饮水型氟中毒改水干预措施效果的Meta分析

Meta analysis on the effects of water defluoridation measures in China

目的 了解全国改水降氟措施防治饮水型地方性氟中毒的效果，探索控制饮水型氟中毒改水干预措施效果的综合评价方法。方法 制定纳入标准、剔除标准，制定检索策略；通过检索，共查找相关文献450篇，其中符合Meta分析要求的有效文献54篇。采用Cochrane协作网提供的Revman4．2．3统计软件对入选文献进行Meta分析。结果 改水11～20年，儿童氟斑牙患病率从69．3％降到23．8％，成人氟骨症患病率下降了4．9％，儿童尿氟由5．31mg／L降到1．50mg／L。改水21～31年，儿童氟斑牙患病率从78．6％降到23．9％，成人氟骨症患病率下降19．2％。平均改水13年，水含氟量由改水前的4．85mg／L降到0．60mg／L。改水后经济效益明显增加，血生化指标明显降低。结论改水降氟是防治饮水型氟中毒的有效措施，只要饮水含氟量降到允许标准以下，儿童氟斑牙患病率、成人氟骨症患病率和儿童尿含氟量都会明显降低。经济效益的增加间接反映了改水降氟的效果。Meta分析为从整体水平揭示全国改水降氟预防饮水型地方性氟中毒的效果提供了新的研究方法和手段，将对饮水型氟中毒防控干预措施效果综合评价研究起到积极的推动作用。

Objective To evaluate the effects of water defluoridation measures and provide a new approach to the methodological research of endemic fluorosis. Methods According to the established strategy, the author searched out 450 articles, among which 54 were effective for meta-analysis according to the included and excluded criteria. Meta-analysis is performed by using the statistical software Revman4.2.3 provided by the Cochrane Collaboration net. Results The dental fluorosis prevalence rate of children decreased from 63.9% to 23.8%, the prevalence of skeletal fluorosis dropped by 4.9%, the fluoride concentration in water and urinary fluorine reduced from 5.31 mg/L to 1.50 mg/L during 11 - 20 years of defluoridation. The dental fluorosis prevalence rate of children decreased from 78.6% to 23.9%, the prevalence of skeletal fluorosis reduced by 19.2% during 21 - 31 years of defluoridation. The fluoride concentration in water decreased from 4.85 mg/L to 0.60 mg/L after 13 years of defluoridation. The economic gains obviously increased and the biochemical indicators became normal. Conclusions Water defluoridatation is an efficacious method for endemic fluorosis control. Meta analysis provides a new approach for evaluating the overall effects of water defluoridation on endemic fluorosis control.