2013年山西省饮水型地方性氟中毒监测结果分析

目的 掌握山西省饮水型地方性氟中毒病情动态和防治措施落实情况,为下一步防治工作提供科学依据.方法 按照国家《饮水型地方性氟中毒监测方案》和《2013年山西省饮水型地方性氟中毒监测方案》的要求,在全省选择6个病区县,每个县选择3个病区村作为监测点,调查监测村的改水情况,测定水氟含量;检查全部8岁~12岁儿童氟斑牙患病情况.水氟含量测定采用氟离子选择电极法,儿童氟斑牙依照《氟斑牙诊断》标准(WS/T208—2011)进行诊断.结果 16个已改水村中,水氟合格工程9个,占56.25%(9/16),8岁~12岁儿童氟斑牙检出率为19.49%(162/831),氟斑牙指数为0.3;水氟超标工程7个,占43.75%(7/16),8岁~12岁儿童氟斑牙检出率为40.56%(273/673),氟斑牙指数为0.9;2个未改水村,水氟含量均>2.0 mg/L且≤4.0 mg/L,8岁~12岁儿童氟斑牙检出率为56.32%(49/87),氟斑牙指数为1.4.结论 山西省降氟改水工程水氟含量超标比较严重,部分病区流行趋势严峻,需加大防治力度.     

山西省大骨节病调查结果分析

目的了解山西省大骨节病病情,为防治工作提供科学依据。方法按照《2012年医改地方病防治项目实施方案》的要求,在全省抽取18个县,每个县抽取5个乡,每个乡抽取3个村,调查病区村大骨节病防控措施落实情况,包括调查点的人口、耕种、主食以及其他防治措施等落实情况,并对调查村所有7~12岁儿童开展临床和X线检查。结果共调查18个县514个村,病区人口32.31万人;病区实施了病区村搬迁81个,搬迁22 832人;退耕还林还草150 965亩,占耕地面积的56.00%,改种经济作物68 473亩,占耕地面积24.90%,异地育人3 203人;近几年未采取补硒措施;调查了211个病区村病情,检查7~12岁儿童6 793人,临床未检出阳性病例;X线检出阳性4例,均为单纯干骺端改变,检出率为0.06%(4/6 793),未检出骨骺、骨端及腕骨阳性儿童。结论山西省儿童大骨节病病情已经控制,处于持续稳定状态,由于大骨节病致病因子仍然存在,需继续加强大骨节病的病情监测工作。     

2007年山西省高氟水源筛查及降氟改水工程现状调查

Objective To explore into the condition of fluoride content of the drinking water and the present status of water-improving projects in the endemic fluomsis areas in Shanxi province,and to provide the evidence for making scientific and effective tactics in prevention and control.Methods In 2007,according to "The National Technical Scheme for Endemic Disease Control",screening for drinking water fluoride content was carried out in non-improving water villages of 15 counties(cities,districts).The investigation of all water-improving projects was carried out in 10 counties(cities).The fluoride content in drinking water was determined by fluoride selective ion electrode(GB/T 8538-1995).Results Screening for drinking water fluoride content was carried out in 969 non-improving water villages in 15 counties(cities,districts).Average water fluoride content was≤1.0 mg/L in 497 villages,accounting for 51.29%(497/969).Average water fluoride content was>1.0 mg/L in 472 villages.accounting for 48.71%(472/969).The overall standard drinking water fluoride content was mainlv>1.0-4.0mg/L,and the maximum average water fluoride content was 8.96 mg/L.The investigation of 290 water-improving projects was carried out in 10 counties(cities).Among 290 water-improving projects 213 water-improving projects were running normally,accounting for 73.45%(213/290);77 water-improving projects were running abnormally,accounting for 26.55%(77/290).Water fluoride content was≤1.0 mg/L in 158 projects,accounting for 54.48%(158/290).Water fluoride content was>1.0 mg/L in 132 projects,accounting for 45.52%(132/290).The maximal water fluoride content was 5.20 mg/L.Conclusions The situation of drinking water fluoride content over the national standard is serious in Shanxi province.The qualification rate was lower for the fluoride content of water-improving projects.Therefore,we should strength water-improving projects to raise the effectiveness of prevention and treatment and assure their quality.     

地方性砷中毒对机体氧化应激和免疫功能的远期影响

目的 观察地方性砷中毒(简称地砷病)对机体氧化应激及免疫功能的远期影响,为地砷病病区居民的预防和治疗提供科学依据.方法 2009年,在改水5年的地砷病病区(山西省山阴县古城镇四里庄村、大营村、古城村)选取轻、中、重度病例作为轻、中、重度病例组,在当地选择健康人群作为内对照组,另选取非病区(合盛堡乡杨庄村)健康人群作为外对照组.采集观察对象血样,检测氧化应激指标[采用黄嘌呤氧化酶法检测血清超氧化物歧化酶(SOD)活力,采用二硫代二硝基苯甲酸分光光度法检测谷胱甘肽过氧化物酶(GSH-Px)活力、采用硫代巴比妥酸分光光度法检测丙二醛(MDA)水平]和免疫功能指标[采用放射免疫(RIA)法检测免疫球蛋白G(IgG),采用比浊法检测血清溶菌酶].结果 本次共调查了252人,外对照组,内对照组,轻、中、重度病例组分别为56、57、49、44、46人.5组血清SOD活力分别为(72.19±11.75)、(66.96±12.02)、(49.79±11.07)、(48.54±10.56)、(47.68±10.68)kU/L,组间比较差异有统计学意义(F=52.42,P＜0.01),外对照组明显高于其他组别(P均＜0.05),内对照组高于3个病例组(P均＜0.05),病例组组间比较差异无统计学意义(P＞0.05);5组血清GSH-Px活力分别为(197.41±38.54)、(195.02±31.93)、(187.26±28.22)、(187.24±25.40)、(186.88±21.84)U/mg,组间比较差异无统计学意义(H=4.21,P＞0.05);5组血清MDA水平分别为(4.51±2.14)、(5.88±2.00)、(6.44±2.83)、(5.89±2.57)、(5.88±2.40)μmol/L,组间比较差异有统计学意义(F=3.36,P＜0.05),外对照组明显低于其他组别(P均＜0.05),其他组间比较差异无统计学意义(P均＞0.05);5组血清IgG水平分别为(11.16±2.08)、(8.15±1.44)、(8.77±2.54)、(9.19±1.97)、(8.44±2.52)g/L,组间比较差异有统计学意义(H=52.92,P＜0.01),外对照组明显高于其他组别(P均＜0.05),其他组间比较差异无统计学意义(P均＞0.05);5组血清溶菌酶水平分别为(13.57±5.16)、(10.05±3.96)、(8.78±3.35)、(8.72±3.76)、(9.38±4.26)mg/L,组间比较差异有统计学意义(H=35.00,P＜0.01),外对照组明显高于其他组别(P均＜0.05),其他组间比较差异无统计学意义(P均＞0.05).结论 地砷病患者饮用低砷水5年后,砷对机体的氧化应激反应及免疫功能影响仍然存在,地砷病病区在加大除砷改水力度的同时,应加强居民身体状况的监测.

Abstract：

Objective To explore the long-term effect of endemic arsenism on oxidative stress and immune function, and to provide scientific basis for prevention and treatment of the disease in the areas. Methods In 2009, Using cluster sampling and typical investigation, the cross-sectional study was completed. The patient groups and the internal control group were selected in the arsenism areas after 5 years quality improvement of drinking water(Silizhuang village, Daying village and Gucheng village in Shanyin county, Gucheng city, Shanxi province) and they were divided into mild, moderate, severe case and internal control groups, respectively. The external control group was selected in a non-arsenism area(Yangzhuang village in Heshengbu city). The Oxidative stress indicators were determined and analyzed [serum superoxide dismutase (SOD) activity was determined with xanthine oxidase method, glutathione peroxidase(GSH-Px) activity was determined with 2-thio-2-nitrobenzoic acid method, and mmuuity malondisldohyde(MDA) levels was determined with thiobarbituric acid method]. The immune function was determined and analyzed [immunoglobulin G (IgG) was determined with radioimmunoassay method, and serum lysozyme was determined with turbidimetric method]. Results A total of 252 people were surveyed, in which the external control group, the internal control group, mild, moderate and severe patient groups were 56, 57, 49,44 and 46, respectively. Serum SOD activities were (72.19 ± 11.75), (66.96 ± 12.02), (49.79±11.07), (48.54 ±10.56) and (47.68 ± 10.68)kU/L, respectively. The difference of serum SOD activities between the groups was statistically significant(F = 52.42, P ＜ 0.01 ). Serum SOD activities in the external control group were significantly higher than other groups (all P ＜ 0.05). The value in the internal control group was significantly higher than the 3patient groups (all P ＜ 0.05). There were no significant differences between the case groups (P ＞ 0.05). Serum GSH-Px activities of the five groups were (197.41 ± 38.54), (195.02 ± 31.93), (187.26 ± 28.22), (187.24 ± 25.40),(186.88 ± 21.84)U/mg, respectively, and the difference between the groups was not significant(H = 4.21, P ＞0.05). Serum MDA levels of the five groups were (4.51 ± 2.14), (5.88 ± 2.00), (6.44 ± 2.83), (5.89 ± 2.57),(5.88 ± 2.40)μ mol/L, respectively, and the difference between the groups was statistically significant(F = 3.36,P ＜ 0.05). The external control group was significantly lower than other groups(all P ＜ 0.05). No significant difference was observed between other groups(all P ＞ 0.05). Serum IgG levels were(11.16 ± 2.08), (8.15 ± 1.44), (8.77 ±2.54), (9.19 ± 1.97), (8.44 ± 2.52)g/L, respectively, and the difference between the groups was statistically significant(H = 52.92, P ＜ 0.01 ). The external control group was significantly higher than other groups(all P ＜0.05). No significant difference was observed between other groups(all P ＞ 0.05). Serum lysozyme levels were (13.57 ± 5.16), (10.05 ± 3.96), (8.78 ± 3.35), (8.72 ± 3.76), (9.38 ± 4.26)mg/L, respectively, and the difference between the groups was statistically significant (H = 35.00, P ＜ 0.01 ). The external control group was significantly higher than other groups(all P ＜ 0.05). No significant difference was observed between other groups(all P ＞ 0.05). Conclusions The effect of arsenic on the body's oxidative stress response and immune function persists after 5 years of drinking low arsenic water. In addition to intensify arsenic removal from drinking water, it should also strengthen the monitoring of population's health in the diseased areas.     

地方性砷中毒对居民免疫功能远期影响

目的 探讨地方性砷中毒对机体免疫功能的远期影响,为砷中毒病区居民的预防和治疗提供科学依据.方法采用整群抽样和典型调查相结合的方法进行现场调查,将改水5年后的砷中毒病区调查者分为轻、中、重度病例组和内对照组,非病区调查者为外对照组；对调查者的免疫功能指标免疫球蛋白G(IgG)和溶菌酶(LSZ)进行测定,采用SPSS 13.0软件对数据进行统计分析.结果调查5个组共252人,所选择的病区村5年前已实施改水,水砷含量符合国家标准(≤0.05 mg/L),各组尿砷含量差异无统计学意义(H=2.698,P＞0.05)；各组IgG含量差异有统计学意义(H=52.923,P＜0.01),外对照组IgG均数为11.16g/L,含量明显高于其他组(P＜0.05),其他组间比较差异无统计学意义(P＞0.05)；各组溶菌酶水平差异有统计学意义(H= 34.998,P＜0.01),外对照组溶菌酶水平为13.57 μ g/ml,明显高于其他组(P＜0.05),其他组间比较差异无统计学意义(P＞0.05).结论地方性砷中毒患者饮用低砷水5年后砷对机体免疫功能的影响仍然存在,砷中毒病区在加大除砷改水力度的同时,应加强居民身体状况的监测.     

山西省地方性砷中毒病区改水降砷调查结果分析

目的 了解山西省地方性砷中毒病区改水降砷落实情况,为砷中毒的防治工作提供科学依据.方法 2011年6月,采用调查问卷的方式,在山西省的151个砷中毒病区村调查改水降砷工程使用和运转情况.在病区村采集改水工程水样,水砷测定采用原子荧光法.结果 在151个砷中毒病区村,有126个已经改水,改水率为83.44％;在已改水的病区村中,有22个村不能正常使用.覆盖全省砷中毒病区村的改水降砷工程有33个,正常运行的有23个;正常运行的改水降砷工程覆盖砷中毒病区村110个,受益人口为97 920人,占病区村总人口的46.9％(97 920/208 736).改水工程水含砷超过国家标准(≤0.05 mg/L)的有10个,覆盖31个村,包括15个非病区村和16个病区村,覆盖病区村人口数为24 764人.结论 山西省的地方性砷中毒病区改水力度有待加强,改水工程质量需要提高,工程的后期管理和维护还需要进一步加强.     

山西省饮水型地方性氟中毒病区监测分析

目的评价山西省饮水型地方性氟中毒病区改水防治效果,进一步制定和完善可持续防治策略。方法在全省选择6个县(区),每个县(区)采用随机抽样方法抽取3个病区村作为固定监测点,检测水源水氟含量,调查改水工程运行情况,在每村检查全部8~12岁儿童氟斑牙患病情况。结果2013年和2014年18个监测村中已改水村16个,未改水村2个,已改水工程均运转正常;2015年18监测村中仅1个村未改水,已改水工程中16个运行正常、报废1个,2016年18个监测村全部完成改水,2016年和2017年各有2处改水工程报废,其余运行正常;所有改水工程规模以小型为主,改水工程水氟含量合格分别占56.25%,62.50%,58.82%,66.67%和66.67%;改水工程运行正常且水氟含量合格的监测村,儿童氟斑牙检出率总体在30%以下,呈下降趋势,差异有统计学意义(χ^2=14.11,P<0.05);改水工程水氟含量超标和未改水村的监测村,儿童氟斑牙病情超出30%的控制线,仍然处于流行状态。结论山西省改水工程水氟含量合格的监测村,儿童氟斑牙病情已达到控制标准,水氟含量超标及未改水的监测村,儿童氟斑牙病情仍处于流行状态;今后应加强水质和病情监测。     

2020年山西省水源性高碘地区监测结果分析

目的掌握山西省水源性高碘危害现状及防治措施落实情况, 为下一步防治工作提供科学依据。方法 2020年, 调查山西省4个市、12个水源性高碘县的所有高碘行政村居民饮用水碘含量和改水情况;在每个监测县按行政村水碘值排序, 采用系统抽样方法, 各抽取5个行政村作为监测村。在每个监测村所在地抽取1所小学的40名8 ～ 10岁非寄宿学生及20名孕妇, 采集家中食用盐盐样和随机1次尿样检测盐碘、尿碘含量;并采用B超法进行儿童甲状腺检查。结果共调查297个高碘行政村的居民饮用水情况, 其中改水村268个、未改水村29个, 改水率为90.24%;水碘含量范围为0.33 ～ 803.75 μg/L, 水碘含量> 100 μg/L的村有159个。共检测居民家中食用盐盐样1 926份, 未加碘食盐率为62.20%(1 198/1 926);检测儿童尿样1 704份、孕妇尿样222份, 尿碘中位数分别为426.2、318.9 μg/L;检查儿童甲状腺1 690例, 甲状腺肿大率为3.91%(66/1 690), 结节检出率为13.67%(231/1 690)。结论山西省水源性高碘地区儿童碘营养处于过量水...     

2007年山西省高氟水源筛查及降氟改水工程现状调查

目的 了解山西省地方性氟中毒病区居民饮水含氟量及降氟改水工程使用现状,为制订科学有效的防治策略提供可靠依据.方法 2007年,根据<地方病防治项目技术方案>的要求,在山西省选择15个县(市、区)的未改水村进行高氟水源筛查,选择10个县(市)的全部降氟改水工程进行调查.水氟测定采用氟离子选择电极法(GB/T 8538-1995).结果 15个县(市、区)共调查未改水村969个,居民饮用水平均水氟合格(≤1.0mg/L)的村有497个,占51.29%(497/969),超过国家饮用水卫生标准(>1.0 mg/L)的村有472个,占48.71%(472/969),超标水氟主要集中在>1.0～4.0 mg/L,最高平均水氟达8.96 mg/L.10个县(市)共调查降氟改水工程290个,正常运行的有213个,占73.45%(213/290),间歇运行的有77个,占26.55%(77/290);降氟改水工程的出厂水水氟合格(≤1.0mg/L)的有158个,占54.48%(158/290),超过国家饮用水卫生标准(>1.0mg/L)的有132个,占45.52%(132/290),最高水氟达5.20 mg/L.结论 山西省饮水型氟中毒病区水氟超标情况仍然较重,降氟改水工程水氟合格率较低,今后应加大改水力度,保证工程质量,进一步提高防治效果.     

2007年山西省高氟水源筛查及降氟改水工程现状调查

Objective To explore into the condition of fluoride content of the drinking water and the present status of water-improving projects in the endemic fluomsis areas in Shanxi province,and to provide the evidence for making scientific and effective tactics in prevention and control.Methods In 2007,according to "The National Technical Scheme for Endemic Disease Control",screening for drinking water fluoride content was carried out in non-improving water villages of 15 counties(cities,districts).The investigation of all water-improving projects was carried out in 10 counties(cities).The fluoride content in drinking water was determined by fluoride selective ion electrode(GB/T 8538-1995).Results Screening for drinking water fluoride content was carried out in 969 non-improving water villages in 15 counties(cities,districts).Average water fluoride content was≤1.0 mg/L in 497 villages,accounting for 51.29%(497/969).Average water fluoride content was>1.0 mg/L in 472 villages.accounting for 48.71%(472/969).The overall standard drinking water fluoride content was mainlv>1.0-4.0mg/L,and the maximum average water fluoride content was 8.96 mg/L.The investigation of 290 water-improving projects was carried out in 10 counties(cities).Among 290 water-improving projects 213 water-improving projects were running normally,accounting for 73.45%(213/290);77 water-improving projects were running abnormally,accounting for 26.55%(77/290).Water fluoride content was≤1.0 mg/L in 158 projects,accounting for 54.48%(158/290).Water fluoride content was>1.0 mg/L in 132 projects,accounting for 45.52%(132/290).The maximal water fluoride content was 5.20 mg/L.Conclusions The situation of drinking water fluoride content over the national standard is serious in Shanxi province.The qualification rate was lower for the fluoride content of water-improving projects.Therefore,we should strength water-improving projects to raise the effectiveness of prevention and treatment and assure their quality.