2006和2007年吉林省地方性砷中毒全国重点监测结果分析

目的 了解2006和2007年吉林省地方性砷中毒全国重点监测县(通榆)和所属监测点(白音吐海村)地方性砷中毒(地砷病)现状、防治措施落实情况及防治效果.方法 2006和2007年,按照<全国地方性砷中毒监测方案>,调查通榆县的防砷改水进度、改水工程的管理和使用情况及饮水含砷量.在监测点普查居民砷中毒患病情况,检测改水后的饮水含砷量、8～12岁儿童及18岁以上成人尿砷,调查监测点年内居民死亡原因.水砷和尿砷测定采用AFS-930双道原子荧光光度法.结果 通榆县共有地砷病病区30个,高砷区157个,总人口为57 576人.2006年有已改水病区6个,改水率为20.0%(6/30),6个改水工程均可正常使用,受益人口1670人;有已改水高砷区8个,改水率为5.09%(8/157),8个改水工程均正常使用,受益人口4350人.2007年有已改水病区28个,改水率为93.33%(28/30),28个改水工程均可正常使用,受益人口7980人:有已改水高砷区共148个,改水率为94.27%(148/157),148个改水工程均正常使用,受益人口46 214人.监测点2006年水砷在0.004～0.005 mg/L;2007年在0.010～0.021 mg/L,均在正常范围之内.2006年8～12岁儿童尿砷均值为0.024 mg/L,波动范围为0.005～0.048 mg/L.2007年成人尿砷均值为0.019 mg/L,波动范围为0.005～0.087 mg/L,尿砷均在正常范围之内.2006年查出砷中毒患者14例,均为轻度患者,检出率6.19%(14/226);2007年查出砷中毒患者17例,均为轻度患者,检出率6.94%(17/245).两年检出率比较差异无统计学意义(χ2=0.1059,P>0.05).2006和2007年监测点各死亡2例,死亡原因分别是肝癌、脑出血和尿毒症,死亡病例无饮高砷水历史.结论 通榆县降砷改水防治措施落实较好,且改水工程均可正常使用;监测点砷中毒病情较轻,两年监测检出率无明显变化,儿童及成人尿砷均在正常范围内,表明改水降砷可控制地砷病病情的发展,达到防治效果.     

2006和2007年吉林省地方性砷中毒全国重点监测结果分析

Objective To explore the present condition of endemic arsenism, the implementation of control measures and the effect of the monitored county (Tongyu County) and the monitoring spot (Baiyintuhai Village) in 2006 and 2007. Methods According to the National Survey Scheme of Endemic Arsenism, the progress of anti-arsenic water in Tongyu, and the management and running of all engineering projects and the arsenic content in water were surveyed. The patients with endemic arsenism in Tongyu were generally surveyed. The arsenic content of the improved drinking water in Tongyu and the arsenic in urine of children aged 8-12 and adults over 18 years of age were determinted. The causes of resident death in the monitoring spot from the year of 2006 and 2007 were investigated. Arsenic content of drinking water and the urine of local residents was examined with "Model AFS-930 Double-Channel Atomic Fluorescence Spectrometer". Results There were 30 endemic arsenism areas, 157 areas with high arsenic content and all population of 57 576 in Tongyu. Six areas had improved water till 2006, where 20.0% of water had improved, and six water-improving projects were all running normally, benefiting a population of 1670. Eight high arsenic areas changed water, in a rate of 5.09%. Eight water-improving projects were functioning well, benefiting a population of 4350. Until 2007, 28 areas had improved water in Tongyu, accounting for 93.33%. These 28 projects were well running, covering a population of 7980. One hundred and fouty-eight high arsenic areas had changed water, reaching a rate of 94.27%. One hundred and fouty-eight projects changedg water were running normally, benefiting a population of 46 214. In the surveyed spots, arsenic content was between 0.004 mg/L and 0.005 mg/L in 2006 and between 0.010 mg/L and 0.021 mg/L in 2007, all in the normal range to the time being. The arsenic contents in urine of the children aged 8-12 in the monitoring spots were determinted, averaging at 0.024 mg/L in 15 samples, fluctuating between 0.005 mg/L and 0.048 mg/L in 2006. The average content in urine from adults was 0.019 mg/L in 53 samples, fluctuating between 0.005 mg/L and 0.087 mg/L in 2007. The arsenic contents in urine were all in the normal range in 2006 and 2007. In 2006 14 endemic arsenism patients, all in light symptoms, had been checked out, the morbidity being 6.19%. In 2007, 17 patients who were all in light symptoms were identified in a rate of 6.94%. There was no significant difference of morbidity between the two years(χ2=0.1059, P>0.05). Two patients died, unrelating with drinking high arsenic water in 2006 and 2007. Conclusions The prevention and control measures are well implemented in Tongyu. The water-improving projects are functioning well. The condition of endemic arsenism is slight and hasn't changed so much in these two years. The arsenic contents in urine of children and adults within the normal range, showing that improving water can control the occurrence and the development of endemic arsenism.     

吉林省2004～2006年高氟水源筛查及改水降氟工程现状调查

目的了解吉林省地方性氟中毒防治状况,总结经验,发现问题,为制定新的防治对策提供科学依据。方法按照中央补助地方公共卫生专项资金地方病项目工作方案要求,在未改水病区屯采集东、西、南、北、中5个方位饮用水样,检测氟含量;在已改水病区调查改水工程管理、使用情况并采集水源水和末梢水样检测氟含量;调查部分病区16岁以上人群Ⅱ度及Ⅱ度以上地方性氟骨症检出率。饮水氟含量检测用氟离子选择电极法,氟骨症诊断按现行标准进行。结果在未改水病区或虽已改水但防氟井损坏而仍饮用小井水的病区屯共调查了2101个病区屯,采集水样10505份。饮水氟含量在0．1～10．0mg／L之间。超过1．0μg／L的病区为1493个（71．1％）。在4个地区的3164个病区屯中,有1407个病区已改水,改水率占被调查病区数的44．5％,其中,能够正常使用的为776个防氟井,正常使用率为55．2％,有173个水氟含量超过1．0mg／L,占正常使用井数的22．3％。超标井水氟含量最高可达4．0μg／L。调查了663个病区屯中Ⅱ度及Ⅱ度以上地方性氟中毒病人患病情况。结果显示,调查屯Ⅱ度以上地方性氟中毒病人较以前减少58．1％。结论截至2006年,我省多数病区尚未改水。在未改水病区,约1／3屯水氟含量在1．0mg／L以下。现有防氟井因损坏和管理不善而未使用以及部分正在使用的防氟井水氟含量超标制约了防治效果。今后应完善管理制度,加大管理力度,提高防病改水效益;随时掌握病情变化,为调整、制定防治对策提供科学依据。同时加强健康教育、增强病区群众防病意识,这是在我省最终控制地方性氟中毒的必要措施。     

2002-2004年吉林省高砷水源筛查结果分析

目的了解吉林省砷中毒病区范围及饮水高砷的分布规律．方法采取普查和抽样调查相结合的方法，半定量检测饮水含砷量，对超标（≥0．05mg／L）水样用二乙氨基二硫代甲酸银比色法进行复检。结果对9个县（市、区）的2063个自然村进行了筛查工作．其检测水样40536份，检出超标水样2598份，超标率为6．41％，其筛查出有超标水源的县（市）6个．占所筛查县的66．67％：高砷自然村283个，占所筛查自然村的13．72％：高砷暴露人口近13万人，其中儿童近3万人结论．吉林省西部平原地区高砷水源分布较广，且部分地区已有砷中毒的病情流行．需尽早开展全面的高砷水源筛查及病情普查工作，以便进行防治。     

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.     

吉林省通榆县地方性砷中毒流行病学现况调查

目的 查清吉林省地方性砷中毒病区的病情情况。方法 采用流行病学现况典型调查方法。对吉林省西部的通榆县4个乡（镇）进行了地方性砷中毒病情调查。结果 共调查16481人，发现不同程度的掌跖部角化、皲裂的砷中毒患者共251人，占调查人数的1．52％，其中年龄最小6岁，最大81岁。检出率男性高于女性（P〈0．005）。检出率随着年龄的增长而上升，以41-50岁年龄组检出率最高。结论 吉林省地方性砷中毒病区患者的临床特点是以掌跖角化为主，属轻病区。     

吉林省地方性氟中毒11年监测尿氟结果分析

目的了解和掌握吉林省地方性氟中毒病区人群尿氟变化，评价防治效果。方法按照“吉林省地方性氟中毒监测方案”要求，对1996～2006年11年间流动监测点和固定监测点改水及未改水的人群尿氟进行了测定。结果改水监测点1996～2006年健康居民尿氟平均值2．47mg／L，氟骨症患者尿氟平均值3．26mg／L，8～12岁儿童尿氟平均值1.77mg／L。未改水监测点健康居民尿氟平均值3.66mg／L，氟骨症患者尿氟平均值5，58mg／L，8～12岁儿童尿氟平均值4．36mg／L。结论吉林省改水监测点无论健康居民，还是氟骨症患者，尿氟仍维持较高水平，8～12岁儿童尿氟处于下降趋势，但平均水平仍超过正常值（1．50mg／L）。未改水监测点人群尿氟是居高不下，看出与水氟密切相关。     

地方性氟中毒病区与非病区儿童氟斑牙表现及意义

目的了解地方性氟中毒病区和非病区儿童氟斑牙表现、特点及区别,为地方性氟中毒临床诊断提供参考。方法以分层抽样的方法,随机抽取轻、中、重地方性氟中毒病区12个屯,非病区8个屯。对4063名8～12岁儿童做氟斑牙检查,按Dean法进行诊断、分度,计算和比较不同地区儿童氟斑牙总的检出率和各度检出率;测定受检者饮水氟和尿氟排泄量。对重点对象进行随访。结果高氟区儿童氟斑牙检出率55.7%,低氟区为16.5%,高氟区检出率明显高于低氟区(P<0.005)。在高氟区儿童各度氟斑牙检出率均较高,而低氟区氟斑牙以极轻度为主。中、重度氟斑牙仅见于长期居住在高氟区者。结论氟斑牙并非仅为高氟摄入所致,它与氟化物广泛联系着,较低水平的氟化物即可造成氟斑牙。中、重度氟斑牙是氟中毒的结果,这两种程度的改变对氟中毒的临床诊断有重要意义。     

中国饮水型砷中毒重病区病情调查报告

目的查明山西、吉林、宁夏和内蒙古地方性砷中毒(地砷病)重病区居民患病情况,为全国地砷病防治措施和策略的制定提供科学依据。方法采用现场流行病学调查的方法。结果山西、吉林、宁夏和内蒙古4省(区)砷中毒重病区居民地砷病检出率分别为8.75%、3.33%、8.14%和2.83%;病例主要分布在40岁以上各年龄段;男女检出率之间差异有统计学意义(P<0.01),男性(6.98%)高于女性(5.40%);在饮水砷0.01～、0.05～、0.10～、0.30～和≥0.50mg/L人群中,患者检出率分别为11.85%、69.61%、72.00%、63.48%和92.19%。结论饮水砷在0.05mg/L以上时可引起地砷病发生,在0.5mg/L以上时引起重度地砷病发生。