2023年陕西省燃煤污染型地方性砷中毒病区监测结果分析

Analysis of monitoring results of coal-burning-borne endemic arsenic poisoning in Shaanxi Province in 2023

目的掌握陕西省燃煤污染型地方性砷中毒病区各项监测指标和患者管理情况,为巩固提升防控成果提供依据。方法2023年3-12月,按照《陕西省卫生健康委办公室关于印发大骨节病等重点地方病监测方案的通知》《陕西省地方性氟中毒和砷中毒监测方案》要求,在陕西省所有燃煤污染型地方性砷中毒病区县的病区村,开展基本情况调查,实地走访查看高砷煤矿管理情况。每个村按单纯随机抽样方法选择30户居民调查炉灶使用、相关健康生活行为形成情况。对病区村所有人群开展砷中毒病情调查。在3个病区县的12个病区村,抽取720人测定尿砷含量,根据《人群尿砷安全指导值》(WS/T 665-2019)进行判定。根据《国家卫健委关于印发重点地方病控制和消除评价办法(2019版)》进行消除评价。结果共监测2个市、8个县(区)、99个乡(镇)、1414个病区村,53处高砷煤矿已全部停止开采。合格改良炉灶率为99.97%,合格改良炉灶正确使用率及病区村供人食用的玉米和辣椒正确干燥率均为100.00%。砷中毒病情调查,实际检查2064138人,共检出砷中毒患者2682例,均为历史患者,无新发病例和砷相关皮肤癌患者,现存2682例砷中毒患者均进行了家庭医生签约服务,落实了随访管理。尿砷含量几何均值为0.0167 mg/L,低于人群尿砷安全指导值(0.032 mg/L)。结论陕西省燃煤污染型地方性砷中毒病区各项监测指标达到消除标准。今后还应继续加强高砷煤矿管理,落实改炉改灶和健康促进为主的各项综合防控措施,并做好患者管理工作,持续巩固提升防控成果。

Objective To learn about the monitoring indicators and patient management in coal-burning-borne endemic arsenic poisoning areas in Shaanxi Province,and provide a basis for consolidating and improving the prevention and control achievements.Methods From March to December 2023,in accordance with the requirements of the"Notice of the Office of Shaanxi Provincial Health Commission on Issuing of the Monitoring Plan for Key Endemic Diseases Such as Kashin-Beck Disease"and"The Monitoring Plan for Endemic Fluorosis and Arsenic Poisoning in Shaanxi Province",a basic situation investigation was conducted in the affected villages of all counties(districts)with coal-burning-borne endemic arsenic poisoning in Shaanxi Province,and on-site visits were conducted to check the management of high arsenic coal mines.Using the simple random sampling method,30 families in each village were selected to investigate the use of stoves and the formation of health-related behaviors.A survey on arsenic poisoning was carried out among all populations in the affected villages.According to the requirements of the provincial monitoring program,720 people were randomly selected from 12 affected villages in 3 monitoring counties to measure their urinary arsenic level.The determination was based on the"Guidelines for the Safety of Urinary Arsenic in Population"(WS/T 665-2019).The evaluation for elimination of disease areas was carried out in accordance with the"National Health Commission Issued the Evaluation Approach for Control and Elimination of Priority Endemic Diseases(2019 edition)".Results A total of 2 cities,8 counties(districts),99 townships,and 1414 affected villages were monitored.All 53 high arsenic coal mines had stopped mining.The rate of qualified improved stoves was 99.97%;the correct utilization rate of qualified improved stoves,and the correct drying rate of corn and chili peppers provided for human consumption in the affected villages were 100.00%.A total of 2064138 people were examined,and 2682 cases of arsenic poisoning were detected,all of whom were historical patients.There were no new cases of arsenic poisoning or skin cancer.There were currently 2682 arsenic poisoning patients who had received family doctor contract services and implemented follow-up management.The geometric mean of urinary arsenic was 0.0167 mg/L,which was lower than the safety guideline value for human urinary arsenic(0.032 mg/L).Conclusions The monitoring indicators in the coal-burning-borne endemic arsenic poisoning areas in Shaanxi Province have reached the elimination standards.In the future,we should continue to strengthen the management of high arsenic coal mines,implement comprehensive prevention and control measures mainly focused on furnace and stove renovation and health promotion,and do a good job in patient management to continuously consolidate and improve the prevention and control achievements.