1991—2006年吉林省地方性氟中毒病情监测结果分析

Outcome analysis of surveillance on endemic fluorosis during thr period of 1991 to 2006 in Jilin Province

目的了解与掌握吉林省地方性氟中毒病情变化，为调整防治对策提供科学依据。方法1991—2006年在吉林省乾安县选择改水时间不同的7个屯作为监测点，每年检测全部8～12岁儿童氟斑牙（Dean法）、尿氟（氟离子选择电极法），每3年临床调查全部16岁以上人群氟骨症，每5年拍摄其骨盆、前臂、小腿骨关节X线片。结果改水较好的监测点监测结束后氟斑牙检出率比监测开始时明显下降（位字屯由11_3％降至2．2％、淡字屯由16-3％降至12．1％、后岂屯由53．7％降至37．5％、后鞠屯由38．6％降至33．3％），氟斑牙严重程度明显降低（东南竞屯中度氟斑牙检出率由11_3％降至7．8％、重度由2．8％降至0；后岂屯中度氟斑牙检出率由16．7％降至0，重度由1．9％降至O；后鞠屯中度氟斑牙检出率由1．4％降至O，重度由4％降至0），尿氟降至正常水平（〈1．5mg／L）。持续饮用高氟水的监测点儿童氟斑牙检出率升高（大宾屯由61．7％升至70．0％，东宾-东鞠屯由52．7％升至71．1％），尿氟持续在较高水平（大宾屯由4．03mg／L升至4．57mg／L）。7个监测点16岁以上人群临床氟骨症检出率在11．1％～25．7％，其中仅大宾屯呈逐年升高趋势（1991、1993、1995年分别为15．9％、21．6％、25．7％）。有3个监测点X线氟骨症检查阳性率呈逐年下降趋势（大宾屯由54．9％降至24．0％，东宾-东鞠屯由40．7％降至23．5％、东南竞屯由28．6％降至20．4％）。结论改水降氟能使病区病情得到控制，持续饮用高氟水病区病情将持续增高，控制氟中毒应采取综合措施有效减少高氟摄入。

Objective To unveil the changes of endemic fluorosis in order to provide the scientific basis for making countermeasure. Methods Seven villages was selected as monitoring points in Qianan County of Jilin Province where drinking water was improved or was going tobe improved. Dental fluorosis was surveyed with Dean method and for urine fluoride content was tested using fluoride ion-selective electrode analysis in 8 - 12 years old children. Clinical skeletal fluorosis was detected in all residents of aged 16 and over in the beginning of the monitor and every 3 years. X-ray films were taken in those over 16 years old at the beginning of the monitor and every 5 years. Results Detectable rate of dental fluorosis was decreased compared with before（Weizi： 11.3% to 2.2%, Danzi： 16.3% to 12.1%, Houqi： 53.7% to 37.5%, Houju： 38.6% to 33.3%）, and severity was declining, for example, in Dongnanjing, rate of being moderate was dropping from 11.3% to 7.8%, severe rate from 2.8% to 0; in Houqi： moderate rate from 16.7% to 0, severe rate from 1.9% to 0; in Houju, moderate rate from 1.4% to 0,severe rate from 1.4% to 0. However, detectable rate of dental fluorosis rose in Dabin from 61.7% to 70.0% and in Dongbin- donju from 52.7% to 71.1% due to increased fluorides in drinking water. Urine fluorides content in 8 - 12 years old children was decreased to normal level（1.5 mg/L） in most of monitoring spots, but in Dabin it still remained at a high level, being 4.03 and 4.57 mg/L before and after respectively. Detectable rate clinical skeletal fluorosis was between 11.1% - 25.7% among those aged 16 and over in 7 monitoring point in 1991 - 2006, however it increased year after year in Dabin （15.9%, 21.6% and 25.7% in 1991, 1993 and 1995）. Positive X-ray rate for skeletal fluorosis was decreased from 54.9% to 24.0% in Dabin, from 40.7% to 23.5% in Dongbin-donju and from 28.6% to 20.4% in Dongnanjing. Conclusions Endemic fluorosis has been controlled attributed to improved drinking water and decreased fluorides content in drinking water. Combined methods are needed to decrease to the intake of fluorides to control the diseases.