山东省鲁西北地区宁津、夏津、武城县饮水型地方性氟中毒流行病学调查

Epidemiological investigation on endemic fluorosis of drinking water type in Ningjin, Xiajin and Wucheng counties in the northwest area of Shandong Province

目的了解山东省鲁西北地区饮水型地方性氟中毒（简称地氟病）流行现状，为今后防治工作及调整防治策略提供科学依据。方法2015年选择山东省鲁西北地区地氟病重病区宁津、夏津、武城3个县，调查地氟病防治现状：在3个县选出7个原地氟病重病村，调查居民饮水含氟量、8～12岁儿童氟斑牙患病情况、人群尿氟水平、30岁以上成人临床与X线氟骨症流行状况及骨密度，同时在各县非病区村设对照点l处，检测成人骨密度。水、尿氟测定采用离子选择性电极法，氟斑牙诊断应用Dean法（WS／T208—2011），成人氟骨症诊断按照《地方性氟骨症诊断标准》（WS192．2008）执行，骨密度应用EXA．3000双能X线骨密度仪检测。结果本次调查的3个县中，宁津、武城2个县的地氟病重病村已全部完成改水降氟，水氟合格。3个县的7个村8～12岁儿童氟斑牙总检出率为85．09％（411／483），氟斑牙指数为1．88；3个县中，以夏津县、武城县病情较重，氟斑牙检出率分别高达92_48％（295／319）、88．76％（79／89），宁津县为49.33％（37／75），3个县氟斑牙检出率比较差异有统计学意义（Х^2=90．26，P〈0．01）。分别检测儿童与成人尿样206、298份，尿氟几何均数分别为3．29、3．41mg,／L；3个县中群体尿氟以夏津县超标最重，两组人群几何均数分别高达5．11、6．30mg／L。成人临床与X线氟骨症总检出率分别为30．07％（92／306）、14．38％（44／306）。病区与非病区成人骨质疏松检出率分别为33．11％（100／302），8．99％（17／189），两者比较差异有统计学意义（Х^2=37．25，P〈0．01）；病区与非病区成人骨密度平均值分别为0．416、0．475g／cm^2，两者比较差异有统计学意义（t=8．508，P〈0．01）。结论鲁西北地区地氟病病情仍存在一定程度流行；夏津县尚未完成病区改水，应尽快落实改水降氟措施，加强水氟与病情监测，彻底控制其流行。

Objective To investigate the endemic fluorosis of drinking water type in 3 counties in the northwest of Shandong Province, and to provide scientific basis for prevention and control of endemic fluorosis. Methods Seven villages in 3 counties of Ningjin, Xiajin and Wucheng were investigated to achieve the results including fluoride of drinking water, 8 - 12 year-old children＇s dental fluorosis incidence rate, the fluoride of urine, prevalence of skeletal fluorosis by clinical and X-ray diagnosis in adults over 30-year old, and the bone mineral density. At the same time, set up a control point to detect the adult bone density in non-ward village of each investigated county, The water and urine fluoride were checked by selective electrode method, dental fluorosis was diagnosed by Dean method （WS/T 208-201l） and the diagnosis of adult fluorosis was performed in accordance with the diagnostic criteria of endemic fluorosis （WS 192-2008）, and bone mineral density was measured by EXA-3000. Results The villages in Ningjin and Wucheng had finished defluoridation, where the water fluoride was at normal level. In the 7 villages, the total detection rate of 8 - 12 year-old children＇s dental fluorosis was 85.09% （411/483）, dental fluorosis index was 1.88; the dental fluorosis detection rate in Wucheng, Xiajin and Ningjin was 92.48%（295/319）, 88.76% （79/89） and 49.33% （35/75）, respectively, the difference was statistically significant （Х^2 = 90.26, P 〈 0.01）. The average urine fluoride geometric mean of children （206） and adults （298） was 3.29 and 3.41 mg/L, respectively. The urine fluoride of Xiajin was the highest in the 3 counties, and the average urine fluoride geometric mean of the two groups was as high as 5.11 and 6.30 mg/L, respectively. The total detection rate of clinical and radiographic skeletal fluorosis in adults was 30.07% （92/306） and 14.38% （44/306）, respectively. The osteoporosis detection rate of adults in endemic fluorosis area and non-endemic fluoresis area was 33.11% （100/302） and 8.99% （17/189）, respectively. The difference was statistically significant （Х^2 = 37.25, P 〈 0.01）; the average bone mineral density in endemic area and non-endemic area was 0.416 and 0.475 g/cm^2, respectively, the difference was statistieally significant （t = 8.508, P 〈 0.01）. Conclusions The endemic fluorosis in the 3 counties in the northwest of Shandong Province is still existed. The defluoridation has not been completed in Xiajin County. Therefore, it is necessary to implement defluoridation measures of the drinking water as soon as possible and strengthen the water fluoride monitoring so as to prevent and control endemic fluorosis.