2021年青海省玉树藏族自治州饮茶型地方性氟中毒地区成人氟骨症调查分析

Investigation and analysis of adult skeletal fluorosis caused by drinking tea-type endemic fluorosis in Yushu Tibetan Autonomous Prefecture,Qinghai Province in 2021

目的了解青海省玉树藏族自治州(以下简称玉树州)饮茶型地方性氟中毒地区成人氟骨症患病情况,为防治工作提供科学依据。方法2021年8月,在玉树州囊谦、称多、玉树、杂多、曲麻莱、治多6个县(市),每个县(市)抽取1个村作为调查点,每个村采集所有生活饮用水源水样和10份砖茶样,测定水氟、砖茶氟含量;并抽取至少100名≥25岁、有饮砖茶习惯且在当地居住5年以上的常住居民进行X线拍片,检查成人氟骨症患病情况。结果共采集居民生活饮用水水样75份,水氟含量为(0.21±0.05)mg/L,范围为0.11~0.34 mg/L;采集砖茶样60份,砖茶氟含量为(626.70±157.27)mg/kg,范围为324.00~2102.00 mg/kg。共检查成人1136例,检出氟骨症318例,检出率为27.99%;其中,轻、中、重度氟骨症检出率分别为20.95%(238/1136)、6.07%(69/1136)、0.97%(11/1136),病情以轻度为主。男、女性氟骨症检出率分别为29.09%(121/416)、27.36%(197/720),比较差异无统计学意义(χ^(2)=0.39,P=0.533);但不同性别人群氟骨症病情分度比较,差异有统计学意义(χ^(2)=22.31,P<0.001)。25~35、36~45、46~55、56~65、66~75和≥76岁年龄组人群氟骨症检出率依次为6.86%(7/102)、22.37%(51/228)、24.02%(92/383)、37.44%(73/195)、43.48%(70/161)、37.31%(25/67),比较差异有统计学意义(χ^(2)=59.84,P<0.001);且不同年龄组人群氟骨症病情分度比较,差异有统计学意义(H=37.66,P<0.001)。Spearman相关分析结果显示,成人氟骨症病情分度与年龄呈正相关(r=0.34,P<0.001)。结论玉树州存在一定程度的成人氟骨症流行;且随着年龄增长,氟骨症病情越严重。

Objective To investigate the prevalence of adult skeletal fluorosis caused by drinking tea-type endemic fluorosis in Yushu Tibetan Autonomous Prefecture(hereinafter referred to as Yushu Prefecture),Qinghai Province,and provide scientific basis for prevention and control of the disease.Methods In August 2021,one village was selected as a survey site in six counties(cities)in Yushu Prefecture,including Nangqian,Chindu,Yushu,Zadoi,Qumarlêb,and Zhiduo.Drinking water samples and 10 brick tea samples were collected from each village to determine the fluoride content in water and brick tea;at least 100 permanent residents aged≥25,who had a habit of drinking brick tea and had lived in the local area for more than 5 years,were selected for X-ray imaging to examine the prevalence of adult skeletal fluorosis.Results A total of 75 samples of residential drinking water were collected,with a fluoride content of(0.21±0.05)mg/L,ranging from 0.11 to 0.34 mg/L;60 samples of brick tea,with a fluoride content of(626.70±157.27)mg/kg,ranging from 324.00 to 2102.00 mg/kg.A total of 1136 adults were examined,and 318 cases of skeletal fluorosis were diagnosed,with a detection rate of 27.99%.Among them,the detection rates of mild,moderate,and severe skeletal fluorosis were 20.95%(238/1136),6.07%(69/1136),and 0.97%(11/1136),respectively,with mild symptoms being the main.The detection rates of skeletal fluorosis in males and females were 29.09%(121/416)and 27.36%(197/720),respectively,with no statistically significant difference between the gender(χ^(2)=0.39,P=0.533).Comparison of the skeletal fluorosis in different gender,the differences were statistically significant(χ^(2)=22.31,P<0.001).The detection rates of skeletal fluorosis in the age groups of 25-35,36-45,46-55,56-65,66-75,and≥76 years old were 6.86%(7/102),22.37%(51/228),24.02%(92/383),37.44%(73/195),43.48%(70/161),and 37.31%(25/67),respectively.The differences between the groups were statistically significant(χ^(2)=59.84,P<0.001).Moreover,there was a statistically significant difference in the composition of skeletal fluorosis among different age groups(H=37.66,P<0.001).The Spearman correlation analysis results showed that the severity of adult skeletal fluorosis was positively correlated with age(r=0.34,P<0.001).Conclusions There is a certain degree of prevalence of adult skeletal fluorosis in Yushu Prefecture.And as age increases,the condition of skeletal fluorosis becomes more severe.