2016年青海省海南州饮茶型氟中毒流行现况调查分析

An investigation and analysis of the prevalence of drinking-tea type fluorosis in Hainan Prefecture, Qinghai Province in 2016

目的 了解青海省海南州饮茶型地方性氟中毒的流行现状，为今后制定防治策略提供科学依据。方法 2016年采用横断面调查法，按照《全国饮茶型地方性氟中毒流行现状调查方案》，选取海南州贵德、贵南、兴海、共和、同德5个县。每个县按东、西、南、北、中方位抽取5个乡镇，每个乡（镇）抽取1个行政村作为调查点。每个调查点抽取全部8 - 12岁儿童及60名16岁以上成人作为调查对象。8 - 12岁儿童进行氟斑牙检查，氟斑牙诊断依据《氟斑牙诊断》（WS／T 208-2011）。成人采用问卷调查的方法，调查居民日均饮茶水量。采集居民户饮用水水样和调查对象饮茶水样及尿样（调查点同一水源采1份，不同水源全部采集；茶水样按东、西、南、北、中5个方位采集；尿样每个调查点≥12份），水氟、尿氟、茶水氟含量测定采用氟离子选择电极法。对成人进行临床氟骨症检查，氟骨症诊断依据参考《地方性氟骨症诊断标准》（WS 192-2008）进行，统计临床患病率。结果 海南州5个县水氟中位数为0.29 mg／L，茶水氟中位数为1.43 mg／L，日人均茶氟摄入量平均值为1.82 mg，尿氟几何均值为0.83 mg／L；儿童氟斑牙患病率为14.06%（559／3975），氟斑牙流行指数为0.24；成人临床氟骨症患病率为8.01%（119／1484）。儿童氟斑牙检出率同德县最高，为15.96%（83／520）；贵南县最低，为10.76%（111／1032）。成人临床氟骨症兴海县最高，为10.87%（30／276）；同德县最低，为5.75%（15／261）。结论海南州饮茶型地方性氟中毒病情相对较轻。居民仍受高氟砖茶危害，应继续加强健康教育宣传，维护群众身体健康。

Objective To understand the prevalence state of drinking-tea type fluorosis in Hainan Prefecture, Qinghai Province, and provide scientific data for its prevention and control. Methods In 2016, a cross-sectional survey method was used to select five counties of Guide, Guinan, Xinghai, Gonghe and Tongde in Hainan according to ＂National Investigation Measure of Prevalence of Drinking-tea Type Fluorosis＂. In each county, 5 villages （towns） were selected according to the directions of east, west, north, south and center positions, and 1 administrative village was randomly selected in each village （town） as the survey site. All the children aged 8 to 12 years old at the survey site and 60 adults aged 16 years old and older at each survey site were selected as the survey subjects. We investigated the volume of brick-tea water consumed per day among objective population with questionnaire, and collected water, brick-tea water and urine samples （if each region has one water source, we collected one water sample, if this place have different water sources, we collected all the water samples from each water source; brick-tea water samples were collected based on different locations; more than 12 urine samples were collected in each survey site）. The fluoride concentration in water, urine and tea water were detected with fluoride ion-selective electrode, the dental fluorosis of children aged 8 - 12 years were diagnosed by ＂Diagnosis of Dental Fluorosis＂ （WS/T 208-2011）, and clinic skeletal fluorosis of population was diagnosed based on the ＂Diagnostic Criteria for Endemic Skeletal Fluorosis＂ （WS 192-2008）. Results The medians of fluoride in drinking water, drinking-tea water were 0.29 and 1.43 mg/L, respectively. The mean of daily fluoride intake of each person was 1.82 mg, and the geometric mean of urinary fluoride was 0.83 mg/L; the rate of dental fluorosis among children was 14.06% （559/3 975）, its index was 0.24, the prevalence rate of clinic skeletal fluorosis among adult was 8.01% （119/1 484）. The rate of dental fluorosis among children in Tongde County was the highest, about 15.96% （83/520）, while the rate of dental fluorosis among children in Guinan County was the lowest, about 10.76% （111/1 032）. The prevalence rate of clinic skeletal fluorosis among adult in Xinghai County was the highest, about 10.87% （30/276）, while Tongde County was the lowest, about 5.75% （15/261）. Conclusions The prevalence of drinking-tea type fluorosis is relative low. However, the local population are still under the risk of brick-tea with high fluoride, so it is necessary to strengthen the health education propaganda to keep the population healthy.