内蒙古呼伦贝尔市饮茶型氟中毒调查与分析

目的了解呼伦贝尔市牧区饮茶型氟中毒病区分布、病情程度、氟骨症X线特征等流行病学特点。方法采用现场流行病学调查方法,在呼伦贝尔市牧区4个旗调查儿童氟斑牙、成人氟骨症、儿童和成人尿氟以及砖茶氟、奶茶氟、水氟水平。结果8～12岁儿童氟斑牙检出率均为29.34%;成人氟骨症X线检出率平均为46.71%;儿童尿氟在0.18～10.60mg/L,成人尿氟在0.11～10.40mg/L;砖茶氟平均为(569.45±65.50)mg/kg,奶茶氟平均为2.5mg/L。结论呼伦贝尔市牧区4个旗均为饮茶型氟中毒病区,部分病区还并存饮水型氟中毒,由于叠加作用,造成呼伦贝尔市氟中毒病情比较严重。     

2007年新疆塔城地区饮茶型氟中毒调查报告

目的了解饮用高氟砖茶对居民身体健康的危害,掌握饮茶型氟中毒的地区分布及人群分布情况。方法调查县（市）根据牧区、农业区、半农半牧区及城镇分层,各随机抽取1个乡（镇、场）,每个乡镇调查成人、8-12岁儿童各100名。检查氟斑牙、氟骨症,测定水、茶、尿氟含量。结果调查成人2 006人,平均氟斑牙、氟骨症患病率分别为19.44%,6.33%。调查8-12岁儿童2 008人,平均氟斑牙患病率为19.02%。人均年砖茶消耗量为7.12 kg,人均日饮茶量为1 763 mL;饮水、茶水含氟量均值分别为0.46 mg/L,1.35 mg/L;成人、儿童尿氟均值分别为1.598 mg/L,1.262 mg/L。结论塔城地区存在饮茶型氟中毒病区。     

2007年山东省博兴县地方性氟中毒流行病学调查

目的 了解山东省博兴县地方性氟中毒的病情现状,为制订预防控制策略提供科学依据.方法 选择博兴县2个镇中的8个地方性氟中毒病村作为调查点.在每个调查点选择8-12岁儿童和30岁以上成年人作为调查对象.水、尿含氟量测定采用氟离子选择电极法,8-12岁儿童氟斑牙诊断采用Dean法,30岁以上成人氟骨症检查采用临床和X线摄片方法.结果 8个村的水氟均值均＞4.50 mg/L,最大值为5.78 mg/L;8-12岁儿童氟斑牙总检出率为90.70%(195/215),氟斑牙指数为2.15,缺损率为24.65%(53/215);30岁以上成人的氟骨症临床和X线检出率分别为30.71%(78/254)、16.54%(42/254);儿童和成人尿氟均值在1.50 mg/L以上的人数分别占98.95%(189/191)、97.92%(235/240),最高值分别为14.50、17.99 ras/L.结论 博兴县地方性氟中毒病情尚未得到控制,须进一步加大控制力度.     

2008年青海省饮水型地方性氟中毒病情调查分析

目的 掌握2008年青海省地方性氟中毒病情,为地方性氟中毒防治提供科学依据.方法 将青海省所有地方性氟中毒病村以改水前的水氟分为轻、中、重3类,分别抽取2、4、4个调查村.对未改水的村按东、西、南、北、中5个方位采集5份水样,测定水氟;对已改水病村,抽检3份末梢水样和1份水源水样测定水氟,水氟测定用<地方性氟中毒病区饮水氟化物的测定方法>;用Dean法对调查村所有8～12岁儿童进行氟斑牙检查,并按年龄段各抽检6人的尿氟;尿氟测定采用离子选择电极法;对调查村16岁及以上成人进行临床氟骨症检查,在中等病区和重病区调查村,每村按年龄段抽取约20人进行X线氟骨症检查.结果 共检查8～12岁儿童562名,氟斑牙检出率为43.59%(245/562);检测300例8～12岁儿童尿样,尿氟为1.52 mg/L:对3144名16岁以上成人进行临床氟骨症检查,临床氟骨症检出率为50.32%(1582/3144);对163名成人进行了X线拍片检查,氟骨症检出率为29.45%(48/163).结论 青海省地方性氟中毒病情仍然很严重,并且有回升趋势,须进一步加强防治措施.     

2007年内蒙古察右后旗饮茶型氟中毒调查报告

目的 了解饮用高氟砖茶对居民身体健康的危害,掌握饮茶型氟中毒的地区分布及人群分布情况. 方法 选择水氟低于2 mg/L的4个乡镇的8个行政村,每个乡镇调查成人、8～12岁儿童各100名.检查氟斑牙、氟骨症,测定水、茶、尿氟含量. 结果 调查成人412人,平均氟斑牙、氟骨症患病率分别为32.8%,7.77%.调查8～12岁儿童451人,平均氟斑牙患病率为29.5%.人均年砖茶消耗量为3.14 kg,人均日饮茶量为1 269 mL;饮水、茶水含氟量均值分别为1.17 mg/L,2.65 mg/L;成人、儿童尿氟均值分别为2.453 mg/L,0.922 mg/L. 结论 察右后旗存在饮茶型氟中毒病区.     

2007年青海省饮茶型氟中毒流行现状与居民饮食结构调查

目的 调查青海省饮茶型氟中毒流行现状,了解居民饮食结构,为预防控制和科研工作提供科学依据.方法 2007年,依据全国<饮茶型地方性氟中毒流行现状调查方案>,结合青海省具体情况对28个县进行调查,每个县抽查3个乡、1个镇,每个乡(镇)抽查2个行政村(居委会),每个村(居委会)抽查50名成人、50名学龄儿童;同时每个县抽查1座寺院,每座寺院抽查成人僧侣50名、儿童僧侣50名.人户调查居民经济收入、饮食结构、砖茶消耗量等.对全部调查对象用Dean法诊断氟斑牙,对同仁、达日、互助县和隆务寺16岁以上成人用200 mA X线机拍片诊断氟骨症,并用调查结果估算全省饮茶型氟中毒的患病人数.结果 ①居民家庭年人均收入大部分在500～<1000元,其次在1000～<3000元;牧业区居民经济收入略高于农业区、半农半牧区和城镇居民.②居民饮食结构,牧业区及半农半牧区主食以面粉为主,其次是糌粑及大米;农业区及城镇主食以面粉为主,其次是大米及糌杷;各地区副食均为肉制品占多数,其次为奶制品,蛋类比例很小.③经常食用的蔬菜为土豆、白菜及青椒,每日食用的家庭占62.82%(6497/10 343);水果以苹果、梨及橘子为主,每月食用不足10次的家庭占75.95%(7856/10 343).④共调查居民61 999人,年砖茶消耗量为153 335 kg,人均2.47 ks;共调查僧侣1001人,年砖茶消耗量为4120 kg,人均4.12 kg.⑤乡镇成人氟斑牙检出率为24.11%(2494/10 343),儿童氟斑牙检出率为24.38%(3012/12 355);成人僧侣氟斑牙检出率为26.13%(203/777),儿童僧侣氟斑牙检出率为39.73%(89/224).⑥乡镇成人氟骨症检出率为15.60%(17/109);成人僧侣氟骨症检出率为4.88%(2/41).⑦氟斑牙患者95%可信限估算总人数为1 084 306～1 134 170人.中位数为1 109 238人;氟骨症患者95%可信限估算总人数为309 177～758 199人,中位数为533 688人.结论 青海省砖茶消耗量较大,饮茶型氟中毒人数多,危害程度比较重;居民饮食结构比较单调,主要靠外地运输.     

2007年青海省地方性氟中毒国家监测点监测报告

目的 掌握青海省地方性氟中毒病区改水降氟措施落实进度和病情现状及发展趋势,为政府部门制订防治措施提供依据.方法 在青海省互助县普查改水防氟工程使用情况,同时以互助县蔡家堡乡岩崖村作为监测点,检测该村生活饮用水,8-12岁儿童及16岁以上成人氟斑牙和尿氟,成人临床及X线氟骨症.水氟和尿氟测定采用氟离子电极法,氟斑牙诊断用Dean法,氟骨症诊断按国标(GB 16396-1996,WS 192-1999)进行.结果 互助县有60个病区村,其中有36个村实施了改水,改水率为60%.监测点岩崖村水氟均值为1.25 mg/L(国家标准＜0.05 mg/L),儿童氟斑牙检出率为90.20%(46/51),成人为88.89%(48/54),儿童氟斑牙指数为1.77,成人为2.95,儿童尿氟几何均数为2.27 mg/L,成人为2.00 mg/L,成人氟骨症临床检出53例,检出率为98.15%(53/54),X线检出10例,检出率为18.87%(10/53).结论 青海省地方性氟中毒病情重,降氟措施落实缓慢.     

西藏拉萨市饮茶型氟中毒流行现状调查分析

目的 了解饮茶型氟中毒对人体的危害,为制订有效防治措施提供科学依据.方法 2008年,选择西藏拉萨市的7个县作为调查县,每个县抽取4个乡(其中城关区2个乡)、每个乡抽取2个行政村作为调查村.调查监测村所有8～ 12岁学生氟斑牙患病情况,氟斑牙诊断采用Dean法,同时采集尿样,尿氟测定采用尿中氟的离子选择电极法(WS/T 30-1996),依据《人群尿氟正常值》(WS/T 256-2005)进行评价.对监测村18周岁以上人群,按～25、～35、～45、～ 55和56～分为5个年龄段,每个年龄段抽取不少于10人,进行临床氟骨症检查,诊断采用地方性氟骨症诊断标准(WS 192-2007).每个调查点采集居民饮用水,以及所有调查对象日常饮用的砖茶水进行水氟测定,水氟测定采用离子选择电极法.结果 ①儿童氟斑牙:共对723名8～12岁儿童进行氟斑牙检查,检出氟斑牙患者91例,检出率为12.58％,氟斑牙指数为0.34;②成人氟斑牙:共对2626名成人进行氟斑牙检查,检出氟斑牙患者998例,检出率为38.00％,氟斑牙指数为0.71;③成人临床氟骨症:共对2626名成人进行了临床氟骨症检查,检出Ⅱ度以上患者15人,检出率为0.57％;④儿童尿氟:共采集测定儿童尿样700份,尿氟几何均数为1.97 mg/L,范围为0.01 ～ 17.56 mg/L;⑤成人尿氟:共检测成人尿样2626份,尿氟几何均数为2.16 mg/L,范围为0.01～-56.87 mg/L;⑥水氟:共检测水样52份,其中有15份水样的水氟含量范围超标;⑦茶氟:各县共检测2000份茶水样品,茶水氟中位数为2.38 mg/L,范围为0.03～56.87 mg/L.结论 氟斑牙、氟骨症、尿氟增高与调查点饮用茶水氟含量有直接关系.     

理县饮茶型氟中毒流行病学调查

目的 了解理县饮茶型氟中毒病情范围与流行状况.方法 采集饮用水样、(砖)茶水样和尿样用氟离子选择电极法检测氟含量,氟斑牙诊断采用Dean氏诊断标准,氟骨症诊断按照地方性氟骨症临床诊断标准.结果 饮用水样氟含量均符合国家饮用水卫生标准(1.0 mg/L);400份(砖)茶水氟含量均值为1.59 mg/L.400名8～12岁儿童氟斑牙检出率29.25％,尿氟算术均数为0.43 mg/L;400名16岁以上成人氟斑牙检出率46.25％,临床氟骨症检出率32.25％;400份成人尿氟算术均数为0.73 mg/L.结论 理县为饮茶型氟中毒轻病区,加强病情监测和健康教育是防治饮茶型氟中毒的关键.     

2010年青海省果洛州饮茶型氟中毒监测分析

目的 了解青海省果洛州饮茶型氟中毒的病情现状,为制订预防控制策略提供科学依据.方法 2010年选择青海省果洛州玛沁、达日2个县为调查点,按照东、西、南、北、中5个方位,各抽取1个乡(镇),在每个乡(镇)抽取1个村,以村中全部8～ 12岁在校儿童和36～45岁成年人作为调查对象.采用Dean法诊断儿童氟斑牙,对成人进行前臂、小腿X线摄片,按《地方性氟骨症临床分度诊断标准》(WS 192-2008)进行诊断.每个监测村抽取10户家庭采集砖茶样品,用氟离子选择电极法测定砖茶含氟量.结果 玛沁、达日县儿童氟斑牙检出率分别为11.43％(32/280)、3.77％(6/159);成人氟骨症X线检出率分别为16.36％(9/55)、34.38％(11/32);砖茶含氟量均值分别为492.71、517.36mg/kg,均超过国家标准(300 mg/kg).结论 果洛州饮茶型氟中毒病情尚未得到有效控制,须进一步加大预防控制力度.     

2008年江苏省苏北地区饮水型地方性氟中毒病情监测结果分析

目的 掌握江苏省苏北地区饮水型地方性氟中毒(简称地氟病)病情及降氟改水工程使用情况.为进一步开展地氟病的防治工作提供科学依据.方法 2008年,在徐州、连云港、宿迁市的10个饮水型地氟病重点县(区),按照以往水氟调查资料,采用分层抽样的方法,抽取40个病区村,对所有8～12岁儿童进行氟斑牙检查;对所有16岁以上成人进行临床氟骨症检查.在40个病区村中,抽取30%的病区村,每个病区村选择20名16岁以上成人进行X线氟骨症检查,抽取50%病区村,每个村采集30名8～12岁儿童的任意一次尿样 检测尿氟.在每个市,选择1个县,对分层抽样方法抽取剑的病区村的改水工程现状、供水能力及覆盖范围等进行调查.结果 共计对3560名8～12岁儿童进行氟斑牙检查,检出率为38.51%(1371/3560).缺损率为5.34%(190/3560),氟斑牙指数为0.8;共抽取708份尿样,尿氟中位数为1.47 mg/L,范围为0.08～10.08 mg/L;16岁以上成人临床氟骨症检出率为21.3%(1294/6083),X线氟骨症检出率为39.2%(123/314).共调查了248个集中式改水设施,无经费运行或损坏的有49个,水氟>1.0 mg/L的有18个.结论 江苏省苏北地区饮水型地氟病病情尚未完全控制,并有回升趋势,须进一步加强降氟改水监管力度.

Abstract：

Objective To investigate the state of endemic fluorosis, running status of water improvement project to reduce fluoride in Jiangsu province, and to provide a scientific basis for prevention and control of endemic fluorosis. Methods In 2008, in the ten key counties of endemic fluorosis (zone), in Xuzhou,Lianyungang and Suqian, a stratified sampling method was employed to select 40 diseased villages according to their past water fluoride survey data. All children aged 8 to 12 were examined dental fluorosis, and all adults over 16 years were examined clinical skeletal fluorosis. Thirty per cent of the 40 diseased villages were selected, and 20 adults over the age of 16 in each selected village were examined by X-ray, respectively;50% of the 40 diseased villages were selected, and 30 any time urine samples of children aged 8 to 12 in each diseased village were tested urine fluoride. In each city, select a county, the status of water improvement project to reduce fluoride, water supply capacity and coverage in the county were investigated. Results A total of 3560 children aged 8 to 12 were examined, the detection rate of dental fluorosis was 38.51% (1371/3560), tooth defect rate was 5.34% (190/3560), and dental fluorosis index was 0.8. Seven hundred and eight urine samples were tested, the median urinary fluoride was 1.47 mg/L and the range was 0.08 ~ 10.08 mg/L. Clinical detection of skeletal fluorosis was 21.3% among adults over the age of 16, and X-ray detection rate of skeletal fluorosis was 39.2% (123/314).Investigated a total of 248 facilities of centralized water improvement projects, no funds to run or damaged 49, the water fluoride > 1.0 mg/L was 18. Conclusions Endemic fluorosis in Northern Jiangsu province has not been controlled completely, but has a rising trend, we should further strengthen the supervision of water fluoride reduction.     

低氟砖茶对甘肃省阿克塞县饮茶型地方性氟中毒地区人群的干预观察

目的 观察低氟砖茶的人群干预效果,为饮茶型地方性氟中毒的预防控制提供参考.方法 在甘肃省阿克塞县饮茶型地方性氟中毒霞病区.选取有5～12岁儿童的哈萨克族家庭86户,分成两组:46户为干预组,投放低氟砖茶;40户为对照组,仍饮普通砖茶.在干预前及干预期间,监测干预组、对照组饮水、茶水、砖茶、尿的含氟量,通过茶水含氟量计算干预组、对照组成人和儿童日均总摄氟量;干预前对8～15岁在校哈萨克族儿童进行氟斑牙患病情况基线调查,干预结束后对干预组、对照组儿童进行氟斑牙检查.饮水、茶水、砖茶及尿液样品含氟量测定采用离子选择电极法,氟斑牙诊断采用Dean法.结果 干预前、干预42个月时,居民饮水含氟量分别为0.36、0.50 mg/L.成人及儿童日总摄氟量,干预组(成人:4.39、5.12、5.38、4.49 mg,儿童:1.90、2.23、2.33、1.94 mg),明显低于对照组(成人:8.42、9.07、8.35、7.92,儿童:3.65、3.93、3.62、3.43 mg).监测低氟砖茶、市售砖茶各4批,4批低氟砖茶平均含氟量除第2批(530.4 mg/kg)较高外、其余3批(239.3、222.88、154.7mg/kg)均低于市售砖茶(366.9、412.2、286.0、379.6 mg/kg),4批共21份低氟茶样中有16份含氟量符合茶氟国家标准(<300 mg/kg),合格率为76.19%(16/21),4批市售砖茶21份茶样只有5份合格,合格率为23.80%(5/21),两组比较差异有统计学意义(χ2=11.52,P<0.01).干预12、36、42个月时,干预组成人(1.84、1.23、1.77 mg/L)和儿童尿氟(1.55、0.65、1.10 mg/L)均低于对照组(成人:3.37、3.68、3.02 mg/L,儿童:2.64、1.64、2.62mg/L),二者比较差异均有统计学意义(t值分别为2.94、2.43,3.91、3.29,2.31、4.42,P<0.01或<0.05).儿童氟斑牙基线调查的检}H率为69.02%(127/184),干预后干预组儿童氟斑牙检出率[44.83%(13/29)]明显低于对照组[71.88%(23/32);χ2=4.60,P<0.05].结论 饮低氟砖茶可降低饮砖茶人群总氟摄入量,减轻机体氟负荷和高氟危害.     

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.     

2006年四川省洪雅县燃煤污染型氟中毒监测结果分析

目的 了解四川省洪雅县燃煤型地方性氟中毒病区病情现况及食物、饮水含氟量.方法 对高庙镇和瓦屋山镇两所中心小学8～12岁儿童进行氟斑牙检查和尿氟测定:对高庙镇三星村20岁以上人口进行临床检查,并在花园村选取50名20岁以上成年人进行前臂和小腿部X线摄片,检查氟骨症;对高庙镇三星村、瓦屋山镇付田村的食物(腊肉、玉米、干辣椒)和三星村5户居民饮用水样进行含氟量检测.结果 高庙镇儿童氟斑牙检出率为40.76%(161/395),氟斑牙指数为0.86;瓦屋山镇儿童氟斑牙检出率为14.36%(82/571),氟斑牙指数为0.31.儿童尿氟中位数为0.81 mg/L,范围0.16～3.89 mg/L.氟骨症临床检出率为5.27%(27/512),X线检出率为4.00%(2/50).腊肉、玉米、:干辣椒含氟量中位数分别为6.00、0.64、1.49 mg/kg.居民饮用水含氟量为(0.14±0.06)mg/L,全部合格.结论 洪雅县目前病情较轻,病区范围明显缩小,环境氟对人体的致病强度降低.摄氟途径主要是食用被氟污染的腊肉,腊肉的含氟量在洪雅县病区具有流行病学意义,应加强干预措施,降低摄氟量.     

2009年青海省湟源县地方性氟中毒病情监测结果分析

目的 掌握青海省湟源县饮水型地方性氟中毒病情变化和防治措施落实效果.方法 2009年将湟源县所有地方性氟中毒病区村按改水前水含氟量分为轻、中两类,分别抽取1、2个病区村作为监测点,共抽取3个监测村;每村采集出厂水和末梢水水样进行水氟测定;对监测村所有8～12岁儿童进行氟斑牙检查,并按年龄组采集儿童尿样进行尿氟测定;对监测村16岁及以上成人进行临床氟骨症检查,并采集20人份的尿样,检测尿氟;在3个监测村中选择1个村进行X线氟骨症检查.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,尿氟测定采用氟离子选择电极法(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>(WS 192-2008).结果 共检测12份水样,水氟为(0.35 ±0.43)mg/L.共检查8～12岁儿童122名,氟斑牙检出率为34.43%(42/122);检测96例儿童尿样,尿氟几何均数为0.89 mg/L.对834名16岁及以上成人进行氟骨症检查,临床氟骨症检出率为47.72%(398/834):检测65例成人尿样,尿氟几何均数为1.10 mg/L;对甘沟村35名成人进行了X线氟骨症检查,检出率为31.4%(11/35).结论 湟源县的3个监测村饮用水含氟量正常,但氟中毒病情仍然很严重,应密切监测,分析原因,改进防治措施.

Abstract：

Objective To investigate the prevalence change of drinking water type of endemic fluorosis and the effect of control measures implemented in Huangyuan county of Qinghai province. Methods In 2009, all the endemic fluorosis villages in Huangyuan county were divided into two degrees, light and medium, according to the water fluorosis content before implementing the improving water project, 1 to 2 villages were selected from each degree village, respectively,as monitoring sites, and a total of 3 villages were selected. Source water and tap water samples were collected from each village and water fluoride concentration was determined. Dental fluorosis of all children aged 8 to 12 of monitoring villages was examined, and urine samples were collected by age group of children for determination of urinary fluoride. Clinical skeletal fluorosis of adults over 16 years of age was examined, and 20 copies of adults urine samples were collected to determine urinary fluoride. One village was selected in the 3 villages monitored to conduct X-rays examination of skeletal fluorosis. Water fluoride was tested in accordance with the "Non-metallic Targets Test Methods for Drinking Water" (GB/T 5750.6-2006); urinary fluoride was tested by fluoride ion-selective electrode method (WS/T 89-1996); dental fluorosis was diagnosed using Dean method;adult skeletal fluorosis was diagnosed by "Clinical Diagnostic Criteria for Endemic Skeletal Fluorosis"(WS 192-2008). Results Twelve water samples were assayed, water fluoride was (0.35 ± 0.43) mg/L. The detectable rate of dental fluorosis of 122 children aged 8-12 was 34.43%(42/122) and the geometric mean urinary fluoride was 0.89 mg/L of the 96 children. Of the 834 adults aged 16 and over, clinical detection of skeletal fluorosis was 47.72% (398/836) and geometric mean urinary fluoride was 1.10 mg/L of the 65 cases of adult urine samples assayed, detection rate of X-rays was 31.4% (11/35) in Gangou village of the 35 adults examined.Conclusions In Huangyuan county, water fluoride of the 3 surveyed villages are normal but the endemic fluorosis is still serious. It should strengthen monitoring and analyze the causes and improve prevention measures.     

2008年青海省贵德县地方性氟中毒病情监测结果分析

目的 掌握青海省贵德县地方性氟中毒病情与流行状况,进一步做好氟中毒监测防控工作.方法 2008年,选择贵德县大磨、温泉、保宁村(已改水村)和太平村(未改水村),分别采集枯水期和丰水期末梢水样各1份,按照<生活饮用水标准检验方法>(GB/T 5750.5-2006)检测水氟;对全部8～12岁儿童采用Dean法进行氟斑牙检查,每个年龄组抽检6人采集尿样,用氟离子选择电极法(WS/T 89-1996)检测尿氟;按照<地方性氟骨症诊断标准>(WS 192-2008),对16岁以上成人进行临床氟骨症检查,每个村抽取男女各10人,进行氟骨症X线诊断.结果 大磨、温泉、太平、保宁4个村水氟均值分别为0.58、0.38、2.28、0.57 mg/L,其中太平村水氟均值超过国家生活饮用水卫生标准(1.0 mg/L).共检查8～12岁儿童193人,儿童氟斑牙检出率为49.74%(96/193);共检测儿童尿样116份,尿氟中位数为1.49 mg/L.共检查16岁以上成人1503人,临床氟骨症检出率为51.63%(776/1503);共对82人进行X线拍片,X线氟骨症检出率为20.73%(17/82),X线表现以关节退行性改变及骨间膜骨化为主.结论 贵德县儿童氟斑牙和成人临床氟骨症检出率较高,氟中毒流行较重,防治形势刻不容缓.

Abstract：

Objective To investigate the prevalence of endemic fluorosis in Guide county of Qinghai province, in order to provide appropriate measures to monitor and control the disease. Methods Damo, Wenquan, Baoning villages(water source has been changed) and Taiping village(water source has not been changed) in Guide county were involved in the study in 2008. One tap water sample was collected in dry and rainy seasons, respectively. Water fluoride was tested in accordance with the "Standard Test Methods for Drinking Water" (GB/T 5750.5-2006); of all the children aged 8 to 12, dental fluorosis was diagnosed using Dean criteria; 6 copies of urine samples were collected in each age group, urinary fluoride was measured using fluoride ion-selective electrode (WS/T 89-1996). According to the "Clinical Diagnostic Criteria of Endemic Skeletal Fluorosis "(WS 192-2008), clinical skeletal fluorosis was determined in adults over the age of 16 by X-ray examination for 10 people in each selected village. Results The mean water fluoride was 0.58,0.38,2.28,0.37 mg/L in Damo, Wenquan, Taiping, and Baoning villages, respectively, and that of Taiping village exceeded the national standard(1.0 mg/L). One hundred and ninety-three children aged 8-12 were checked, the detection rate of dental fluorosis was 49.74% (96/193); urine samples of 116 children were tested, median urinary fluoride was 1.49 mg/L A total of 1503 adults over the age of 16 were examined, the clinical detection of skeletal fluorosis was 51.63%(776/1503); a total of 82 people were X-rayed, X-ray detection of skeletal fluorosis was 20.73%(17/82). The characteristic of X-rays were degeneration and ossification of interosseous membrane. Conclusions Prevalence of dental fluorosis of children and adult clinical skeletal fluorosis are higher. The endemic fluorosis is still comparatively serious. Prevention efforts need to be further strengthened.     

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.     

温泉型氟病区开展健康教育后防治效果分析

目的通过了解氟病区实施健康教育后，氟中毒患病情况，变化规律及效果，以便探索防制策略。方法调查健康教育方案实施前后氟巾毒患病情况，分别进行比较。调查内容包括患氟斑牙及氟骨症的人数：水、尿、土壤、农作物、空气巾含氟量。结果实施健康教育前儿童氟斑牙检出率95．7％（453／473），战人氟骨症检出率67．0％（110／164），成人及8～12岁学生尿氟均值分别为3．4、2．7mg／L，温泉水氟9．2mg／L，河流、池塘水氟0．6mg／C，土壤氟5．1mg／kg，室内空气禽氟量0．01mg／m^3。实施健康教育后，氟斑牙检出率6．9％（16／228），氟骨症检出率19．0％（19／100），成人及8～12岁学尿氟均值分别为1．1、1．0mg／L，河流、池塘水氟0．5mg／L，土壤氟5．2mg／kg，室内空气含氟量0．0lmg／m^3。结论实施健康教育后．温泉型氟病区由氟中毒中等病区达到了基本消灭区．开展健康教育是防治地氟病的重要措施。     

2009年陕西省饮水型氟中毒监测结果分析

目的 掌握陕西省饮水型氟中毒改水工程运行情况及降氟效果,为饮水型氟中毒防治工作提供科学依据.方法 2009年对陕西省西安、宝鸡和榆林3个市16个县48个自然村进行监测.在未改水村按东、西、南、北、中采集5份水样,在已改水村采集3份末梢水和1份出厂水,用氟化物离子选择电极法(GB/I'5750-2006)检测水氟.对监测村所有在校8～12岁儿童采用Dean法进行氟斑牙检查,16岁以上成人全部进行临床氟骨症检查,抽取30%的项目县,每个县选择1个村,对已诊断的临床氟骨症患者进行X线拍片检查,临床和X线氟骨症诊断采用<地方性氟骨症诊断标准>(WS 192-2007).每个村采集8～12岁儿童尿样30份、16岁以上成人尿样20份,用<尿中氟化物的测定离子选择电极法)(WS/T 89-1996)检测尿氟.结果 22处运行正常的改水工程中,出厂水超标8处,占36.36%(8/22);工程报废5处.共检测水样202份,已改水村出厂水和末梢水水氟中位数分别为0.72、0.62mg/L,水氟超标率分别为36.36%(8/22)、31.94%(23/72);未改水村水氟中位数为1.00 mg/L,水氟超标率为39.81%(43/108).8～12岁儿童氟斑牙检出率为16.06%(367/2285),氟斑牙指数为0.30,流行程度为阴性;16岁以上成人临床氟骨症检出率为5.09%(1542/30 272),共有198人拍摄X线片,阳性68人,检出率为34.34%(68/198).共检测儿童尿样1051份,尿氟几何均数为0.95mg/L;共检测16岁以上成人尿样914份,尿氟几何均数为1.16 mg/L.结论 陕西省饮水型氟中毒流行范围较大,病情程度较为严重,防治任务还很艰巨.进一步加大病区改水力度,加强病情监测、健康教育和改水工程的管理工作是防治地方性氟中毒的关键.

Abstract：

Objective To investigate the running conditions of the water improvement projects and the role of these projects in reducing fluoride in drinking-water type of fluorosis in Shaanxi province, and provide a scientific basis for prevention and control of the disease. Methods Forty-eight villages of 16 counties in Xi'an, Baoji, and Yulin cities of Shaanxi province were monitored in 2009. Five water samples were collected randomly in water unimproved monitoring villages by the position of east, west, south, north, and center parts. In water improved monitoring villages, 3 tap water and one source water samples were collected. Water fluoride was tested using fluoride ion selective electrode method according to the "Standard Testing Methods for Drinking Water" (GB/T 5750-2006). All school children aged 8 to 12 in monitored villages were examined their dental fluorosis using Dean criteria. All people over 16 years old were examined clinical skeletal fluorosis, and 30% of the project counties were randomly selected, then randomly selected one village among these counties, clinically diagnosed patients with skeletal fluorosis were examined again by X-ray using "Diagnostic Criteria of Endemic Skeletal Fluorosis"(WS 192-2007). Urine samples of 30 children aged 8 to 12 and of 20 adults over the age of 16 were randomly collected, urinary fluoride was tested according to "the Determination of Urinary Fluoride by Ion Selective Electrode Method" (WS/T 89-19%). Results Of the 22 water improvement projects that in normal operation, fluoride level of 8 source waters exceeded the standard, accounting for 36.36%(8/22), and projects scrapped 5. Two hundred and two water samples were tested. In water improved historical diseased areas, the median of water fluoride of source water and tap water were 0.72,0.62 mg/L, respectively, and the average rate of water fluoride exceeded the standard ere 36.36%(8/22) and 31.94%(23/72), respectively. In water unimproved historical diseased areas, the median of water fluoride was 1.00 mg/L, and the average rate of water fluoride exceeded the standard was 39.81%(43/108). Detection rate of dental fluorosis among children aged 8 to 12 was 16.06% (367/2285), dental fluorosis index was 0.30, and the prevalence was negative. Detection rate of clinical skeletal fluorosis among adults over 16 years old was 5.09%(1542/30 272), a totally of 198 people had X-ray film taken, positive 68, the positive detection rate was 34.34%(68/198). One thousand and fifty-one copies of children's urine samples were tested, geometric mean of urinary fluoride was 0.95 mg/L; nine hundred and fourteen copies of adults urine samples were tested, geometric mean of urinary fluoride was 1.16 mg/L Conclusions Drinking-water type of fluorosis affects a large area in Shaanxi province, the disease is still serious, and the task of prevention remains very arduous. Further intensify the water improvement project in diseased areas, and strengthen disease monitoring, health education and water improvement project management is the key to prevention and control of endemic fluorosis.     

2009年山东省地方性氟中毒监测结果分析

目的 了解山东省地方性氟中毒的病情现状,为制订防治策略提供科学依据.方法 按照国家<2008年地方病防治项目技术实施方案>的要求,在山东省选择34个县为项目县,各项目县将所有病区村按病情的严重程度分为轻、中、重3层,再在每一层各选择1个病区村,进行病情监测.水氟、尿氟测定采用氟离子选择电极法,8～12岁儿童氟斑牙诊断采用Dean法,16岁以上成人临床和X线摄片检查氟骨症.结果 在34个县中,调查70个改水村,水氟≤1.00 mg/L的村54个,占77.14%(54/70);＞1.00 mg/L的村16个,占22.86%(16/70);水氟最大值为4.46 mg/L.调查32个未改水村,水氟≤1.00 mg/L的村9个,占28.12%(9/32);＞1.00mg/L的村23个,占71.88%(23/32),水氟最大值为4.09 mg/L.8～12岁儿童氟斑牙总检出率为45.81%(1988/4340),氟斑牙指数为0.97,缺损率为6.91%(300/4340).儿童尿氟在1.40 mg/L以上的人数占55.33%(1417/2657),最高值为18.53 mg/L.16岁以上成人的氟骨症临床和X线检出率分别为4.25%(2462/57 968)、28.40%(23/81).成人尿氟在1.60 mg/L以上的人数占55.86%(1130/2023),最高值为25.44 mg/L.结论 山东省地方性氟中毒病情尚未得到有效的控制,防治形势依然比较严峻,须进一步加大防治力度.

Abstract：

Objective To investigate the current status of endemic fluorosis in Shandong province, and to provide the scientific evidence for making strategies for prevention and control of the disease. Methods According to "The National Technical Scheme for Endemic Disease Control in 2008", thirty-four counties 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. The content of fluoride in drinking water and urine was determined by F-ion selective electrode, dental fluorosis of children aged 8 to 12 was diagnosed by Dean method and skeletal fluorosis diagnosed by clinic and X-rays. Results The monitoring was done in 70 water-improving villages in 34 counties, among which 54 villages had water fluoride content ≤ 1.00 mg/L and accounted for 77.14%(54/70), 16 villages had water fluoride content ＞ 1.00 mg/L and accounted for 22.86%(16/70), the highest water fluoride content was 4.46 mg/L. The monitoring was also carried out in 32 non-water-improving villages in 34 counties, among which 9 villages had water fluoride content ≤ 1.00 mg/L and accounted for 28.12%(9/32), 23 villages had water fluoride content ＞ 1.00 mg/L and accounted for 71.88% (23/32), the highest water fluoride content was 4.09 mg/L. The total rate of dental fluorosis of children aged 8 to 12 was 45.81%(1988/4340), the index of dental fluorosis was 0.97 and the rate of dental damage was 6.91%(300/4340). The urinary fluoride values above 1.40 mg/L were found in 55.33%(1417/2657) of children aged 8 to 12, with the highest urinary fluoride concentrations was 18.53 mg/L. The rate of skeletal fluorosis by clinic and X-rays in adults older than 16 years were 4.25% (2462/57 968) and 28.40%(23/81 ), respectively. The urinary fluoride values above 1.60 mg/L were found in 55.86% (1130/2023) of adults older than 16 years, with the highest urinary fluoride concentrations was 25.44 mg/L. Conclusions Endemic fluorosis in Shandong province has not yet been effectively controlled,control situation is still grim. Prevention efforts need to be further strengthened.