甘肃省不同生态区地方性氟中毒病情调查分析

Analysis of endemic fluorosis prevalence in different ecotypic areas in Gansu Province

目的掌握甘肃省不同生态类型区饮水型地方性氟中毒病情现状,为制定防治策略提供科学依据。方法根据地形地貌、气象气候与水资源状况等,将病区划分为不同的生态类型,在每个生态类型区抽取病区村,用Dean氏法对调查村所有8～12岁儿童进行氟斑牙检查;根据地方性氟骨症临床诊断标准(WS192-2001),检查并诊断30岁以上成人的临床氟骨症,对诊断的患者进行X线氟骨症检查;采用离子选择电极法测定儿童及成人的尿氟含量。结果 8～12岁儿童氟斑牙检出率河西走廊戈壁区<陇南秦岭山区<黄土高原丘陵区<荒漠区<黄土高原沟壑区,氟斑牙流行强度黄土高原沟壑区、荒漠区中等流行,黄土高原丘陵区轻微流行,陇南秦岭山区是边缘,河西走廊戈壁区阴性;30岁以上成人临床氟骨症检出率陇南秦岭山区<荒漠区<黄土高原丘陵区<黄土高原沟壑区<河西走廊戈壁区;氟骨症X线检出率结果显示,陇南秦岭山区和荒漠区未检出阳性患者,黄土高原丘陵区<河西走廊戈壁区<黄土高原沟壑区;儿童尿氟几何均值黄土高原丘陵区,大于正常参考值,余各生态区几何均值均在1.5 mg/L以下;成人尿氟含量几何均值除黄土高原沟壑区大于1.5 mg/L,其余均小于1.5 mg/L。结论随着改水降氟工程的实施,甘肃省饮水型地方性氟中毒病情明显减轻,改水降氟措施发挥了明显的防病作用,各个生态区病情不同,应针对不同生态区因地制宜采取不同的防治措施。

Objective To master present situation of drinking water fluorosis in different ecotypic areas of Gansu Province, and to provide evidence for formulating scientific and effective strategies of prevention and control. Methods According to topography, weather, climate and water conditions, the endemic areas were divided into different ecotypic types. Villages with endemic were taken in each ecological zones, and dental fluorosis in children of 8-12 years old were diagnosed with Dean method, while skeletal fluorosis in adults was diagnosed according to national criteria （WS192） and X-rays. The fluo- ride levels in urine were determined by fluoride selective ion electrode. Results The detection rate of dental fluorosis in children aged 8-12 years old were the gobi region of Hexi Corridor 〈 the Longuan Qingling mountains 〈 the hills and valleys region of Loess Plateau 〈 the desert region 〈 the Loess Plateau-gully region. The dental fluorosis was middle prevalent in the Loess Plateau-gully region and the desert region, and a slight enpidemic in the hills and valleys region of Loess Plateau, the Longuan Qingling mountains were at the edge of prevalence, and the gobi region of Hexi Corridor was negative. The rate of skeletal fluorosis detected clinically in adults over 30 years old were the Longuan Qingling mountains 〈 the desert region 〈 the hills and valleys region of Loess Plateau 〈 the Loess Platean-gully region 〈 the gobi region of Hexi Corridor. The rate of skeletal fluorosis detected by X-ray in adults over 30 years old indicated that the Longnan Qingling mountains and the desert region were not detected in the positive patients. The rest of the ecocotypic areas were that, the hills and valleys region of Loess Plateau 〈 the gobi region of Hexi Corridor 〈 the Loess Plateau-gully region. Children＇s geometric mean of urinary flu- oride in the hills and valleys region of Loess Plateau was greater than the normal reference values. The geometric mean of urinary fluoride was within the normal reference range for children in other ecological zones, greater for adults older than 30years old in the Loess Plateau-gully region than the normal reference values, and in the normal reference range for the adults over 30 years old in the other ecological zones. Conclusions Along with the implementation of water-improving and de- fluoridation projects in Gansu Province, the prevalence of endemic fluorosis are controlled or alleviated. Water-improvement and defluoridation has an important role. Under the different conditions in the various ecological zones, various control mea- sures should be taken accordingly.