盐池县马儿庄村地方性氟中毒八年动态监测报告

报告了盐池县马儿庄监测点的水氟、氟斑牙、氟骨症患者的症状与体征,骨 X线,包括骨密度、骨结构(骨小梁)、骨周与关节改变以及群体尿氟的变化。结果表明,8年来为群众供给充足的水氟稳定在国家标准内0.8mg/L 饮用水后,摆脱了原均值为6.63mg/L 高氟危害。400余名成人氟斑牙型度稳定未变,但改水后出生的儿童已扪出恒牙的小孩长出了洁白有光泽的牙齿,避免了氟斑牙的损害。氟骨症患者的症状和体征改善率达60～90%。骨 X 线片结果显示:部分患者骨密度明显下降,骨小梁细密、清晰。群体尿氟值降至3.07mg/L,接近宁夏非病区正常值2.6mg/L 水平。改水取得了明显的防治效果。     

氟骨症骨愈合的实验研究

观察 Wistar 大鼠氟中毒对骨折愈合过程的影响及探索硅酸镁、自然铜有无抗氟毒促进骨折愈合的作用。结果表明:1、随着机体骨氟沉积量的增加,骨折愈合所受到的影响也随之增加;2、硅酸镁具有稳定的抗氟、促进骨愈合作用;3、自然铜在治疗初期有明显疗效。     

流动暗房研制及在地方性氟中毒病区X线检查中的应用

目的 探讨流动暗房配合X线防护罩在地方性氟中毒(简称地氟病)病区X线检查中的应用价值.方法 使用流动暗房和固定暗室对地氟病病区320例受检者前臂和小腿X线照片进行冲洗,观察操作效果,通过洗片成像质量,评价对地氟病的诊断效果.结果 流动暗房冲洗照片320例,有指纹印记268个,照片划痕47处,优良照片298例(93.13%),氟骨症检出率47.18%(151/320),Ⅰ期氟骨症检出率26.25%(84/320);固定暗室冲洗照片320例,有指纹印记735个,照片划痕384处,优良照片227例(70.93%),氟骨症检出率34.70%(111/320),Ⅰ期氟骨症检出率16.25%(52/320).优良照片率、氟骨症及Ⅰ期氟骨症检出率比较,流动暗房明显高于固定暗室(χ2值分别为53.43、10.34、9.56,P＜0.01).结论 流动暗房比固定暗室洗片成像质量优越,照片诊断准确率高,在各地氟病病区采用X线流动检查中具有重要的应用价值.     

人体总摄氟量与氟骨症的剂量-效应关系

目的 探讨人体总摄氟量和氟骨症患病情况间的确切剂量-效应关系,为地方性氟中毒防治提供参考依据.方法 根据家庭手压井饮水含氟量的不同,分别从江苏省地方性氟中毒重病区村瓦庙村和非病区村新淮村抽取调查对象,观察日均总摄氟量和氟骨症患病情况,并把两村的调查对象作为一个整体,根据每个调查对象日均总摄氟量分为5个剂量组(＜2.00、2.00～、3.00～、4.00～、≥5.00 mg/d),分析日均总摄氟量和氟骨症患病情况的关系.结果 瓦庙村氟骨症检出率为31.06%(41/132),新淮村未发现氟骨症患者(0/35).调查对象随着日均总摄氟量的升高,氟骨症的检出率明显增加,有显著的剂量-效应关系(Quadriatic fit模型拟合曲线的回归方程为:y=2.624-6.855x+3.424x2,r=0.997).根据剂量-效应关系计算的总摄氟量的基准剂量95%可信限的下限值为2.50 mg/d,由此可得日均总摄氟量的参考剂量为2.50 mg/d.瓦庙村氟骨症患者[(5.09±1.20)mg/d]和非氟骨症者[(3.08±1.12)mg/d]的日均总摄氟量比较,差异有统计学意义(t=-9.32,P＜0.01).结论 在饮水型地方性氟中毒病区,日均总摄氟量和氟骨症检出率间呈正相关剂量-效应关系,日均总摄氟量的参考剂量(2.50 mg/d)低于<人群总摄氟量卫生标准>(WS/T 87-1996)的要求(3.50 mg/d).     

2005-2007年陕西省饮用水含氟量和地方性氟中毒病情调查

目的 调查2005-2007年陕西省饮用水含氟量和地方性氟中毒病情,评价改水工程降氟效果.方法 根据以往调查资料,在陕西省选择地方性氟中毒病情流行的10个市作为调查地区,以村为调查点,每村按东、西、南、北、中5个方位抽取水源水5份,同时采集每个改水工程水源水1份、出厂水1份和末梢水2份,采用氟离子选择电极法或氟试剂分光光度法测定水氟;在饮用水含氟量>1.00 mg/L的人群中进行地方性氟中毒流行病学调查,采用Dean法进行8～12岁儿童氟斑牙诊断,成人氟骨症按<地方性氟骨症临床分度诊断>(GB16396-1996)诊断.结果 共测定6390个村的水源水含氟量,其中水氟在1.00～<2.00 mg/L的有2619个村,暴露人口为1 654 998人;水氟在2.00～<4.00 mg/L的有845个村,暴露人口为355 623人;水氟≥4.00mg/L的有272个村,暴露人口为111 466人.全省水氟中位数为1.15 mg/L.渭南、咸阳和榆林3个市水氟中位数>1.00 mg/L,为高氟水集中分布的地区.共检测了3115个改水工程水氟,其中水氟在1.00～<2.00 mg/L的有1269个,暴露人口为1 415 877人;水氟在2.00～<4.00 mg/L的有120个,暴露人口为43 888人:水氟≥4.00 mg/L的有14个,暴露人口为5960人.44 081名8～12岁儿童进行氟斑牙临床检查,检出16 489例氟斑牙患者,检出率为37.4%(16 489/44 081);对310 993名成人进行氟骨症临床检查,检出15 877例Ⅱ度以上氟骨症患者,检出率为5.1%(15 877/310 993).结论 高氟水在陕西省广泛分布,地方性氟中毒流行较严重,降氟改水工程质量有待进一步提高.     

临床与X线方法诊断氟骨症结果比较

目的 比较临床与X线诊断氟骨症结果,为制订诊断标准提供参考依据.方法 采用资料回顾方法,在占林省乾安、农安县选末改水的15个病区屯,按各电饮水平均含氟量分为0.5、1.0、1.5、2.0、2.2、2.4、3.0、3.5、4.0、6.0、7.0 mg/L共11个等级.抽取居住10年以上的16～60岁居民共675例作为观察对象,对两种诊断方法的氟骨症检出情况进行分析和比较.结果 水氟为2.0、2.2、2.4、3.0、4.0 mg/L时,临床检出率(21.43%、22.45%、21.28%、19.05%、38.89%)明显高于X线(0、2.04%、0、4.76%、12.96%,X2值分别为7.96、9.49、11.19、4.08、9.45,P<0.05);水氟为2.0、2.4 mg/L时,X线检出率为0;水氟为3.0、4.0 mg/L时,X线检出率仍较低;水氟为0.5、1.0、1.5、3.5、6.0、7.0 mg/L时,临床检出率(1.00%、4.44%、7.23%、18.00%、54.39%、49.18%)和X线检出率(0、2.22%、3.61%、8.00%、36.84%、52.46%)的差别不明显X2值分别为1.00、0.17、0.47、2.21、3.54、0.13,P>0.05).结论 氟骨症临床和X线检出率随水氟增高析增高,临床方法检出氟骨症随水氟增高的规律性好于X线方法.     

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.     

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.     

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.