饮茶型氟中毒病区藏族人群血清镁、铝、钙、铁、锌和铜离子的分布研究

Distribution of serum Mg, AI, Ca, Fe, Zn and Cu ions in Tibetan population in drinking tea type fluorosis areas

目的探讨饮茶型氟中毒病区藏族人群血清镁、铝、钙、铁、锌和铜离子的水平，为饮茶型氟中毒发病机制的研究提供线索。方法2012年，选择青海省果洛州玛沁县、达日县的6个藏族聚集村为调查地点。对生活于当地的16岁以上人群进行问卷调查，采集调查对象饮用的茶水样，根据《砖茶含氟量》（GB19965-2005）标准方法检测砖茶水氟含量并计算日均茶氟摄入量；采集调查对象的静脉血，离心、取上层血清，采用电感耦合等离子体质谱法检测血清镁、铝、钙、铁、锌和铜离子水平；对全部调查对象进行数字化X线摄片，拍摄部位为前臂、小腿和骨盆，根据《地方性氟骨症诊断标准》（WS／T192-2008）进行氟骨症诊断。结果共调查170人，其中氟骨症74人，非氟骨症96人。受检人群日均茶氟摄入量的中位数（四分位数）为7．35（3．00，12．30）mg；血清镁离子含量为22．02（17．30，23．67）mg／L，铝离子为O．22（O．14，0．38）mg／L，钙离子为100．03（88．56，112．73）mg／L，铁离子为1．66（1．26，2．36）mg／L，锌离子为0．80（0．63，0．95）mg／L，铜离子为1．28（0．99，l.48）mg／L。男性血清铁离子含量为2．13（1．37，3．09）mg／L，高于女性[1．56（1．18，2．02）mg／L]，性别比较差异有统计学意义（Z=3．28，P〈0．01）；≥70岁人群血清中镁、钙、铜和锌离子含量分别为15．09（13．64，24．13）、68．67（58．67，97．24）、0．97（0．72，1．34）、Q54（048，0．74）mg／L，均低于〈40岁人群[21．67（20．08，2276）、98．71（90．77，113．97）、1．35（1．21，1．71）、O．78（O．73，1．01）mg／L]，年龄比较差异均有统计学意义（Z=2．26、2．99、3．01、3．34，P均〈0．05）。40～49和50～59岁人群血清中铁离子含量分别为1．77（1．45，3．02）、1．92（1．44，2．66）mg／L，均高于〈40岁人群[1．34（0．94，1．57）mg／L]，年龄比较差异均有统计学意义（Z=-3．25、-2．89，P均〈0．05）。日均茶氟摄入量〉4mg的人群钙离子含量为98．22（75．48，111．22）mg／L，低于日均茶氟摄入量〈2mg的人群[110．24（97．50，113．97）mg／L]，人群比较差异有统计学意义（Z=2．41，P〈0．05）。不同程度氟骨症人群6种金属离子分布水平与非氟骨症人群比较差异均无统计学意义（P均〉0．05）。结论在饮茶型氟中毒病区藏族人群中，不同程度氟骨症人群与正常人群血清中镁、铝、钙、铁、锌和铜分布水平相似，日均茶氟摄入量高的人群与日均茶氟摄入低的人群之间分布也相似，但高年龄段人群与低年龄段人群之间分布存在差异。

Objective To explore the distribution of serum Mg, A1, Ca, Fe, Zn and Cu ions in Tibetan population in drinking tea type fluorosis areas, and to provide a clue for pathogenesis of drinking tea type fluorosis. Methods Tibetans from six villages in Qinghai Province （Maqin County and Dari County）, who were over 16 years old, born and grew up in those villages, were included. All of the participants were received epidemic questionnaire survey, tea water samples were collected and the fluoride concentration was tested based on the standard of ＂Brick Tea Fluoride Content＂ （GB 19965-2005）. Meanwhile, the daily amount of brick tea consumption was surveyed to calculate the daily intake of tea fluoride. Blood samples were collected and the concentration of serum Mg, A1, C% Fe, Zn and Cu ions was tested by the method of inductively coupled plasma mass spectrometry （ICP-MS）. All of the participants were diagnosed by X-ray, the parts we scheduled were forearm, shank and pelvic, then the skeletal fluorosis was diagnosed based on the ＂Diagnostic Criteria for Endemic Fluorosis＂ （WS/T 192-2008）. Results A total of 170 people were surveyed, 74 people were skeletal fluorosis, and 96 people were non-skeletal fluorosis. The median （quartiles） of daily intake of tea fluoride was 7.35 （3.00, 12.30） mg. The concentration of serum Mg ion was 22.02 （17.30, 23.67） mg/L, A1 ion was 0.22 （0.14, 0.38） mg/L, Ca ion was 100.03 （88.56, 112.73） mg/L, Fe ion was 1.66 （1.26, 2.36） mg/L, Zn ion was 0.80 （0.63, 0.95） mg/L and Cu ion was 1.28 （0.99, 1.48） mg/L. The concentration of serum Fe ion was higher in male [2.13 （1.37, 3.09） mg/L] than that of female [1.56 （1.18, 2.02） mg/L, Z = 3.28, P 〈 0.01]. The concentration of serum Mg, Ca, Cu and Zn ions in ≥70 years old group was 15.09 （13.64, 24.13）, 68.67 （58.67, 97.24）, 0.97 （0.72, 1.34）, and 0.54 （0.48, 0.74） mg/L, respectively, which was lower than those in 〈 40 years old group [21.67 （20.08, 22.76）, 98.71 （90.77, 113.97）, 1.35 （1.21, 1.71）, and 0.78 （0.73, 1.01） mg/L], the differences were statistically significant （Z = 2.26, 2.99, 3.01, 3.34, P 〈 0.05）. Fe ion in 40 - 49 years old group was 1.77 （1.45, 3.02） mg/L, in 50 - 59 years old group was 1.92 （1.44, 2.66） mg/L, both of them were higher than those of 〈 40 years old group [1.34 （0.94, 1.57） mg/L, Z = - 3.25, - 2.89, P 〈 0.05]. People whose daily intake of tea fluoride over 4 mg had a lower concentration of Ca ion [98.22 （75.48, 111.22） mg/L] than people whose daily intake of tea fluoride 〈 2 mg [110.24 （97-50, 113.97） mg/L, Z = 2.41, P 〈 0.05]. No significant difference was found between different degrees of skeletal fluorosis and non-skeletal fluorosis （P 〉 0.05）. Conclusions In the Tibetans who lived in the drinking tea type fluorosis areas, the concentration of serum Mg, A1, Ca, Fe, Zn and Cu ions is similar between skeletal fluorosis and non-skeletal fluorosis, which is also similar between higher daily intake of tea fluoride and lower daily intake of tea fluoride. However, it is different between older people and younger people.