我国4个民族饮茶型氟中毒病情差异研究

The differences of brick-tea fluorosis of four ethnic in China

目的探讨饮茶型氟中毒地区藏、蒙古、哈萨克、汉4个民族的氟中毒病情是否存在差异及引起差异的可能原因。方法在青海省果洛州藏族居住地区、内蒙古自治区呼伦贝尔市蒙古族居住地区、新疆维吾尔自治区阿勒泰哈萨克族居住地区各选择了2个县，每个县分别选择人1：3相对集中的3～4个病区乡为调查点。选择调查点内16岁以上少数民族及汉族人群进行问卷调查，调查内容包括调查对象的一般情况、日均砖茶水摄人量等；并采集调查点的居民家中饮用水样，以及调查对象的砖茶水、尿样进行氟含量测定：使用便携式数字化X光机（DR）对调查对象的前臂、腰椎及盆骨进行X线拍片。饮用水水氟、砖茶氟和尿氟测定采用离子选择电极法（ws／T89．2006）；x线氟骨症诊断依据《地方性氟骨症诊断标准》（wS／r192．2007），并结合流行病学特征及临床表现。结果共调查16岁以上成人1703人，其中藏族、蒙古族、哈萨克族和汉族分别为525、328、305和545人。4个民族日均砖茶水摄入量、饮用水氟含量、茶水氟含量、日均砖茶摄氟量的均值以及尿氟的几何均数分别为2758．42ml、0．88mg／L、2．76mg／L、8．77mg、1．75mg／L。其中藏族、蒙古族、哈萨克族和汉族人群的日均砖茶水摄入量、饮用水氟含量、茶水氟含量、日均砖茶摄氟量、尿氟分别为3304．58、2170．42、2476．34、J583．93ml，0．27、0．88、1．04，0．35mg／L，2．91，1．66、3．14，0．93mg／L，10．17、4114、9．22、2．66mg，2，17、1．41、3．3771．15mg／L。日均砖茶水摄人量、饮用水氟含量、茶水氟含量、日均砖茶摄氟量、尿氟含量各民族间比较差异均有统计学意义（F值分别为10．639、50．498、25．371、10．800、166．852，P均〈0．05）。X线氟骨症总体检出率为27．25％（399／1464）。其中藏族、蒙古族、哈萨克族和汉族的检出率分别为43．55％（179／411）、21．90％（60／274）、33．22％（98／295）和12．81％（62／484）；男性氟骨症检出率[30．70％（175／570）]高于女性[25．06％（224／894），χ2=5．596，P〈0．05]；不同年龄段藏族、蒙古族、汉族氟骨症检出率组间比较差异均具有统计学意义（x。值分别为50．423、8．899、18．676，P均〈0．05）。结论我国饮茶型氟中毒流行程度在不同民族间存在明显差异，藏族人群的氟骨症检出率和病情程度明显重于哈萨克族、蒙古族和汉族，与不同民族之间砖茶氟暴露程度不同有关。在砖茶氟暴露程度相近的情况下，哈萨克族氟骨症检出率和病情程度明显较藏族人群轻，提示在饮茶型氟中毒流行中还有非暴露因素的参与。

Objective To investigate the differences of fluorosis of Tibetans, Mongolians, Kazakhs and Han in drinking tea type fluorosis areas. Methods In Guoluo Autonomous Prefecture of Qinghai Province, Hulunbuir City of Inner Mongolia Autonomous Region and Ahay Prefecture of Xinjiang Autonomous Region, two counties were selected in each province respectively, and 3 - 4 diseased townships were selected from each county. People 16 years and older of Tibetans, Mongolians, Kazakhs and Han were examined. A questionnaire survey of endemic fluorosis was conducted, the survey contents included general characteristics, average daily brick tea intake; drinking water, brick tea and urine were collected and used for analysis; forearm, lumbar spine and pelvisof subjects were examined by Portable DR. Water fluoride, ion selective electrode （WS/T 89-2006）. X-ray diagnosis brick tea fluorine and urinary fluoride were detected by of skeletal fluorosis was based on ＂Endemic Skeletal Fluorosis Diagnostic Criteria＂ （WS/T 192-2007）, and epidemiological and clinical descriptive information were combined. Results The total number of respondents was 1 703. The numbers of respondents in Tibetan, Mongolian, Kazak and Han were 525, 328, 305 and 545, respectively. In the four ethnic, average daily brick tea intake, fluoride content in drinking water, fluoride content in brick tea, average daily fluoride intake of brick tea, urinary fluoride content were 2 758.42 ml, 0.88 rag/L, 2.76 mg/L, 8.77 mg and 1.75 mg/L. Average daily brick tea intake, fluoride contents in drinking water, fluoride contents in brick tea, average daily fluoride intake of brick tea, urinary fluoride contents in Tibetan, Mongolian, Kazak and Han were 3 304.58, 2 170.42, 2 476.34, 1 583.93 ml, 0.27, 0.88, 1.04, 0.35 mg/L, 2.91, 1.66, 3.14, 0.93 mg/L, 10.17, 4.14, 9.22, 2.66 mg, 2.17, 1.41, 3.37, 1.15 mg/L. The differences of average daily brick tea intake, fluoride content in drinking water, fluoride content in brick tea, average daily fluoride intake of brick tea and urinary fluoride content between groups were statistically signifieant（F = 10.639, 50.498, 25.371, 10.800, 166.852, all P 〈 0.05）. The average detectable rate of X-ray skeletal fluorosis was 27.25% （399/1 464）. The X-ray detectable rate of skeletal fluorosis of Tibetan, Mongolian, Kazak and Han were 43.55% （ 179/41 t ）, 21.90% （60/274）, 3.22% （98/295） and 12.81% （62/484）, respectively. The detectable rate of skeletal fluorosis of males [30.70% （175/570）] was higher than that of females[ （25.06% （224/894）, χ2 = 5.596, P 〈 0.05]. The differences of detectable rate of skeletal fluorosis was statistically significant in different age groups of Tibetan, Mongolian and Han（χ2 = 50.423, 8.899, 18.676, all P 〈 0.05）. Conclusions Significant differences of tea type finorosis prevalence are found in different ethnic population. Compared with Mongolian, Kazak and Han, the detectable rate of skeletal fluorosis is higher and the condition of skeletal fluorosis is more serious in Tibetan, which is associated with higher fluoride exposures through brick tea. However, the skeletal fluorosis detectable rate of Kazakh is significantly lower than that of the Tibetan population buf both have similar level of fluoride exposure. It is demonstrated that non-exposure factors may be involved in the mechanism of tea type fluorosis.