2009年陕西省饮水型氟中毒监测结果分析

Drinking-water type of fluorosis in Shaanxi province in 2009： an analysis of surveillance results

目的 掌握陕西省饮水型氟中毒改水工程运行情况及降氟效果,为饮水型氟中毒防治工作提供科学依据.方法 2009年对陕西省西安、宝鸡和榆林3个市16个县48个自然村进行监测.在未改水村按东、西、南、北、中采集5份水样,在已改水村采集3份末梢水和1份出厂水,用氟化物离子选择电极法（GB/I＇5750-2006）检测水氟.对监测村所有在校8～12岁儿童采用Dean法进行氟斑牙检查,16岁以上成人全部进行临床氟骨症检查,抽取30%的项目县,每个县选择1个村,对已诊断的临床氟骨症患者进行X线拍片检查,临床和X线氟骨症诊断采用〈地方性氟骨症诊断标准〉（WS 192-2007）.每个村采集8～12岁儿童尿样30份、16岁以上成人尿样20份,用〈尿中氟化物的测定离子选择电极法）（WS/T 89-1996）检测尿氟.结果 22处运行正常的改水工程中,出厂水超标8处,占36.36%（8/22）;工程报废5处.共检测水样202份,已改水村出厂水和末梢水水氟中位数分别为0.72、0.62mg/L,水氟超标率分别为36.36%（8/22）、31.94%（23/72）;未改水村水氟中位数为1.00 mg/L,水氟超标率为39.81%（43/108）.8～12岁儿童氟斑牙检出率为16.06%（367/2285）,氟斑牙指数为0.30,流行程度为阴性;16岁以上成人临床氟骨症检出率为5.09%（1542/30 272）,共有198人拍摄X线片,阳性68人,检出率为34.34%（68/198）.共检测儿童尿样1051份,尿氟几何均数为0.95mg/L;共检测16岁以上成人尿样914份,尿氟几何均数为1.16 mg/L.结论 陕西省饮水型氟中毒流行范围较大,病情程度较为严重,防治任务还很艰巨.进一步加大病区改水力度,加强病情监测、健康教育和改水工程的管理工作是防治地方性氟中毒的关键.

Objective To investigate the running conditions of the water improvement projects and the role of these projects in reducing fluoride in drinking-water type of fluorosis in Shaanxi province, and provide a scientific basis for prevention and control of the disease. Methods Forty-eight villages of 16 counties in Xi＇an, Baoji, and Yulin cities of Shaanxi province were monitored in 2009. Five water samples were collected randomly in water unimproved monitoring villages by the position of east, west, south, north, and center parts. In water improved monitoring villages, 3 tap water and one source water samples were collected. Water fluoride was tested using fluoride ion selective electrode method according to the ＂Standard Testing Methods for Drinking Water＂ （GB/T 5750-2006）. All school children aged 8 to 12 in monitored villages were examined their dental fluorosis using Dean criteria. All people over 16 years old were examined clinical skeletal fluorosis, and 30% of the project counties were randomly selected, then randomly selected one village among these counties, clinically diagnosed patients with skeletal fluorosis were examined again by X-ray using ＂Diagnostic Criteria of Endemic Skeletal Fluorosis＂（WS 192-2007）. Urine samples of 30 children aged 8 to 12 and of 20 adults over the age of 16 were randomly collected, urinary fluoride was tested according to ＂the Determination of Urinary Fluoride by Ion Selective Electrode Method＂ （WS/T 89-19%）. Results Of the 22 water improvement projects that in normal operation, fluoride level of 8 source waters exceeded the standard, accounting for 36.36%（8/22）, and projects scrapped 5. Two hundred and two water samples were tested. In water improved historical diseased areas, the median of water fluoride of source water and tap water were 0.72,0.62 mg/L, respectively, and the average rate of water fluoride exceeded the standard ere 36.36%（8/22） and 31.94%（23/72）, respectively. In water unimproved historical diseased areas, the median of water fluoride was 1.00 mg/L, and the average rate of water fluoride exceeded the standard was 39.81%（43/108）. Detection rate of dental fluorosis among children aged 8 to 12 was 16.06% （367/2285）, dental fluorosis index was 0.30, and the prevalence was negative. Detection rate of clinical skeletal fluorosis among adults over 16 years old was 5.09%（1542/30 272）, a totally of 198 people had X-ray film taken, positive 68, the positive detection rate was 34.34%（68/198）. One thousand and fifty-one copies of children＇s urine samples were tested, geometric mean of urinary fluoride was 0.95 mg/L; nine hundred and fourteen copies of adults urine samples were tested, geometric mean of urinary fluoride was 1.16 mg/L Conclusions Drinking-water type of fluorosis affects a large area in Shaanxi province, the disease is still serious, and the task of prevention remains very arduous. Further intensify the water improvement project in diseased areas, and strengthen disease monitoring, health education and water improvement project management is the key to prevention and control of endemic fluorosis.