1992—2006年山东省地方性氟中毒重点监测分析

Analysis on surveillance outcome of endemic fluorosis in Shandong Province from 1992 to 2006

目的了解1992—2006年山东省地方性氟中毒防治措施落实进度和病情变化动态，为制订控制措施提供科学依据。方法按照《全国地方性氟中毒监测方案》，选择桓台县（1992—1996年）和梁山县（1997—2006年）作为监测县，调查2个县改水情况和饮水含氟量；在桓台县选择李家村，染山县选择东徐村，调查居民饮水含氟量，8—12岁儿童氟斑牙患病情况、尿氟水平以及16岁以上成人临床与X线氟骨症患病情况。结果1992年桓台县、2006年粱山县的改水降氟完成率分别为100．00％（304／304）、63．72％（137／215）；1992—1996年桓台县正常使用工程的水氟超标（〉1．0mg／L）率范围为5．00％（5／100）-17．14％（18／105），1997—2006年梁山县为18．97％（11／58）-45．61％（26／57）。1992—1996年李家村居民饮用水水氟均〈1．00mg／L，1997—2006年东徐村居民饮用水水氟均〈0．50mg/L。李家村8—12岁儿童氟斑牙检出率由1992年的30．86％（25／81）降为1996年的10．13％（8／79，χ^2=12．41，P〈0．05），东徐村则由1997年的68．95％（151／219）降为2006年的0（0／38，χ^2=222．04，P〈0．01）；李家村和东徐村儿童尿氟水平连续监测均低于1．40mg／L。桓台县李家村16岁以上成人X线氟骨症阳性检出率由1992年的30．0％（15／50）降为1996年的13．95％（6／43，χ^2=3．41，P〉0．05），均为Ⅰ度病例；东徐村由1997年的64．58％（31／48）降至16．67％（4／24，χ^2=14．71，P〈0．01），且无Ⅲ度病例检出。结论监测县改水降氟措施落实进度尚不平衡，梁山县进展比较缓慢；部分改水工程水氟超标；重点监测村居民饮用水水氟正常，氟中毒病情得到有效控制。今后应加大投入，加快改水进度并加强改水设施的管理与病情监测，最大限度降低氟中毒危害。

Objective To understand the fulfillment of control measures of endemic fluorosis and find out the prevalent trend of this disease in Shandong Province from 1992 to 2006 in order to provide a scientific basis for the set up of control strategies. Methods According to ＂the National Survey Scheme of Endemic fluorosis＂, Huantai County in 1992 - 1996 and Liangshan County in 1997 - 2006 were selected, where water-improving defluoridation and the contents of water fluoride were＇searched in two counties; dental fluorosis and urine fluoride in children aged 8 - 12 years old, clinical and X-ray skeletal fluorosis in adult over 16 years old were searched respectively in Lijia Village of Huantai County and Dongxu Village of Liangshan County. Results One hundred percent（304/304） high- fluoride villages of Huantai County in 1992 and 63.72% （137/215） villages of Liangshan County in 2006 had finished the project of water-improving defluoridation; the rate of high-fluorine water（ 〉 1.0 mg/L） in normal operation projects was 5.00%（5/100） - 17.14%（18/105） in Huantai County from 1992 to 1996, and 18.97%（11/58） - 45.61% （26/57） in Liangshan County from 1997 to 2006. The water fluoride of Lijia Village was 〈 1.0 mg/L from 1992 to 1996, the water fluoride of Dongxu Village was 〈 0.5 mg/L from 1997 to 2006. The detection rate of dental fluorosis of children aged 8 - 12 years at Lijia Village dropped from 30.86%（25/81） in 1992 to 10.13%（8/79） in 1996（χ^2 = 12.41, P 〈 0.05）, and the Dongxu Village dropped from 68.95%（151/219） in 1997 to 0（0/38） in 2006（χ^2 = 222.04, P 〈 0.01 ）. In the Lijia and Dongxu Villages, urine fluoride in children aged 8 - 12 years old was lower than 1.40 mg/L. In the adults over 16 years of the two villages, the positive rate of X-ray skeletal fluorosis of Lijia Village dropped from 30.0%（15/50） in 1992 to 13.95%（6/43） in 1996（χ^2 = 3.41, P 〉 0.05）, and all the cases were in degree Ⅰ, the rate of Dongxu Village dropped from 64.58%（31/48） in 1997 to 16.67% （4/24） in 2006（χ^2 = 14.71, P 〈 0.01 ）, and no cases of degrees llI was detected, Conclusions The progress of water defluoridation was uneven in 2 counties, slow in Liangshan County; and the water fluoride in part of the project exceeded standard; the water fluorid of 2 surveyed villages was normal and the endemic fluorosis was under control. More financial input is requested to accelerate the process of water defluoridation and to reinforce the management of the projects and illness monitoring, thus to reduce the harm of fluorosis to the limit.