低氟青砖茶预防饮茶型氟中毒效果观察

Role of brick tea with low-fluoride level in prevention of tea type fluorosis

目的观察不同含氟量低氟青砖茶预防饮茶型氟中毒效果。方法选择内蒙古克什克腾旗饮茶型氟中毒病区达来诺日镇罕达罕、哈达英格嘎查作为预防试验点，分别投放含氟量为（204．5±10．2）、（308．2±15．4）mg／kg的低氟青砖茶12个月。观察指标包括预防试验点病情[采用Dean法检测20-70岁成人氟斑牙，临床及x线法检测氟骨症，并根据《地方性氟骨症诊断标准》（ws192-2008）进行诊断]和预防试验前后砖茶、饮水、奶茶、成人尿含氟量（采用氟离子选择电极法），并计算经奶茶的摄氟量。结果预防试验点罕达罕嘎查成人氟斑牙检出率为68．89％（62／90），临床氟骨症检出率为55.32％（52／94），X线氟骨症检出率为65．17％（58／89）；哈达英格嘎查成人氟斑牙检出率为54．84％（51／93），临床氟骨症检出率为65．69％（67／102），X线氟骨症检出率为61．36％（54／88）。罕达罕、哈达英格嘎查预防试验前砖茶含氟量分别为（831．4±138．9）、（864．34-134．6）mg／kg，饮水含氟量分别为（0．27±0．05）、（0．54±O．24）mg／L，奶茶含氟量分别为（2．16±1．12）、（2．82±1．38）mg／L，成人尿含氟量分别为（2．78±1．57）、（2．96±1．80）mg／L，经奶茶摄氟量分别为（8．12±5．84）、（6．42±5．04）mg／d；而预防试验后砖茶含氟量分别为（204．5±10．2）、（308．2±15．4）mg／kg，饮水含氟量分别为（0．344-0．11）、（0．62±O．30）mg／L，奶茶含氟量分别为（0．97±0．33）、（1．83±0．66）mg／L，成人尿含氟量分别为（1．29±0．55）、（1．47±0．62）mg／L，经奶茶摄氟量分别为（3．45±2．05）、（3．71．4-2．07）mg／d。罕达罕、哈达英格嘎查预防试验后砖茶、奶茶、成人尿含氟量和经奶茶摄氟量均明显低于预防试验前（f值分别为14．30、12．97，6．46、3．95，6．69、5．72，6．27、3．57，P均〈0．01），罕达罕嘎查经奶茶摄氟量在《人群总摄氟量卫生标准））（WS／T87-1996）允许限量内（〈3．5mg／d）。结论饮低氟青砖茶可以预防饮茶型氟中毒，尤以含氟量为（204．5±10．2）mg／kg的低氟青砖茶预防效果更为可靠。

Objective To investigate the effect of drinking brick tea with low-fluoride level on prevention of tea type fluorosis. Methods Handahangacha, Hadayinggegacha, Dalainuoyi town, in Keshiketengqi Inner Mongolia endemic fluorosis area were selected as test points, and brick tea with fluoride [ （204.5 ± 10.2）, （308.2 ± 15.4）mg/kg] was given for 12 months. Dental fluorosis, clinical skeletal fluorosis, and X-ray diagnosis of skeletal fluorosis [according to Endemic Skeletal Fluorosis Diagnostic Criteria＂ （WS 192-2008）] of adults 20 to 70 years of age were examined and level of fluoride before and after the prevention trial, in brick tea, drinking water, milk tea and urine were tested （fluoride ion selective electrode method）, and fluoride intake through tea was calculated. Results Detection rate of adult dental fluorosis in Handahangacha was 68.89% （62/90）, clinical detection of skeletal fluorosis was 55.32% （52/94）, and X-ray detection of skeletal fluorosis was 65.17% （58/89）; adult dental fluorosis detection rate in Hadayinggegacha was 54.84% （51/93）, clinical detection of skeletal fluorosis was 65.69% （67/102）, and X-ray detection rate of skeletal fluorosis was 61.36% （54/88）. Brick tea fluoride was （831.4 ± 138.9）, （864.3± 134.6）mg/kg before the prevention trial in Handahangacha and Hadayinggegacha, respectively, drinking water fluoride content was （0.27 ± 0.05）, （0.54 ±0.24）mg/L, fluoride content of milk tea was （2.16 ± 1.12）, （2.82 ± 1.38）mg/L, adult urine fluoride content was （2.78 ±1.57）, （2.96 ± 1.80）mg/L, and fluoride intake throughmilk tea was （8.12 ± 5.84）, （6.42± 5.04）mg/d, respectively; after the prevention trial the fluoride content of brick tea was （204.5 ± 10.2）, （308.2 ± 15.4）mg/kg, fluoride content of drinking water （0.34 ±0.11）, （0.62 ± 0.30） mg/L, fluoride content of milk tea（0.97 ± 0.33）, （1.83 ±0.66）mg/L, fluoride content in urine（1.29 ±0.55）, （1.47 ±0.62）mg/L, fluoride intake through milk tea （3.45 ± 2.05）, （3.71 ± 2.07）mg/d, respectively; in Handahan and Hadayinggegacha after the prevention trial the fluoride in brick tea, milk tea, urine fluoride, and fluoride intake through milk tea was significantly lower than that before the trial （t = 14.30,12.97; 6.46,3.95 ; 6.69,5.72 ; 6.27,3.57, all P 〈 0.01）. Fluoride intake in Handahangacha through milk tea was within the state heath standard limits （ 〈 3.5 mg/d）. Conclusion Drinking low-fluoride brick tea can prevent drinking brick tea type fluorosis, the preventive effect is especially more reliable with low fluoride brick tea （204.5 ± 10.2）mg/kg.