地方性氟中毒病区人群氟性骨损伤致病风险评价

目的探讨地氟病区人群氟性骨损伤致病风险评价指标,通过风险评价,预测病情分布,分析致病因素,为氟危害控制策略的制定提供依据。方法通过现场流行病学调查,分析饮水氟、日摄氟量、累计总摄氟量和尿氟与氟性骨损伤发生率之间的关系,进行剂量-反应关系评价,得出特定接触剂量下引起地氟病区人群氟性骨损伤的各危险因素的基准剂量(BMD)、95%的可信限下限值(BMDL)及其参考剂量(Rf D)。结果氟性骨损伤的发生率随饮水氟、日摄氟量、累计总摄氟量、尿氟的增加而升高,线性趋势明显,差异均有统计学意义(P0.01);饮水氟、日摄氟量和尿氟的BMD分别为1.43 mg/L、4.47 mg/(人·d)、1.90 mg/L;BMDL为1.19 mg/L、2.94 mg/(人·d)、1.77 mg/L;Rf D为0.60 mg/L、2.94 mg/(人·d)、1.77 mg/L。结论改水后地氟病区氟接触人群氟性骨损伤致病风险仍与水氟含量、日摄氟总量、累计总摄氟量以及尿氟含量密切相关,建议进一步加强改水降氟措施,并结合机体排氟、改变生活方式、改善营养结构等方法进行预防,降低氟性骨损伤致病风险。

Evaluation on the risk of fluoride bone injury among the population in endemic fluorosis area

Objective To explore the risk assessment indicators of fluoride bone injury among the population in endemic fluoro- sis areas, to forecast the disease distribution and analyze the risk factors by risk evaluation so as to provide a basis for formulating the fluorine hazard control strategies. Methods With field epidemiological survey, we analyzed the relationship between the drinking water fluoride, daily fluoride intake, total cumulative fluoride intake, urine fluoride and the incidence of fluoridebone in- jury, evaluated the dose- response relationship, and obtained the benchmark dose （BMD）, benchmark dose lower- confidence limit （BMDL） and the reference dose （RfD） of the risk factors for fluoride bone injury on certain exposure levels. Results The incidence of fluoride bone injury elevated with the increase of drinking water fluoride, daily fluoride intake, total cumulative fluoride intake and urine fluoride; moreover, the linear trend was clearly, and the differences were statistically significant （P〈 0.01）. The BMDs of drinking water fluoride, daily fluoride intake and urine fluoride were 1.43 rng/L, 4.47 mg/（person· day） and 1.90 rag/L; the BMDGs were 1.19 mg/L, 2.94 mg/（person· day） and 1.77 mg/L; and the RfDs1N were 0.60 mg/L, 2.94 mg/（person· day） and 1.77 mg/L. Conclusions The risk of fluoride bone injury in the population exposed to endemic fluoro- sis is still closely related to drinking water fluoride, daily fluoride intake, total cumulative fluoride intake and urine fluoride after the water- improvement. To reduce the risk of fluoride bone injury, we propose to further strengthen the water- improvement measures and implement the preventive countermeasures, such as fluoride exclusion, change of lifestyle and improvement of nutri- tion structure.