三邻甲苯磷酸酯污染面粉致中毒性周围神经病暴发的危险因素分析

ANALYSIS OF RISK FACTORS FOR A TOXIC POLYNEUROPATH OUTBREAK DUE TO TRI-ORTHO-CRESYL PHOSPHATE CONTAMINATED FLOUR

发生一起农民因食用三邻甲苯磷酸酯（ＴＯＣＰ）污染的面粉，导致中毒性周围神经病暴发事件。总罹患率为６．０５‰，红光村２６．３５‰，潜伏期４０～９４天，具有明显的家庭聚集性。在排除病毒、细菌、重金属、非金属及生物碱作为病因可能后，经对食用不同来源蔬莱、食用油、面粉及小麦使用农药史等危险因素进行逐一分析后，发现食用河道磨房面粉为患病高危险因素，ＲＲ＝１８．２４，Ｐ＜０．００１，并经实验室检测，从该面粉中检出ＴＯＣＰ（０．２６～１．４０ｍｇ／ｋｇ）。证实本次中毒性周围神经病暴发系ＴＯＣＰ中毒所致，受ＴＯＣＰ污染的河道磨房面粉系本次暴发的危险因素。

An outbreak of toxic polyneuropath due to tri-ortho-cresyl phosphate(TOCP) contaminated flour in suburbs of Xi′an was reported. Total attack rate was 6.05 ‰ in five villages and 26.36 ‰ in Hong-guang village. Incubation period was 40 to 94 days. It had clearly family cruster in outbreak. In this study, field and pathogen epidemiological survey was adopted and laboratory tests were used for isolation of virus, bacteria and checking out toxin or chemicals. After some of potential pathogens(virus, bacteria, metals, and alkaloids, etc ) had been ruled out as etiology of the outbreak, risk factors associated with eating vegetables of different sources, cooking oil, spraying or non-spraying pesticides for wheat, and different mill′s flour were analysed. It was found that consumption of He-dao mill′s flour was high risk factor for paralysis outbreak,RR=18.24,P<0.001. TOCP was checked out from He-dao mill′s flour (0.26-1.40 mg/kg).It was concluded that the toxic polyneuropath outbreak was caused by TOCP poisoning and the flour contaminated by TOCP was high risk factor.