山东省黄河冲积平原地区地方性氟中毒流行病学调查

An epidemiological investigation of endemic fluorosis in the alluvial plain area of the Yellow River, Shandong Province

目的了解山东省黄河冲积平原地区地方性氟中毒的流行现状，为制订防治策略提供科学依据。方法采用单纯随机抽样的方法，在山东省黄河冲积平原地区选取6个县（区），在每个县（区）抽取10个改水降氟工程，调查其运行情况，并测定水氟含量；同时，在每个县（区）选取3个病区村作为调查村，调查其改水工程运行情况并检测水氟含量，检查8—12岁儿童氟斑牙患病情况，并对25岁及以上成人进行氟骨症X线检查和尿氟检测。水、尿氟含量测定采用氟离子选择电极法，氟斑牙诊断依据《氟斑牙诊断》（WS／T208．2011），氟骨症X线诊断依据《地方性氟骨症诊断标准》（WS192-2008）。结果①在6个调查县（区），共调查改水降氟工程58个，均运转正常，水氟合格率为44．83％（26／58）。②共调查19个病区村，均已改水，工程均运转正常，水氟合格率为42．11％（8／19）。③19个村的8～12岁儿童氟斑牙总检出率为49．28％（480／974），氟斑牙指数为1．01，氟斑牙流行强度总体上处于轻度流行。水氟合格村的8—12岁儿童氟斑牙检出率为33．41％（148／443）．氟斑牙指数为0．65．氟斑牙流行强度总体上处于极轻度流行；水氟超标村的8～12岁儿童氟斑牙检出率为62．52％（332／531），氟斑牙指数为1．36，氟斑牙流行强度总体上处于轻度流行；水氟合格村的8～12岁儿童氟斑牙检出率低于水氟超标村（Х^2=81．91，P〈0．01）。④17个村的25岁及以上成人氟骨症X线总检出率为6．14％（53／863），水氟合格村与水氟超标村的氟骨症X线检出率分别为5．04％（20／397）和7．08％（33／466），二者比较差异无统计学意义（Х^2=1．55，P〉0．05）。水氟合格村与水氟超标村尿氟几何均值、尿氟超标率分别为1．50mg／L、44．16％（170／385）和2．09mg／L、62．58％（286／457），水氟合格村的成人尿氟超标率低于水氟超标村（Х^2=28．58，P〈0．01）。结论山东省黄河冲积平原地区的饮水型地方性氟中毒防治工作取得了一定的成效，但改水降氟工程水氟超标问题较为严重，地方性氟中毒仍有不同程度的流行，病情尚未得到全面控制，有待进一步强化防控措施。

Objective To investigate the current prevalent status of endemic fluorosis in the alluvial plain area of the Yellow River in Shandong Province, in order to provide a scientific basis for developing control measures against the disease. Methods Six counties were selected as survey counties by random sampling, ten improved- water projects were selected in each survey county, for the projects, the operating effect was investigated and water fluoride content was tested; three epidemic villages were chosen as survey villages in each county, the operating condition and the fluoride level of water were investigated in the villages with water improvement projects. Dental fluorosis of children aged 8 to 12 was surveyed, the urinary fluoride and skeletal fluorosis X-ray diagnosis were checked of adults over the age of 25. Water fluoride and urinary fluoride contents were detected via the F-ion selective electrode method, and the prevalence of dental fluorosis of all children aged 8 to 12 was diagnosed based on ＂Clinical Diagnostic Criteria of Dental Fluorosis＂ （WS/T 208-2011）, skeletal fluorosis X-ray diagnosis was done based on the ＂National Standard for Diagnosis of Endemic Skeletal Fluorosis＂ （WS 192-2008）. Results（1）In the six counties, 58 improved-water defluoridation projects were investigated, all projects were operated normally, the qualified rate of water fluoride content was 44.83% （26/58）.（2）A total of 19 villages that had water-improving and defluoridation projects were investigated, and all projects were operated normally, the qualified rate of water fluoride content was 42.11% （8/19）. （3）The overall rate of dental fluorosis among children aged 8 to 12 years old was 49.28% （480/974）, with the index of dental fluorosis as 1.01 in 19 villages, the prevalence of dental fluorosis was mild. In the qualified villages of water fluoride concentration, the positive rate of dental fluorosis among children aged 8 to 12 was 33.41% （148/443）, dental fluorosis index was 0.65, and the prevalence of dental fluorosis was extremely low; in the exceeding-standard villages of water fluoride content, the positive rate of dental fluorosis among children aged 8 to 12 was 62.52% （332/531）, dental fluorosis index was 1.36, and the prevalence of dental fluorosis was mild; the detection rate of dental fluorosis among children aged 8 to 12 of the villages with qualified fluoride content was lower than the rate of the villages with excessive fluoride （Х^2 = 81.91, P 〈 0.01）. （4）X-ray detection rate of skeletal fluorosis in adults over the age of 25 was 6.14% （53/863） in 17 villages, there was no statistically significant difference between the qualified villages and the exceeding-standard villages of water fluoride concentration （Х^2 = 1.55, P 〉 0.05）, X-ray detection rate of skeletal fluorosis in adults was 5.04% （20/397） and 7.08% （33/466）, respectively. In the qualified villages and the exceeding-standard villages of water fluoride, urinary fluoride geometric average and the exceeding rate of urinary fluoride were 1.50 mg/L, 44.16% （170/385） and 2.09 mg/L, 62.58% （286/466）, respectively. In the qualified villages of water fluoride, the exceeding rate of adult urinary fluoride was lower than that in the exceeding-standard villages （Х^2 = 28.58, P 〈 0.01）. Conclusions The prevention and control measures on endemic fluorosis have had some effects in the alluvial plain area of the Yellow River in Shandong Province. But the water fluoride content of water improving defluoridation projects still exceeds the national standard seriously, and endemic fluorosis has not been effectively controlled. Prevention measures should be further strengthened.