贵州省水城县陡箐苗族彝族乡小学生家庭经济状况与氟斑牙病情关系的分析

Relationship between family economic status and dental fluorosis of primary school students in Douqing Minority Village of Shuicheng County, Guizhou Province

目的调查燃煤型地方性氟中毒（简称燃煤氟中毒）重病区贵州省水城县陡箐苗族彝族乡（简称陡箐乡）小学生的民族归属、家庭经济状况、主食、氟斑牙病情、尿氟水平．为消除高寒山区少数民族聚居地燃煤氟中毒提供依据。方法陡箐乡中心小学和茨冲小学各班班主任填写7～12岁学生家庭经济状况调查表，家庭年现金收入〉8000元和卫生条件较好的判定为“好”、家庭年现金收入在4000—8000元和卫生条件一般的判定为“中”、家庭年现金收入〈4000元和卫生条件较差的判定为“差”。并结合氟斑牙检查、学生任意一次尿氟检测等资料，按照逻辑关系转换为数字后采用PEMS3．1和SPSS17．0统计软件进行分析。结果共调查陡箐乡8～12岁小学生494人，民族构成为苗族占33．4％（165／494）、彝族和回族占9．3％（46／494）、汉族占57-3％（283／494）。家庭经济状况好、中、差分别占8．5％（42／494）、51．6％（255／494）、39．9％（197／494）。陡箐乡中心小学、茨冲小学和夹岩小学8～12岁学生氟斑牙患病率分别为82-3％（186／226）、77．2％（146／189）、86．1％（68／79）；中重度氟斑牙患病率分别为9．7％（22／226）、6．9％（13／189）、5．1％（4／79）；氟斑牙缺损率分别为7．5％（17／226）、613％（12／189）、10．1％（8／79）。家庭经济状况与氟斑牙患病程度呈正相关（r=o．230，P〈0．05）。好、中、差家庭在汉族学生中的比例呈梯度下降，在苗族中则相反。好、中、差家庭小学生尿氟含量分别为1．08、1．01、1．49mg／L，三者比较差异有统计学意义（F=4．17，P〈0．05）。10-12岁学生家庭经济状况好、中、差的主食大米比例呈梯度下降，主食玉米比例则相反。结论高寒山区少数民族聚居地燃煤氟中毒发生的条件还存在，病情距离控制燃煤氟中毒标准仍差距较大。家庭经济状况、是否主食玉米、氟斑牙病情轻重、尿氟水平是主要影响因素，还需持续精准扶贫、夯实防氟改炉等物质基础、加强防氟教育，才能消除燃煤氟中毒对高寒山区少数民族的危害。

Objective To investigate ethnic belonging, family economic status, staple food, dental fluorosis and urinary fluoride level of primary school students in Douqing Minority （Miao and Yi） Village, where is a severity area of coal-burning type of endemic fluorosis, in order to provide a base for diminishing the disease in ethnic minorities lived in the cold plateau regions. Methods We invited the directors in various classes of the school to fill in the questionnaire tables. According to the situations of the economic status, annual income and student health conditions in the families, we evaluated them as ＂good＂ （ 〉 8 000 yuan）, ＂medium＂ （4 000 - 8 000 yuan） and ＂poor＂ （ 〈 4 000 yuan） situations, respectively. In addition, statistical analysis was carried out using software PEMS 3.1 and SPSS 17.0 based on the examination results concerning dental fluorosis and urinary fluoride content at any time. Results Totally 494 students aged 8 - 12 were investigated in the village. Among them, the ethnic composition was 33.4% （165/494） for Miao, 9.3% （46/494） for Yi and Hui, and 57.3% （283/294） for Han. The economic status of these families was 8.5% （42/494） as ＂good＂, 51.6% （255/494） as ＂medium＂ and 39.9% （197/494） as ＂poor＂. The prevalence rate of dental fluorosis of the students in centre primary school, Cichong primary school, and Jiayan primary school was 82.3% （186/226）, 77.2% （146/189） and 86.1% （68/79）, respectively; their prevalence rates of moderate/severe dental fluorosis were 9.7% （22/226）, 6.9% （13/189） and 5.1% （4/79）, respectively; and the defect rate of fluorine spot tooth was 7.5% （17/226）, 6.3% （12/189） and 10.1% （8/79）, respectively. The economic status from these families investigated was positively associated with the indexes of dental fluorosis （r = 0.230, P 〈 0.05）. The proportions with ＂good＂, ＂medium＂ and ＂poor＂ families were shown with gradient descent in Han students, while were opposite in Miao. The fluoride content of urines in ＂good＂, ＂medium＂ and ＂poor＂ families was 1.08, 1.01, 1.49 mg/L, respectively, and the differences were statistically significant （F = 4.17, P 〈 0.05）. The proportions with rice as the main food in ＂good＂, ＂medium＂ and ＂poor＂ families of 10 - 12 students were in gradient descent, while in corn were the opposite. Conclusions In the plateau and cold regions lived with minority groups, the possibility of occurring coal-burning type of endemic fluorosis is still exist, and the situation of illness has a certain distance to the control standard of the disease. The economic status of these families, whether corn as staple food or not, conditions of dental fluorosis and the levels of urinary fluoride are the major influencing factors. The damages of endemic fluorosis on the ethnic minorities lived in the plateau and cold regions can be prevented by helping continuously the poor families, enhancing the modified stoves and improving education.