2009年西藏自治区饮水型氟中毒病情监测结果分析

Surveillance analysis of drinking water borne fluorosis in Tibet autonomous region in 2009

目的了解西藏饮水型地方性氟中毒的病情动态，评价防治措施的效果，为及时调整防治策略提供科学依据。方法按照“2008年中央补助地方公共卫生专项资金西藏饮水型氟中毒防治项目”技术方案，于2009年9—10月选取日喀则谢通门和林芝察隅两县作为项目县．在每个项目县采用单纯随机抽样的方法选择3个项目村，以自然村为单位，对改水及改水工程运转情况、饮水含氟量、儿童氟斑牙和成人临床氟骨症进行调查。按照《生活饮用水标准检验方法非金属指标》（GB／T5750．6—2006）测定水氟；尿中氟化物的测定采用离子选择电极法（WS／T89—1996）；氟斑牙诊断采用Dean法；成人氟骨症诊断按《地方性氟骨症临床诊断标准》（WS192—2008）进行。结果已改水病区水氟均值在0．18～0．34mg／L，未改水病区水氟均值在0．70—2．13mg／L；已改水病区8-10岁儿童氟斑牙检出率为50．78％（65／128），氟斑牙指数为1．04，儿童尿氟均值为1．64mg／L，未改水病区氟斑牙检出率为80．65％（25／31），氟斑牙指数为1．50，儿童尿氟均值为2．08；已改水病区成人氟骨症患病率为38．7％（104／269），尿氟为1．61mg／L，未改水病区成人氟骨症患病率为15．4％（18／117），尿氟为3．54mg／L。结论改水降氟使氟斑牙的检出率降低至控制水平，严重程度也在降低，改水病区尿氟低于未改水病区，说明改水仍对消除氟中毒的危害有重要意义，但氟骨症患病率出现了在改水病区反而高于未改水病区的现象。

Objective To find out the dynamics of drinking water borne endemic fluorosis in Tibet＇s, to evaluate the effect of control measures, and to provide a scientific basis for the timely adjustment of control strategies. Methods During september to october 2009, according to the ＂2008 Central Government Special Funds to Subsidize Local Public Health in Drinking Water Borne Fluorosis in Tibet＂, Xigaze Xietongmen and Nyingehi Zayu were selected as project counties, three project villages were selected with simple random sampling method in each county, the functioning of water improvement projects, drinking water fuoride content, children＇s dental fluorosis and adult skeletal fluorosis were investigated. Water fluoride was detected by the ＂standard examination methods for drinking water the non-metallic targets＂ （GB/T 5750.6-2006） determination of fluoride; urinary fluoride was tested by ion selective electrode （WS/T 89-1996）; dental fluorosis was diagnosed using Deans method; adult skeletal fluorosis was diagnosed by ＂endemic skeletal fluorosis clinical diagnostic criteria＂ （WS 192-2008）. Results Mean water fluoride was 0.18 - 0.34 mg/L in drinking water changed areas, and 0.70 - 2.13 mg/L in not changed areas; prevalence of dental fluorosis of children 8 - 10 was 50.78% （65/128）, dental fluorosis index was 1.04, mean urinary fluoride was 1.64 mg/L in drinking water changed areas ; prevalence of dental flnorosis of ehildren 8 - 10 years old was 80.65% （25/31） in not changed areas, dental fluorosis index was 1.50, mean urinary fluoride of children was 2.08; adult clinical skeletal fluorosis was 38.7% （104/269） in drinking water changed areas, the mean urinary fluoride was 1.61 mg/L, prevalence of skeletal fluorosis was 15.4% （18/117） in not changed areas, mean urinary fluoride was 3.54 mg/L. Conclusions The method of change the water to reduce fluoride decreases dental fluorosis to control levels, and severity is also reduced, urinary fluoride is decreased. However, the prevalence of skeletal fluorosis is higher than that of drinking water not changed areas.