重庆市燃煤型氟中毒流行因素及防治对策

目的调查重庆市燃煤型氟中毒病区流行因素，为制定防治对策提供科学依据。方法调查病区儿童氟斑牙和防治现状。采样检测煤、泥土、空气、水、粮食、蔬菜、茶叶等氟含量；分析燃煤型氟中毒流行因素，提出防治对策。结果调查666个病区村8～12岁儿童86509人，氟斑牙检出率为51．05％，缺损率为4．30％，指数为0．83；检测病区煤、拌煤土、煤混土、土壤的平均氟含量（310．56mg／kg、360．51mg／kg、293．62mg／kg、497．54mg／kg）显著高于非病区（48．68mg／kg、275．66mg／kg、150．20mg／kg、269．98mg／kg），煤渣氟病区（209．14mg／kg）和非病区（186．59mg／kg）无显著性差异：水和辣椒氟病区（0．30mg／L、25．50mg／kg）显著高于非病区（0．18mg／L、2．83mg／kg），大米、土豆、蔬菜氟含量非病区（1.31mg／kg、0．64mg／kg、1．10mg／kg）显著高于病区（0．77mg／kg、0．44mg／kg、0．48mg／kg）；3个重、中度病区村室内空气氟（13．56—14．68μg／m^3）显著高于非病区和1个病区村（1．00、0．31μg／m^3）；病区居民饮茶氟摄入量（2．45mg／人）显著大于非病区（1．80mg／人）；病区居民大米食用率为100％，年人均食用量为77．68kg，玉米食用率为54．63％，年人均食用率为17．79kg，炉灶合格正确使用率为53．44％。结论重庆市燃煤型氟中毒流行因素主要为病区居民使用高氟煤煮饭、取暖，释放出氟化物污染室内空气，经呼吸道进入人体致病。氟化物经呼吸道进入人体的致病机制和致病力有待深入研究。饮茶是否为燃煤型氟中毒病区的另一因素，有待进一步研究。改炉改灶仍是目前防治燃煤型氟中毒的主要措施。

Study on Epidemic Factors and Countermeasures of Coal-burning Fluorosis in Chongqing

Objective To investigate on epidemic factors of coal-burning endemic fluorosis areas in Chongqing and provide a scientific basis for control strategies. Method Dental fluorosis among children and prevention of fluorosis status were analyze through sampling and monitoring of coal, soil, air, water, food, vegetables, tea etc. Coal-burning fluorosis endemic factors and the control strategies were analyzed. Result 86509 children aged from 8-12 in 666 fluorosis regions were investigated. The detection rate of dental fluorosis is 51.05% and defect rate is 4.30%, with the index of 0.83. The fluorine content in coal, mixed coal-soil, soil mixed coal and soil were 310.56 mg/kg, 360.51 mg/ kg, 293.62 mg/kg, 497.54 mg/kg, respectively, are significantly higher than non-endemic area （48.68 mg/kg, 275.66 mg/kg, 150.20 mg/kg, 269.98 mg/kg, respectively ） .There is no significantly difference in fluorine content between Fluoride cinder Ward （209.14 mg/kg） and non-endemic area （186.59 mg/kg）. Fluorine content in water and endemic fluorosis pepper （0.30 mg/L, 25.50 mg/kg） were significantly higher than those in non-endemic area （0.18mg/L, 2.83 mg/kg）. The fluorine contents in rice, potatoes and vegetables in endemic area （1.31 mg/kg,0.64 mg/kg, 1.10 mg/kg） were significantly higher than those in non-endemic area （0.77 mg/kg,0.44 mg/kg,0.48 mg/kg）. The fluorine content of the indoor air of 3 heavy, moderate fluorosis endemic villages （ 13.56, 14.68 μg/m3） was significantly higher than that of the non-endemic area （1.00,0.311μg/m^3）. The fluoride intake of the residents in endemic areas via tea drinking （2.45 mg/person） was significantly higher than that innon-endemic area （1.80 mg/person）. In the endemic areas, the consumption rate of rice was 100 percent, with annual per capita consumption of 77.68 kg; corn consumption rate was 54.63%, with annual per capita consumption of 17.79 kg. The stove pass correct utilization rate was 53.44%. Conclusion The main epidemic factors of coal-burning fluorosis in Chongqing is the fluoride which was released from high fluoride coal in cooking and heating. Fluorosis is manily caused by inhaling fluoride through respiratory tract. Whether there are other factors like tea drinking needs to be further studied. Correct usage stoves is still main prevention and control measures of coal-burning fluorosis.