2009年河北省饮水型地方性氟中毒病情调查

The investigation of drinking-water-borne endemic fluorosis in Hebei province in 2009

目的了解饮水型地方性氟中毒的病情动态和评价防治措施的落实效果，为及时调整防治策略提供科学依据。方法2009年，采用单纯随机抽样的方法，在河北省饮水型氟中毒病区县中抽取38个县（市、区），采用系统抽样方法，将各病区县所有病区村分成轻、中、重3类，从每类病区村中各抽取1个病区村，对全部病区村进行水氟监测：调查病区村全部8～12岁儿童氟斑牙患病情况，从每个年龄段选择6人，检测尿氟；对各病区村全部16岁以上常住人口开展临床氟骨症检查，并检测20人份（男、女各半）尿氟。结果共调查112个病区村，其中改水村66个，未改水村46个。采集改水工程水样236份，水氟范围为0．1—4.3mg／L，有20个工程水氟〉1．2mg／L，占总数的33.3％（20／60）；采集未改水村水样230份，水氟范围为0．2—4．6mg／L，水氟〉1．2mg／L的水源数占总数的76．1％（35／46）。共对5169名8～12岁儿童进行了氟斑牙患病情况调查，氟斑牙检出率为36．43％（1883／5169），氟斑牙指数为0．81。调查16岁以上成人71497人，临床氟骨症检出率为4．81％（3438／71497），中度以上临床氟骨症检出率为1．56％（1114／71497）。分别测定了2876和2021份儿童和成人尿氟，几何均数分别为2．30、3．32mg／L。结论水氟〈1．2mg／L的已改水村儿童氟斑牙检出率均在30％以下．儿童氟斑牙检出率和成人临床氟骨症检出率随着改水时间的延长呈现逐渐下降的趋势。未改水病区，儿童氟斑牙检出率和成人临床氟骨症病情随水氟升高而上升。河北省饮水型氟中毒流行仍然较为严重，应该加快改水降氟进度并提高改水工程合格率。

Objective To understand the status of drinking-water-borne endemic fluorosis and the effect of preventive measure in Hebei province, so as to provide a basis to prevent and cure the disease. Methods Ttfirtyeight affected counties（cities, districts） with drinking-water-borne endemic fluorosis were sampled by random sampling in Hebei in 2009. All affected villages in every county were divided into mild, moderate and severe endemic fluorosis areas and a village was randomly selected from each category of the area to carry out the monitoring of endemic fluorosis. Dental fluorosis of children aged 8 - 12 were examined and 6 copies of urine samples were randomly collected in e0ch age group in the above-mentioned villages. Clinical skeletal fluorosis was diagnosed among adults aged 16 and over and 20 copies of urine samples were tested for fluorosis in every village. Results A total of 112 affected villages were investigated, among which the drinking water quality of 66 villages were improved and 46 villages were not improved. A total of 236 copies of water samples from the 66 villages were measured and the fluoride content ranged from 0.1 to 4.3 rag/L, among which 20 copies of water samples exceeded the fluorine standard of 1.2 mg/L, accounting for 33.3%. A total of 230 copies of water samples were collected in the 46 villages and the fluoride content ranged from 0.2 to 4.6 mg/L, among which 76.1% （35/46） of the water samples exceeded the fluorine standard of 1.2 mg/L. A total of 5169 children aged 8 - 12 were examined of dental fluorosis, the dental fluorosis rate was 36.43%（1883/5169） and the dental fluorosis index was 0.81. A sum of 71 497 adults aged over 16 years were examined, and the rate of skeletal fluorosis was 4.81% （3438/71 497）, moderate or severe clinical detection rate of skeletal fluorosis was 1.56% （1114/71 497 ）. A total of 2876 copies of children urine samples and 2021 copies of adult mine samples were tested and the geometric mean of fluoride content was 2.30,3.32 mg/L, respectively. Conclusions The prevalence of dental fluorosis of children in the areas with improved water is less than 30% and the rate of dental fluorosis and skeletal fluorosis decline gradually with time. The rate of dental fluorosis and skeletal fluorosis increases with the increase of water fluoride in the water quality not improved areas. The endemic fluorosis is still comparatively serious in Hebei. The progress of improving water quality in the areas with endemic fluorosis should be accelerated and the acceptability of improved water should be enhanced.