辽宁省地方性氟中毒的流行和防治现状

目的 了解辽宁省地方性氟中毒(简称地氟病)流行现状和防治措施落实情况.方法 对改水和未改水饮水型地氟病病区分层抽样开展饮用水含氟量筛查和8-12岁儿童氟斑牙,16岁以上成人临床氟骨症病情普查,检测8-12岁儿童志愿者尿氟.结果 全省普查842个未改水村(屯)和1829个改水村(屯),未改水村(屯)居民饮用水水氟0.01-7.10 mg/L,平均(0.96±0.64)mg/L,29.2%(246/842)的未改水村(屯)饮用水含氟量＞1.2 mg/L,在1829个改水村(屯)中调查了1234个降氟改水工程,水氟0.06-7.67 mg/L,工程正常运行且水氟≤1.2 mg/L的工程占调查工程的68.31%(843/1234),已改水村(屯)有31.69%(391/1234)的工程没有发挥其降氟改水作用.普查12127名8-12岁儿童和85 636名16岁以上成人,儿童氟斑牙检出率为24.4%(2960/12 127),成人临床Ⅱ度及以上氟骨症检出率为2.22%(1900/85 636).轻,中,重病区儿童氟斑牙检出情况比较,差异有统计学意义(X2＝19.25,P＜0.01),重病区儿童氟斑牙检出率较高,个别未改水的重病区村(屯)儿童氟斑牙检出率达到100%,成人临床Ⅱ度及以上氟骨症检出率为18.03%(97/538).重病区和轻病区(未改水及工程报废)儿童尿氟中位数分别为2.01,2.00 mg/L.结论 辽宁省未改水的饮水型地氟病中,重病区的病情仍然十分严重,工程停运或报废病区仍亟须落实降氟改水防治措施.     

广东省韶关市饮水型氟中毒现状调查

目的了解改水后广东省韶关市所辖乐昌市和始兴县地方性氟中毒(地氟病)病区病情现状。方法采用流行病学调查方法,8～12岁儿童氟斑牙采用Deans法分度诊断；饮水氟测定采用离子选择电极法。结果乐昌市廊田镇岩前村委的5个村饮冷泉水的水氟均值1．63mg/L,8～12岁儿童氟斑牙检出率44．45%,16岁以上人群氟骨症临床检出率3．80%,氟骨症X线临床检出率8．0%。始兴县的6个病区村改水后饮水氟范围在0．23～0．59mg/L,8～12岁儿童氟斑牙总检出率8．61%；罗坝镇廖屋村饮水氟均值为2．10 mg/L,8～12岁儿童氟斑牙检出率68．75%。结论乐昌市廊田镇岩前村委5个饮用冷泉水的自然村为饮水型氟中毒轻病区；始兴县罗坝镇廖屋村还是饮水型地氟病病区,需要改换饮用水源,才能控制地氟病的流行。     

辽宁省饮水型地方性氟中毒病区病情调查

目的掌握辽宁省饮水型地方性氟中毒的流行现况,评价改水措施的防病效果。方法按病区分层抽取的85个病区村进行8-12岁儿童氟斑牙、16岁以上成人临床氟骨症的普查,采集饮用水和儿童尿样进行氟含量的检测。结果抽样病区8-12岁儿童氟斑牙检出率为16.74%,尿氟几何均值0.97 mg/L。8-12岁儿童氟斑牙检出率重病区高于中病区,中病区高于轻病区,未改水病区儿童尿氟水平明显高于改水病区。16岁以上人群临床氟骨症检出率为4.98%,随着年龄的增长氟骨症检出率逐渐升高。结论地方性氟中毒病情随着病区水氟含量的增高而逐渐加重。     

贵州省燃煤型地方性氟中毒流行现状调查分析

目的全面了解贵州省燃煤型地方性氟中毒流行现状,为制定全省地方性氟中毒(地氟病)防制策略和规划提供基础资料。方法对全省燃煤地区的燃煤方式、食物干燥与保存方法、环境介质含氟量、8～12岁儿童氟斑牙和尿氟水平、成人氟骨症情况等进行横断面抽样调查。结果燃煤地区8～12岁儿童氟斑牙检出率为55.99%,16岁以上人群氟中毒临床症状体征阳性检出率为27.03%,其中临床氟骨症检出率为57.47%,重度氟骨症检出率为7.13%;病区主要分布在毕节地区、六盘水市、遵义市、安顺市、贵阳市、黔西南州、黔南州等7市(地、州),重病区主要分布在毕节地区和六盘水市,病区人口约1900万。结论贵州省地氟病流行现状仍然严峻,流行程度有所降低,但病区范围呈扩大趋势。     

内蒙古新巴尔虎右旗地方性氟中毒流行病学调查

目的 确定贝尔湖附近牧区是否是病区，搞清病情现状及摄氟来源。方法 现况流行病学调查，按Dean氏法调查8-12岁儿童氟斑牙患病情况；检查30岁以上成年人氟骨症患病情况；用氟离子选择电报法测定儿童尿氟、饮水氟、奶茶氟及砖茶氟含量，入户调查饮奶茶量，计算人均日饮奶茶摄氟量。结果 宝东和贝尔2个调查点儿童氟斑牙患病率分别为58．65％和66．00％：成人X线氟骨症检出率分别为39．33％和31．46％，以轻度和中度为主；饮水含氟量均值分别为4．37mg／L和4．12mg／L;奶茶氟含量均值分别为5．80mg／L和5．88mg／L；人均日饮奶茶摄氟量分别为8．70mg和9．50mg。结论 贝尔湖附近牧区是以饮水型为主的饮水饮茶混合型病区；饮水含氟量和奶茶含氟量及儿童尿含氟量均较高，达到重病区水平，但儿童氟斑牙和成人氟骨症相对较轻，其原因有待进一步研究。     

2008年福建省饮水型地方性氟中毒病区监测结果分析

目的了解福建省地方性氟中毒轻、中病区现状。方法按照分层整群抽样的原则,抽取轻病区村6个,中病区村4个作为调查点,每个调查点测定饮用水氟、8～12岁儿童氟斑牙和尿氟、对16岁及以上成人进行临床氟骨症检查和X线检查。结果10个病区村饮水氟均值均低于1.0 mg/L,9个村儿童氟斑牙低于30%,10个病区村儿童尿氟几何均数均未超过1.4 mg/L。临床氟骨症检出率4.42%,X线氟骨症检出率19.82%。结论饮水型氟中毒实施改水措施效果显著,临床与X线氟骨症诊断标准的衔接还有待于进一步探讨。     

山西省饮水型氟中毒重病区县病情现状调查

目的掌握目前山西省饮水型氟中毒(地氟病)重病区地氟病病情现状,为制定科学有效的防治策略提供可靠依据。方法根据山西省地氟病重病区的分布特点,选取4个重病区县(区),每个病区县(区)按照分层整群抽样的方法抽取调查点,对每个调查点8～12岁儿童氟斑牙及成人重度氟骨症患者患病情况进行临床检查；水氟、尿氟采用氟离子选择电极法。结果各县(区)改水任务完成情况相差较大,改水完成率最低的是15．71%,最高为76．36%。大部分改水病区的水氟与改水前相比呈下降趋势,盐湖区下降幅度最大。儿童尿氟均值2．71mg/L,各县(区)病区中儿童氟斑牙患病程度不一,最高检出率为86．91%,未发现成人重度氟骨症患者。结论山西省水氟状况有所好转,地氟病病区病情依然较重,今后应加大改水力度,保证工程质量,进一步提高防治效果。     

西安市饮水型地方性氟中毒病情调查结果分析

目的了解西安市饮水型地方性氟中毒(地氟病)病情现状,用于指导全市地氟病防治。方法Dean法进行儿童氟斑牙诊断,X线拍片检查氟骨症,离子选择电极法测定水氟、儿童尿氟。结果儿童氟斑牙患病率为31.53%,尿氟均值为1.41mg/L,成人氟骨症X线检出率为44.74%。结论西安市属于地方性氟中毒轻病区,但有些地方病情仍很严重,建议继续加强病区改水,只有长期提供合格的低氟水,病情才能得到有效控制。     

黑龙江省地方性氟中毒重点病区调查报告

目的为了解黑龙江省地氟病重病区的病情现状.方法于2001年9～10月份对地氟病重病区县林甸县、安达市、肇州县进行了抽样调查.结果 3县儿童氟斑牙患病率随病情程度加重,患病率呈上升趋势;儿童尿氟浓度与氟斑牙患病情况及病情程度呈现正相关关系,即随病区程度加重,病情加重,尿氟值升高3县水氟检测结果重病区水氟含量明显高于非病区.结论黑龙江省地氟病病情仍很严重,应加大防治力度.     

总摄氟量与儿童氟斑牙相关关系研究

目的探讨总摄氟量与儿童氟斑牙患病率间的剂量-效应关系及总摄氟量的基准剂量。方法选择江苏省某县新淮村（非病区村,饮水氟含量0.36±0.11mg/L）和瓦庙村（地方性氟中毒重病区村,饮水氟含量2.46±0.80mg/L）所有在校的8～13岁儿童为调查对象,并根据儿童总摄氟量的不同将两村儿童分为5个不同的接触组,即：〈1.00mg/人·日、1.00～mg/人·日、2.00～mg/人·日、3.00～mg/人·日、≥4.00mg/人·日5组,分别统计各组儿童的氟斑牙和缺损型氟斑牙患病率。结果随着总摄氟量的增加,儿童氟斑牙和缺损型氟斑牙患病率逐渐增加,呈显著的剂量-效应关系。根据总摄氟量与氟斑牙和缺损型氟斑牙患病率间的剂量-效应关系计算的总摄氟量的基准剂量的95%下限分别为1.40mg/人·日和1.78mg/人·日,由此所得的总摄氟量的参考剂量分别为1.40mg/人·日和1.78mg/人·日。结论本次研究所得的总摄氟量的参考剂量低于国家卫生行业标准中规定的饮水型氟中毒病区8～15周岁儿童的总摄氟量的允许限量。因此,该标准在本次调查地区是否适用值得商榷。     

2006-2010年吉林省地方性氟中毒监测结果分析

目的 掌握吉林省地方性氟中毒病情变化,为调整防治策略提供科学依据.方法 2006-2010年,采用分层整群抽样方法,每年在全省14个病区县的轻、中、重病区中抽取5个屯作为监测点.水氟、尿氟测定采用离子选择电极法(GB/T 8538-1995);8～12岁儿童氟斑牙诊断采用Dean法;氟骨症诊断2006-2008年采用<地方性氟骨症临床分度标准>(GB 16396-1996),2009、2010年采用<地方性氟骨症临床诊断标准>(WS192-2008).结果 共监测25个病区屯,其中改水屯14个,常住人口8005人,受益人口7154人,占常住人口的89.37%;未改水屯11个.按照<国家生活饮用水卫生标准>要求,14个改水屯居民饮用水含氟量均合格(≤1.20 mg/L),14个改水屯学校中有3个饮水含氟量超标;检测11个未改水屯饮用水含氟量,有7个超标.共检查改水屯8-12岁儿童363人,氟斑牙检出率为39.12%(142/363);未改水屯303人,氟斑牙检出率为43.89%(133/303).共检查改水屯16岁以上成人6424人,氟骨症检出率为6.27%(403/6424);未改水屯3572人,氟骨症检出率为13.89%(496/3572).已改水的中、轻病区16岁以上成人氟骨症患者和8-12岁儿童的尿氟几何均值均在正常参考值(WS/T 256-2005,1.40 mg/L)以下.结论 吉林省改水病区氟中毒病情已得到一定程度的控制,未改水病区氟中毒病情仍然较重,氟中毒防治任务仍很艰巨.

Abstract：

Objective To identify changes in the occurrence of endemic fluorosis in order to provide scientific basis for making countermeasures. Methods Five villages from 14 counties of mild, moderate and severe fluorosis affected areas were selected by stratified cluster sampling every year in the whole province during 2006 - 2010. Water and urinary fluorine were determined by ion selective electrode method(GB/T 8538-1995); dental fluorosis of children 8-12 years old was diagnosed with Dean method; skeletal fluorosis was diagnosed according to "clinical indexing standards of endemic skeletal fluorosis "(GB 16396-1996), between 2006 and 2008, and "clinical diagnosis standard of endemic skeletal fluorosis"(WS 192-2008) between 2009 and 2010. Results A total of 25 diseased villages were surveyed, 14 with water sources changed, covered a resident population of 8005 people, beneficiary population 7154, and accounting for 89.37% of the resident population; not changed villages 11. In accordance with the "State drinking water health standards", in the 14 changed villages the fluoride in drinking water was qualified (≤ 1.20 mg/L), there were 3 schools whose water fluorine content exceeded the standard; among the 11 villages that did not change water sources 7 drinking water samples fluorine content exceeded the standard. Of the 8 to 12 years old children in villages with changed water sources, 363 of them were checked and 142 dental fluorosis were found, the detection rate of dental fluorosis was 39.12% (142/363); in villages with water sources not changed, 303 children were checked, the detection rate of dental fluorosis was 43.89%(133/303). Of sixteen and elder adults in water source changed villages, 6424 people were checked and 403 skeletal fluorosis were found, skeletal fluorosis detection rate was 6.27% (403/6424); 3572 people were checked in not changed villages, the detection rate of skeletal fluorosis was 13.89%(496/3572). In water sources changed areas, geometric mean of urinary fluoride was in the normal reference value(WS/T 256-2005, 1.40 mg/L)or less. Conclusions Endemic fluorosis is decreased in water improved areas, but in unimproved areas the disease is still severe, and control of endemic fluorosis is still an arduous task.     

河南省2011年饮水型地方性氟中毒流行状况

目的了解河南省饮水型氟中毒病区病情现状,为防治工作提供科学依据。方法按照《河南省2010年地方病防治项目技术方案》要求,在饮水型氟中毒病区抽取10个县(区),在每个县(区)随机抽取10个降氟改水工程,采用分层抽样方法按照轻、中、重原则随机抽取3个病区村。进行水氟含量及8～12岁儿童氟斑牙患病情况监测。结果在10个县(区)共监测100个降氟改水工程,99个能正常运行,改水工程水氟含量超标率21%(21/100)。共调查30个病区村,其中8个为已改水病区村,降氟改水工程水氟含量全部合格,8～12岁儿童氟斑牙的总检出率52.71%(496/941),缺损率5.84%(55/941),氟斑牙指数1.19,流行强度中等;22个为未改水病区村,8～12岁儿童氟斑牙检出率为47.34%(1015/2144),缺损型氟斑牙检出率为13.29%(285/2144),氟斑牙指数为1.15,流行强度中等。结论河南省改水工程水氟含量超标现象依然严重,氟中毒危害仍然较重。因此,应加强改水工程建设的科学论证和竣工时工程验收,杜绝不合格工程投入使用;坚持定期开展水质监测,对水质超标工程及时进行整改。     

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.     

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.     

2008年陕西省饮水型地方性氟中毒调查分析

目的 掌握2008年陕西省饮水型地方性氟中毒流行现状,为防治工作提供依据.方法 根据陕西省饮水型地方性氟中毒历史资料,将榆林、渭南、咸阳市15个病区县(区)按照饮水含氟量或病情分为轻、中、重病区,在上述病区分别抽取12、39、45个调查村.对每个调查村全部8～12岁儿童进行氟斑牙检查,对16岁及以上人群进行I临床氟骨症检查.在轻、中、重病区中分别抽取30%的调查村,每个村抽取男女各10人进行X线氟骨症检查;在未改水调查村,按东、西、南、北、中采5份水样,水源不足5个的全部采集,对已改水调查村,采3份末梢水样及1份水源水样,水氟测定采用氟离子电极法.在各病区中抽取50%的调查村,每个村采集8～12岁儿童尿样30份,每个年龄组6份,总数不足30人或各年龄组不足6人时全部采集其尿样,采用氟离子电极法测定尿氟.结果 共调查8～12岁儿童3652人,检出氟斑牙患者1930例,检出率为52.85%,氟斑牙指数为1.22.其中定边、靖边、蒲城县的检出率较高,分别为90.43%(170/188)、82.89%(126/152)、80.65%(325/403).共调查16岁及以上成人加543人,检出临床氟骨症患者5935例,总检出率为14.64%.轻、中、重度检出率分别为9.17%(3717/40 543)、4.36%(1769/40 543)、1.11%(449/40 543).X线拍片706例,检出阳性人数280例,总阳性率为39.66%.轻、中、重度阳性率分别为17.28%(122/706)、17.00%(120//06)和5.38%(38/706).采集饮用水水样427份,水氟为(2.22 ±1.41)mg/L,超标率为85.01%(363/427).采集儿童尿样1393份,尿氟中位数为2.37 mr/L.结论 陕西省饮水型氟中毒流行仍然较为严重,改水防治措施应进一步加强和完善.、     

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.     

贵州省燃煤型地方性氟中毒流行病学调查

目的　评价贵州省地方性氟中毒 (地氟病 )流行现状、影响因素及防制效果。方法　采用横断面调查方法 ,2 0 0 1年 5～ 9月对全省燃煤地区乡镇中心小学 8～ 12岁学生氟斑牙患病情况进行了调查 ,同时对原烧柴地区进行了地氟病线索调查。结果　在 85 7个乡镇中调查 772个 (受检率 90 .0 9% ) ,查出病区乡 5 92个 (检出率76 .6 8% ) ,其中轻病区乡 5 19个 (占 87.6 7% ) ,中病区乡 4 9个 (8.2 8% ) ,重病区乡 2 4个 (4.0 5 % )。病区人口约190 0万人 ,全省燃煤地区 8～ 12岁儿童氟斑牙患病率为 5 6 % ,缺损率为 6 .5 % ,推算 8～ 12岁氟斑牙儿童约 110万人。重病区仍然主要分布在省境内西北地区的毕节地区和六盘水市。与 1986年调查结果比较 ,儿童氟斑牙患病率 <30 %的乡镇无明显变化 ,30 %～ 80 %的乡镇检出率增高 ,而 >80 %的乡镇数明显减少。在约 4 0 %的由烧柴转为烧煤的乡镇发现氟中毒病人。结论　贵州省地方性氟中毒流行得到明显控制 ,但形势仍然严峻 ,病区有扩大趋势。     

河南省燃煤污染型地方性氟中毒流行现况调查

目的 掌握河南省燃煤污染型地方性氟中毒(简称地氟病)流行现状,为地氟病的防治工作提供依据.方法 2006、2007年对河南省13个县(市、区)的1832个历史燃煤污染型地氟病病区村燃煤情况、生活习惯、主食、住房结构、水氟等因素进行普查,对仍使用高氟煤的216个村进行重点抽样调查,每村对8～12岁全部儿童进行氟斑牙检查,并采集30份即时尿样检测尿氟.结果 所有历史病区村饮水含氟量<1.0 mg/L;有独立厨房的居民户占93.7%(241 281/257 393),炉灶有排烟设施的占41.9%(107 917/257 393),使用当地高氟煤做饭的户数占28.6%(73 686/257 393);使用当地高氟煤取暖的户数占24.1%(61 924/257 393);主食来源为自产,占病区村的95.7%(1753/1832),均采用自然晾晒的方式干燥粮食;16.2%(35/216)的病区村8～12岁儿童氟斑牙检出率>30.0%,全部集中在洛阳市;77.8%(168/216)的病区村儿童尿氟≤1.50 mg/L.结论 河南省燃煤污染型地氟病病区范围已大大缩小,危害程度明显减轻.其中8个县(市、区)历史病区村8～12岁儿童氟斑牙病情已经达到了病区控制标准,有5个县(市、区)未达到控制标准,集中分布在洛阳市.     

2008年黑龙江省饮水型地方性氟中毒病区成人颈动脉粥样硬化病情调查

目的 调查黑龙江省饮水型地方性氟中毒(简称地氟病)病区成人颈动脉粥样硬化病情,探讨饮水型氟中毒与颈动脉粥样硬化发生的关系.方法 2008年,在黑龙江省肇州县选取4个饮水含氟量≥1.0 mg/L的自然村作为病区组,在泰来县选取4个饮水含氟量＜1.0 mg/L的自然村作为对照组.用B超对40岁以上居民进行了颈动脉粥样硬化检查,保留超声图片并做记分、诊断、评分.结果病区组4个村(新丰村、太平山村、宝产村和后郑村)共检查266人,颈动脉粥样硬化检出率分别为47.3%(35/74)、63.5%(40/63)、73.3%(33/45)、60.7%(51/84);对照组4个村(哈拉村、乾兴村、三家村、爱林村)共检查283人,颈动脉粥样硬化检出率分别为32.7%(17/52)、32.9%(24/73)、39.2%(31/79)、30.4%(24/79),两组间检出率比较,差异有统计学意义(T=26,P＜0.05);病区村与对照村按年龄标准化后的颈动脉动脉粥样硬化检出率分别为47.3%、63.5%、73.3%、60.7%,34.7%、36.3%、43.0%、41.3%,两组间预期阳性率[57.5%(153/266)、37.8%(107/283)]比较,差异有统计学意义(x2=21.36,P＜0.01);按年龄标准化的颈动脉粥样硬化病例病变严重程度两组间比较,差异有统计学意义(x2=36.15,P＜0.01).结论饮水型地氟病病区成人颈动脉粥样硬化的检出率高于对照,病变程度重于对照,高氟与动脉粥样硬化的发生存在一定的关系.     

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.