1991-2007年广东省丰顺县地方性氟中毒重点监测结果分析

目的 调查广东省丰顺县地方性氟中毒(简称地氟病)监测点防治效果、病情状况以及降氟设施使用管理情况.方法 1991-2007年按<全国地方性氟中毒重点监测方案>规定的内容和方法对广东省丰顺县地氟病病区进行监测.选择大寨村(轻病区)、湖陂村(中病区)、安全村(重病区)作为调查点,采用Dean法诊断8～12岁儿童氟斑牙,氟离子选择电极法测定水氟、尿氟,每3～5年检查16岁以上成人临床及X线氟骨症患病情况.结果 大寨村,安全村2个监测点改水降氟后,饮水氟于2007年分别为0.83、0.27 mg/L,达到国家卫生标准(1.0 mg/L),8～12岁儿童氟斑牙检出率呈现逐渐下降趋势并出现波动,2007年分别为20.8%、3.8%.低于国家控制标准(30%);湖陂村监测点改水后,饮水氟仍波动在较高水平(1.01～2.30 mg/L),儿童氟斑牙检出率2007年为44.3%,仍高于国家控制标准.大寨村、湖陂村和安全村氟斑牙指数分别从1991年的1.5、3.0、1.3下降到2007年的0.3、0.8、0.1,流行强度分别达到阴性或轻微流行.2002年以后3个村儿童尿氟<1.50mg/L.成人临床氟骨症症状与体征阳性率[大寨村、湖陂村、安全村1991年分别为31.8%(84/264)、34.4%(131/381)、44.1%(89/202),2005年分别为11.0%(43/388)、12.9%(61/473)、9.6%(27/280)]、X线氟骨症检出率[1991年分别为70.0%(35/50)、86.0%(43/50)、46.0%(23/50),2005年分别为20.0%(10/50)、16.0%(8/50)、10.0%(5/50)]逐渐下降.结论 大寨村、安全村2个监测点的水氟达到国家卫生标准,8～12岁儿童氟斑牙检出率等主要指标已降至非病区水平,监测点病情得到控制.

Analysis on sentinel surveillance outcome of endemic fluorosis in Guangdong Province from 1991 to 2007

Objective To investigate and master the outcome of endemic fluorosis surveillance, the use and management situation of the facilities for decreasing fluorine in water-related endemic fluorosis in Fengshun County, Guangdong Province. Methods The surveillance was carried out according to The National Surveillance Scheme of Endemic Fluorosis in 1991 - 2007. Dazhai, Hupo and Anquan Villages in Fengshun County of Guangdong Province were selected as monitoring spots. The dental fluorosis of 8 - 12 years old children was examined with Dean index, the fluoride contents in urine and drinking water were determined with fluoride selective ion electrode method. Clinical and X-ray skeletal fluorosis of adults over 16 years of age were examined every 3 to 5 years. Results The fluoride contents in water almost reached the hygienic requirements (1.0 mg/L) in Dazhai (0.83 mg/L in 2007) and Anquan Villages(0.27 mg/L in 2007) after improving water and decreasing fluorine. The prevalence rate of dental fluorosis of students aged 8 - 12 years old fluctuated and decreased gradually, especially prevalence rate of mederate and severe fluorosis decreased obviously and reached the hygienic requirements (30%) after altering water source(20.8% in Dazhai, 3.8% in Anquan in 2007). But the fluoride contents in water were in relatively high level (1.01～2.30 mg/L), and the prevalence rate of dental fluorosis of students aged 8-12 years old(44.3% in 2007) was above the hygienic requirements in Hupo Village after improving water and decreasing fluorine. The dental fluorosis index in Daizai, Hupo and Anquan Villages dropped from 1.5, 3.0 and 1.3 in 1991 to 0.30, 0.80 and 0.10 in 2007, respectively. Epidemic strength reached respectively the criteria in mild and non-endemic areas. Fluoride contents in urine of children aged 8-12 years old in the three villages all were under the limit of 1.50 mg/L after 2002. The prevalence rate of adult clinical fluorosis [31.8% (84/264), 34.4% (131/381), 44.1% (89/202) in 1991; 11.0% (43/388), 12.9% (61/473), 9.6% (27/280) in 2005] and positive detection rate of skeletal fluorosis examined by X-ray [70.0% (35/50), 86.0% (43/50), 46.0% (23/50) in 1991 ; 20.0% (10/50), 16.0% (8/50),10.0% (5/50) in 2005] decreased gradually in Dazahai, Hupo and Anquan Villages. Conclusions The fluoride contents in the Dazhai Village and Anquan Village have met the national hygienic standard, with water fluoride content and the rate of dental fluorosis of 8 - 12 years children nearly matching to that of non-disease area. The prevalence of endemic fluorosis in the surveillance villages has been under control.