas has been successful, but sanitary conditions is poor. Water quality monitoring should be strengthened to ensure safe drinking water in the areas.     

许昌市饮水型地方性氟中毒病区控制评价

目的为评价氟中毒病区控制效果并对未控制病区村原因进行分析,为下一步防治提供科学依据。方法调查全部氟中毒病区村改水工程运行状况、水氟含量、8-12岁儿童氟斑牙情况,并收集病区村历年监测数据进行分析。结果许昌市病区村改水工程正常运转且水氟合格率95.14%,8-12岁儿童氟斑牙患病率为14.44%,病区村控制率为84.14%。40.00%的未控制村水氟超标或5年内曾超标,54.29%的未控制村供水氟合格水≤5年,5.71%的未控制村供水氟合格水>5年。结论许昌市氟病区改水工程运行良好,防治效果明显。病区改水时间尚短和工程水氟超标是病区村不能控制的主要原因,整改超标工程和健康教育是下一步防治重点。