2006年和2007年陕西省安康市燃煤污染型氟砷中毒及相关性调查

Investigation on fluorosis and arsenism caused by coal-burning and relevant study in Ankang city of Shaanxi province in the year of 2006 and 2007

目的了解陕西省安康市燃煤污染区氟、砷中毒的病情现况及其相关性，为制订有效地防治策略提供科学依据。方法在安康市燃煤污染区，选择9个调查点进行成人氟骨症和砷中毒的流行病学调查。煤炭氟采用《煤中氟的测定方法》（GB／T4633—1997），煤炭砷采用氢化物原子荧光光度法测定，成人氟骨症诊断采用《地方性氟骨症临床分度诊断标准》（GB16396—1996），砷中毒诊断采用《地方性砷中毒诊断标准》（WS／T211-2001）。结果共调查16岁以上成人569人，检出氟骨症121例，总检出率为21．27％，查出Ⅱ度以上氟骨症病人4例。占受检人数的0．70％；检出砷中毒132例，总检出率为23．20％，查出中度以上砷中毒病人95例，占受检人数的16．69％。氟骨症与砷中毒检出率间呈正相关（r=0．816，P〈0．01）；氟骨症检出率与煤炭含氟量有密切关系（r=0．775，P〈0．05）；砷中毒检出率与煤炭含砷量间也有密切关系（r=0．761，P〈0．05）。40～、50～、60～岁组[27．20％（34／125）、29．27％（36／123），28．13％（36／128）]与〈40岁组[7．77％（15／193）]比较，氟骨症检出率明显增高（χ^2值分别为21．969、25．648、23．856，P均〈0．01）。砷中毒检出率，男性[33．67％（99／294）]明显高于女性[12．00％（33／275），χ^2=37．162，P〈0．01]。结论氟、砷中毒检出率有很高的相关性，但两病同时在同一个体上发生的几率并不很高。体内氟随年龄增加累积到一定水平后，检出率的变化不再明显；而砷中毒则表现出随年龄增加而检出率明显增高。

Objective To investigate the status of the disease of the fluorosis and arsenism caused by coal-burning in Ankang city of Shaanxi. Methods Nine survey spots were chosen to carry out the epidemiological investigation of adult skeletal fluorosis and arsenism in the coal-polluted areas of Ankang, respectively using Determination of Fluorine in Coal （GB/T 4633-1997） to determine the coal fluorine and using hydride generation atomic fluorescence spectrophotometry（HGAFS） to determine coal arsenic. The diagnose of the adult skeletal fluorosis followed the Diagnosis of Clinical Classification for Endemic Skeletal Fluorosis Standard （GB 16396-1996）, that of arsenism using Standard of Diagnosis for Endemic Arsensim （WS/T 211-2001 ）. Results Totally 569 adults were investigated over the age of 16, among which 121 cases were skeletal fluorosis, with a total detection rate of 21.27%. Four cases of II degree and higher skeletal fluorosis patients were identified, accounting for 0.70% of the number of subjects. One hundred and thirty-two cases of arsenic poisonin were detected, in a rate of 23.20%. Ninety- five patients were identified with moderate or severe arsenic poisoning, accounting for 16.69% of subjects. A positive correlation was found between the detection rates of the skeletal fluorosis and the arsenism（r = 0.816, P 〈 0.01）, as well as between the detection rate of skeletal fluorosis and fluoride content of coal（r = 0.775, P 〈 0.05）. The detection rate of arsenism and arsenic content of coal also had close relationship（r = 0.761, P 〈 0.05）. The detection rate of skeletal fluorosis in the group aged 40 - ,50 - , and 60 - [27.20%（34/125）,29.27%（36/123）, 28.13% （36/128）] was increased, compared the group of less than 40 years age[7.77%（15/193）, χ^2= 21.969,25.648,23.856, P 〈 0.011. For the detection rate of arsenism, male [33.67% （99/294） ] was obviously higher than female [ 12.00% （33/275）, χ^2 = 37.162, P 〈 0.011. Conclusions A high detection rate of fluorosis is correlated with arsenic poisoning, but the probability of the two diseases simultaneously occurred in a person is not high. In this polluted area, when fluoride accumulates to a certain level as in adult, the detection rates no longer varies obviously; however, that of arsenism increases along with the age.