西藏饮茶型氟中毒流行现状调查分析

Investigation on the epidemic status of dripking brick-tea type fluorosis in Tibet

目的 掌握西藏饮茶型氟中毒的病情现状，为制订防治策略提供科学依据。方法 在西藏 7个地（市）的12个县，按照《全国饮茶型地方性氟中毒流行现况调查方案》的要求，采用整群分 层抽样方法，共抽取46个行政村作为调查点，入户采集居民饮用水水样、茶水样、成人即时尿样 ，并调查居民茶氟摄入情况、16岁以上成人氟骨症患病情况。在所调查村儿童集中的乡（村）级 小学，抽取全部8 - 12岁儿童，采集即时尿样，并调查氟斑牙患病情况。水氟、茶水氟、尿氟含 量采用离子选择电极法进行检测；氟斑牙采用《氟斑牙诊断》（WS／T 208-2011）标准进行检查 和判定；氟骨症采用《地方性氟骨症诊断标准》（WS 192-2008）进行检查和判定。结果 共调查 了12个县的46个村，检测水样1 992份、茶水样1 662份、儿童尿样664份、成人尿样3 186份，对 547名8 ~ 12岁儿童进行了氟斑牙检查，对3 196名成人进行了临床氟骨症检查。所有调查村水氟 含量均 〈 1.0 mg／L，茶水氟含量范围为0.11 -84.00 mg／L，均值为6.12 mg／L，居民日均砖 茶氟摄入量为24.98 mg。儿童、成人尿氟几何均值分别为0.76、2.28 mg／L。儿童氟斑牙检出率 为31.81%（174／547），氟斑牙指数为0.60。16岁以上成人临床氟骨症检出率为48.59%（1 553／ 3 196），36 - 45岁成人X线氟骨症检出率为13.37%（69／516）。结论 西藏饮茶型氟中毒流行较 为严重，且分布广泛，成人氟骨症病情检出率较高，儿童氟斑牙相对较轻，西藏的饮茶型氟中毒 防控刻不容缓。

Objective To grasp the prevalence of drinking brick-tea type fluorosis in Tibet, and to provide scientific basis for the development of prevention and control strategies. Methods Twelve counties were selected from 7 regions in Tibet. In accordance with the ＂Drinking Brick-Tea Type Endemic Fluorosis Monitoring Program＂, a total of 46 administrative villages were selected as survey points using the cluster stratified sampling method. Household water samples, tea-water samples and adult urine samples were collected, and household fluorine intake status and incidence of skeletal fluorosis in adults over 16 years old were investigated. In the rural grade primary school where the village children were concentrated, all children aged 8 - 12 were selected, urine samples were collected, and the prevalence of dental fluorosis was investigated. Fluoride contents in tea, water, and urine were detected by ion selective electrode method. The dental fluorosis and skeletal fluorosis were examined and judged according to the ＂Diagnosis of Dental Fluorosis＂ （WS/T 208-2011） and the ＂Diagnostic Criteria for Endemic Skeletal Fluorosis＂ （WS 192-2008）, respectively. Results A total of 46 villages in 12 counties were investigated, 1 992 of water samples, 1 662 of tea samples, 664 of children urine samples, 3 186 of adult urine samples were detected; 547 children aged 8 - 12 were examined dental fluorosis and 3 196 adults were examinea skeletal fluorosis, respectively. The water fluoride contents in all the investigated villages were less than 1.0 mg/L; the average fluoride content in brick-tea water was 6.12 mg/L, within the range of 0.11 - 84.00 mg/L, and the average daily brick tea fluorine intake of residents was 24.98 mg. The geometric mean of urine fluoride in children and adults was 0.76, 2.28 mg/L, respectively. The prevalence rates of dental fluorosis in children and skeletal fluorosis in adults over 16 years old were 31.81% （174/547） and 48.59% （1 553/3 196）, respectively. The children dental fluorosis index was 0.60. The detection rate of skeletal fluorosis in adults aged 36 - 45 was 13.37% （69/516）. Conclusions The prevalence of drinking brick-tea type fluorosis in Tibet is serious and widely distributed. In particular, the prevalence rate of skeletal fluorosis in adults is relatively high, while that of dental fluorosis in children is relatively mild. The prevention and control of drinking brick-tea type fluorosis in Tibet brook no delay.