环境化学元素与燃煤型氟中毒的相关性研究

Study on the association between environmental chemical elements and fluorosis caused bycoal-fire pollution

目的了解燃煤型氟中毒病区土壤化学元素分布情况，比较采取降氟措施后重庆市巫山、奉节两县病例与对照全血中化学元素及尿氟含量差异，查找与燃煤型氟中毒相关的化学元素及阐明其发病机制。方法采用生态学比较研究对两县各乡镇患病率与土壤化学元素水平做相关分析，并测定氟斑牙、氟骨症患者与对照组全血中铜、锌、钙、镁、铁及尿氟含量，对比分析各检测指标的含量差异。结果巫山县土壤中镍（r=0．553，P=0．050）、碘（r=0．571，P=0．041）、氟（r=0．303，P=0．005）、pH值（r=0．304，P=0．005）与患病率有较弱的正相关关系；奉节县土壤中汞（r=0．285，P=0．001）、镍（r=0．212，P=0．00）与患病率有较弱的正相关关系。巫山县儿童病例组尿氟含量[（0．64±0．34）mg／L]高于对照组[（0．44±0．59）mg／L]（P〈0．05）。奉节县儿童病例组铜[（29．63±3．32）gmol／L]、尿氟[（0．83±0．37）mg／L]含量高于对照组[（26．76±3．63）gmol／L、（0．53±0．23）mg／L]（P〈0．05）。奉节县氟斑牙儿童锌[（76．13±11．24）gmol／L]、钙[（1．87±O．25）mmol／L]、镁[（1．41±0．18）mmol／L]及尿氟[（0．83±0．37）mg／L]高于巫山县[（71．95±7．53）gmol／L、（1．43±1．34）mmol／L、（1．34±0．15）mmol／L、（0．64±0．34）mg／L]（P〈0．05）。病例组成年氟骨症患者镁[（1．56±1．96）mmol／L]、铁[（8．15±1．00）mmol／L]、尿氟[（2．17±0．99）megL]含量均值高于对照组[分别为（1．46±0．16）mmol／L、（7．64±1．00）mmol／L、（1．44±1．22）mg／L]（P〈0．05）。结论碱性高氟土壤可能增加氟摄入量；土壤中的镉、碘、镍等环境化学元素水平可能与氟中毒的发病有关联。病区人群体内锌、钙、镁等抗氟元素水平较低。

Objective To understand the distribution of chemical elements in soil. To investigate the differences between patients under different state of fluorosis and normal population after preventive measurement was implemented to get rid of some chemical elements and to lower the urine fluoride levels so as to illustrate the pathogenesis of the disease. Methods Both ecological and comparative studies had been used to analyze the rates and levels of chemical elements. Teeth and skeletal from the patients with fluorosis and controls were taken and florin ion-selective-electrode method was used to determine urine the content of fluorine. Atomic Absorption Spectrometry was used to determine the copper, zinc, calcium, magnesium and iron contents in the whole blood. Differences of contents were analyzed. Results In Wushan county, the soil contents of nickel （r= 0.553,P=0.050） ,iodine （r=0.571 ,P=0.041）,fluorine （r=0.303,P=0.005）,pH value （r=0.304, P=0.005） and the rates of fluorosis showed weaker positive relationship. In Fengjie county, the soilcontents of mercury （r=0.285, P=0.001 ）, nickel（r=0.212, P=0.00） and the rates of fluorosis also showed weaker positive relationship. In Wushan county, the urine fluoride level in the patients group [ （0.64± 0.34） mg/L ] was higher than that in the control group [ （0.44 ± 0.59） mg/L ], （P〈 0.05）. In Fengjie county, copper [ （29.63 ± 3.32）μmol/L] and urine fluoride E （0.83 ± 0.37）mg/L] levels in the patients group showed higher than that in the control group [ （26.76±3.63）μmol/L, （0.53_＋ 0.23 ）mg/L], （P〈0.05）. zinc （Zn） [ （76.13 ± 11.24） μmol/L], calcium （Ca） [ （ 1.87 ± 0.25 ）mmol/L ], magnesium （Mg） [ （1.41 ± 0.18）mmol/L] and fluoride [ （0.83 ± 0.37）mg/L] levels in urine of the patients in children were higher in Fengjie than that in Wushan I （71.95 ± 7.53） μmol/L, （1.43 4± 1.34） retool/L, （ 1.34 ±0.15） retool/L, （0.64 ± 0.34）mg/L], （P〈0.05）. Mg [ （ 1.56 ± 1.96）mrnot/L], ferrum [ （8.15 ± 1.00）mmol/L] and fluoride and （2.17±0.99）mg/L] levels among adult patients were significantly higher than in the control group [ （1.46 ± 0.16） mmol/L, （7.64 ± 1.00） mmol/L, （1.44 ± 1.22）mg/L] （P〈0.05）. Conclusion Soil,rich in alkaline and fluorosis could increase the intake of fluorine while nickel, cadmium, iodine content in soil might relate to the occurrence of fluorosis. Residents living in endemic areas where anti-fluorine elements as Zn, Ca and Mg were in shortage, might be affected by these chemical elements that related with fluorosis.