2007年山东省地方性氟中毒重点监测分析

Analysis on Surveillance of Endemic Fluorosis in Shandong Province in 2007

目的掌握山东省地方性氟中毒防治措施落实情况、防治效果与病情变化动态,为制定防治策略提供科学依据。方法按照全国地方性氟中毒监测方案的要求,调查了高密等5县（市）改水降氟进度、部分改水工程使用情况及饮水含氟量;抽查了重点监测点居民饮水含氟量;检查了监测点8-12岁儿童氟斑牙患病情况、30岁以上成人临床与X线氟骨症患病率以及人群尿氟水平。结果高密等5县（市）共有地氟病村2 377个,已完成改水降氟1 537个村,改水率为64.66%;改水设施的正常使用率74.10%,报废与非正常供水率25.87%;正常运转的工程水氟超标率43.37%,水氟最大值6.02 mg/L。5县（市）14个重点监测点居民水氟均值为2.06 mg/L,以博兴县最高5.09 mg/L;重点监测点8-12岁儿童平均氟斑牙检出率86.17%,缺损率17.80%,氟斑牙指数1.94,病情以博兴、嘉祥2县为重;30岁以上成人临床氟骨症阳性率平均43.84%,中度以上为32.12%,X线氟骨症检出率平均25.57%,Ⅱ度以上阳性率为6.70%,并检出13例Ⅲ度病例,其中高密、嘉祥两地病情较重;病区人群尿氟水平明显增高,儿童与成人群体几何均值分别为3.14 mg/L、3.55 mg/L。结论病区改水降氟措施落实进度比较缓慢且不平衡,改水设施水氟超标严重,病情仍存在一定程度流行,对此应增加投入,加大防治工作力度。

Objective To explore the prevalent trends of endemic fluorosis in Shandong province and to provide scientific evidence for control strategies. Methods According to the National Survey Scheme of Endemic Fluomsis, the progress of fluo- rine - removing and water - modifying project, fluoride levels in drinking water, dental fluorosis in children aged 8 - 12 yeras, as well as clinical skeletal fluorosis in adults over 30 years were investigated in five counties. Results There were 2 377 endemic fluorosis villages in the five counties, 64. 66% （ 1 537 ） of which had finished the projects of fluorine - removing and water - modifying. The rate of normally utilized projects was 74. 10% , and that of abnormally utilized projects 25.87%. The water fluoride levels were over standard in 43.37% of the normally utilized projects, with the maximum value of 6.02 mg/L. The mean water fluoride value was 2.06 mg/L for 14 survelianee sites of the 5 counties, with the highest value of 5.09 mg/L in Boxing county. In the major monitoring sites, the detection rate of dental fluorosis was 86. 17% , of dental damage 17.80% , and dental fluorosis index was 1.94 in children aged 8 - 12 years. The disease was more serious in Boxing and Jiaxiang counties. In adults over 30 years, 43. 84% were positive for clinical skeletal fluorosis, among which 32. 12% were clinical stage Ⅱ or Ⅲ; 25.57% were detected positive for X -ray skeletal fluorosis, among which 6.70% were clinical stage Ⅱ , and 13 cases were stage Ⅱ ; the disease was more serious in Gaomi and Jiaxiang counties. The urine fluoride of population in endemic areas was obviously higher than normal value. The geometric mean of urine fluoride were 3.14 and 3.55 mg/L respectively in children aged 8 - 12 years and adults over 30 years old. Conclusion The progress of the project of fluorine - removing and water - modifying is non - equilibrium and slow, and the water fluoride exceeds standard seriously, the endemic fluorosis is still serious and the disease control and prevention should be strengthened.