水氟与骨密度和骨钙素的剂量效应关系研究

目的 分析水氟与骨密度(BMD)、血清骨钙素(BGP)的剂量-效应关系,探讨BMD和血清BGP作为氟中毒早期骨损伤筛查指标的可能性.方法 2006年选择江苏省宿迁市地方性氟中毒重病区村瓦庙村(氟接触组)103例和非病区村新淮村(对照组)43例居民,调查性别、年龄、身高、体质量,测定家庭手压井水氟、BMD及血清BGP水平.根据水氟四分位间距进行分组,分析水氟与BMD和血清BGP的关系,应用Curve Expert 1.3软件拟合水氟与BMD、血清BGP异常率的剂量-效应关系方程.结果 氟接触组的男、女性家中的饮水氟[(2.38±0.68)、(2.62±0.91)mg/L]均高于对照组[(0.35±0.08)、(0.36±0.07)mg/L],组间比较差异均有统计学意义(t值分别为14.27、11.08,P均<0.01);氟接触组男性BMD[(0.78±0.07)g/cm2]低于对照组[(0.83±0.08)g/cm2],组间比较差异有统计学意义(t=2.37,P<0.05).氟接触组男性、女性的血清BGP[(4.17±0.67)、(4.11±0.57)μg/L]均高于对照组[(1.48±0.40)、(1.44±0.39)μg/L],组间比较差异有统计学意义(t值分别为17.64、19.40,P均<0.01).水氟≥2.92 mg/L组的BMD[(0.66μ0.15)g/cm2]低于<0.42 mg/L组[(0.76±0.12)g/cm2],组间比较差异有统计学意义(P<0.01).水氟0.42～、2.05～、≥2.92 mg/L组的血清BGP[(3.83±1.07)、(4.22±0.72)、(3.99±0.63)μg/L]均高于<0.42 mg/L组[(1.44±0.37)μg/L],组间比较差异均有统计学意义(P均<0.01);水氟与BMD异常率的剂量-效应关系方程为Y=(0.284-0.058x)-<'1.260>,r=0.999 94;水氟与血清BGP异常率的剂量-效应关系方程为Y=100.05/(1+78.62e<'-4.55x>),r=0.99999.结论 水氟与BMD、血清BGP均有剂量-效应关系,BMD和血清BGP有可能作为氟中毒特别是骨损伤的敏感筛查指标.

Study on the dose-response relationships between the drinking water fluoride and bone mineral density, and serum osteocalcin

Objective To analyze the relationships between the drinking water fluoride and bone mineral density (BMD), and serum osteocalcin (BGP) and to explore the BMD and serum BGP as significant early screening biomarkers for fluorosis especially for early bone damage in endemic fluorosis areas. Methods Wamiao (severe endemic fluorosis area, as fluoride exposed group) and Xinhuai (non endemic fluorosis area, as control group) Village were selected in 2006. One hundred and fouty-six objects were chosen from 2 villages (103 in Wamiao, 43 in Xinhuai). The sex, age, body height, body weight, drinking water fluoride in each object's household well, BMD, and serum BGP were investigated, and the dose-response relationships were analyzed between the drinking water fluoride and BMD, and serum BGP. CurveExpert 1.3 Software was used to fit the dose-response relationships between the rate of abnormal BMD, the rate of abnormal serum BGP, and the drinking water fluoride. Results The levels of drinking water fluoride in males' and females' families in fluoride exposed group were [(2.38±0.68), (2.62±0.91 )mg/L] significant higher than that in control group [(0.35±0.08), (0.36±0.07)mg/L], the difference being statistically significant(t values were 14.27 and 11.08,and P<0.01, respectively). BMD in males in fluoride exposed group [(0.78±0.07)g/cm2] was significant lower than that in control group[(0.83±0.08)g/cm2], the difference being statistically significant (t=2.37,P<0.05). Serum BGP in males and females in fluoride exposed group [(4.17±0.67), (4.11±0.57) μg/L] were significant higher than that in control group [(1.48±0.40), (1.44±0.39)μg/L], the difference being statistically significant (t values were 17.64 and 19.40, and P<0.01, respectively]. BMD in the group with drinking water fluoride≥2.92 mg/L[(0.66±0.15 )g/cm2] was significant lower than that in the group with drinking water fluoride<0.42 mg/L [(0.76±0.12)g/cm2], the difference being statistically significant (P<0.01). The levels of serum BGP in the groups with the drinking water 0.42-,2.05-, ≥.92 mg/L[(3.83±1.07), (4.22±0.72), (3.99±0.63) μg/L] were significant higher than that in the group with the drinking water<0.42 mg/L [(1.44±0.37) μg/L], the difference being statistically significant (P<0.01). The equation for the dose-response relationship between the drinking water fluoride and the rate of abnormal BMD was y=(0.284-0.058x)-1.260, r=0.999 94; and y=100.05/(1+78.62e-4.5x), r=0.999 99 for the drinking water fluoride and the rate of abnormal serum BGP. Conclusions There were significant dose-response relationships between drinking water fluoride and BMD and serum BGP. It indicated that BMD and BGP might be considered as early screening biomarkers for endemic fluorosis, especially for the bone damage.