燃煤型氟中毒地区居民骨吸收标志的变化规律

Change pattern of bone resorption markers among residents in coal-burning endemic fluorosis area

[目的]观察氟中毒地区居民骨吸收标志——血清Ⅰ型胶原交联氨基末端肽(NTx)以及抗酒石酸酸性磷酸酶-5b(TRACP-5b)的变化情况,为成人氟中毒骨损害机制研究提供资料基础。[方法]以贵州省六盘水市常年敞灶燃用高氟煤的陡箐乡为氟污染区,习惯常年烧柴的花嘎乡为对照区,遵循知情同意原则,对污染区102名居民和对照区45名居民进行氟斑牙、尿氟浓度及血清NTx和TRACP-5b浓度检测,并计算氟斑牙指数。[结果]污染区居民氟斑牙检出率为79.4%,尿氟浓度为1.59(1.22~2.50)mg/L,均高于对照区[8.8%,0.65(0.42~1.04)mg/L](χ2=69.669,Z=-6.024,均P<0.001)。污染区氟斑牙指数为2.42,为较显著流行;对照区氟斑牙指数为0.23,为阴性。污染区居民血清NTx浓度为12.34(10.93~13.96)nmol/L,高于对照区的9.21(7.86~12.91)nmol/L(Z=4.062,P=0.000);TRACP-5b浓度为207.87(187.23~251.52)ng/L,低于对照区的237.36(207.47~305.95)ng/L(Z=2.938,P=0.003)。污染区青年组(18岁~)、老年组(60岁~)居民血清NTx浓度均高于对照区(均P<0.001);中年组(45岁~)居民血清TRACP-5b浓度为209.86(187.40~276.05)ng/L,低于对照区的254.07(226.81~305.07)ng/L(Z=2.268,P=0.023)。污染居民血清NTx与血清TRACP-5b浓度呈正相关(r=0.544,P=0.001);污染区居民年龄与氟斑牙程度呈正相关(r=0.242,P=0.014);血清NTx、TRACP-5b浓度与氟斑牙程度无相关性(r=0.065,P=0.516;r=0.009,P=0.932),与年龄亦无相关性(r=0.010,P=0.918;r=-0.043,P=0.670)。[结论]氟摄入过量可引起成人血清NTx升高、血清TRACP-5b下降,且血清NTx浓度和TRACP-5b浓度变化趋势存在一定联系,两者浓度变化与氟中毒的关系有待进一步验证。

[Objective] To observe the change of bone resorption markers, serum N-telopeptide of type Ⅰ collagen （NTx） and serum tartrate resistant acid phosphatase-5b （TRACP-5b）, among residents in coal-burning endemic fluorosis areas.[Methods] Doujing Village, Liupanshui City, Guizhou Province, was elected as the fluorosis area where high-fluoride coal was used as common home fuel, and the control area was Huaga Village where woods were often used. Dental fluorosis, urinary fluoride, serum NTx, and serum TRACP-5b were detected in 102 residents in the fluorosis area and 45 residents in the control area, and dental fluorosis index was calculated.[Results] The detection rate of dental fluorosis of residents in the fluorosis area was 79.4%, higher than that in the control area （8.8%） （χ^2=69.669, P 〈 0.001）; the urinary fluoride level of residents in the fluorosis area was 1.59 （1.22-2.50） mg/L, also higher than that in the control area [0.65 （0.42-1.04） mg/L] （Z=-6.024, P 〈 0.001）. The dental fluorosis index of residents in the fluorosis area was 2.24, indicating a prevalent dental fluorosis condition; the index in the control area was 0.23, indicating a negative condition. The average concentration of serum NTx in the fluorosis area [12.34 （10.93-13.96） nmol/L] was higher than that in the control area [9.21 （7.86-12.91） nmol/L] （Z=4.062, P=0.000）, and the average concentration of serum TRACP-5b in the fluorosis area [207.87 （187.23-251.52） ng/L] was lower than that in the control area [237.36 （207.47-305.95） ng/L] （Z=2.938, P=0.003）. The average concentrations of serum NTx of the 18-years age group and the 60-years age group in the fluorosis area were higher than that in the control area （Ps 〈 0.001）; the average concentration of serum TRACP-5b of the 45-years age group in the fluorosis area [209.86 （187.40-276.05） ng/L] was lower than that in the control area [254.07 （226.81-305.07） ng/L] （Z=2.268, P=0.023）. For the residents in the fluorosis area, serum NTx was positively correlated with serum TRACP-5b （r=0.544, P=0.001）, and dental fluorosis degree was positively correlated with age （r=0.242, P=0.014）. No association was found of either serum levels of NTx or TRACP-5b with dental fluorosis degree （r=0.065, P=0.516; r=0.009, P=0.932） or age （r=0.010, P=0.918; r=-0.043, P=0.670）.[Conclusion] Over-intake of fluorosis may cause increased serum NTx and decreased serum TRACP-5b in adults, and serum NTx is associated with serum TRACP-5b. But the associations between the two indicators and fluorosis need further verification.