甘肃省天祝藏族自治县饮茶型地方性氟中毒流行现状调查

An investigation of the prevalence of tea-drinking-borne endemic fluorosis in Tianzhu Tibetan Autonomous County,Gansu Province

目的分析甘肃省天祝藏族自治县(简称天祝县)饮茶型地方性氟中毒(地氟病)流行范围,准确掌握饮茶型地氟病患者信息,为推广普及低氟砖茶和开展患者救助救治提供科学依据。方法2019-2020年按照《2019年甘肃省饮茶型地氟病流行现状调查方案》,在天祝县具有饮用砖茶习惯的行政村,采集当地居民生活饮用水检测水氟含量,每村抽取10户家庭,入户调查登记每户家庭成员基本情况及砖茶饮用情况,并采集砖茶样品,测定氟含量。同时对调查村所有8~12岁儿童进行氟斑牙检查;对调查村25周岁以上(不包括25周岁)常住成人进行骨关节症状、体征临床检查,对有明确氟骨症临床症状或体征的患者进行骨和关节的X线检查,并采集尿样检测尿氟含量。水氟、茶氟、尿氟含量检测采用离子选择电极法,氟斑牙诊断采用《氟斑牙诊断》(WS/T 208-2011),氟骨症诊断采用《地方性氟骨症诊断标准》(WS 192-2008)。结果共采集水样161份,水氟含量为0.07~0.68 mg/L,均符合生活饮用水标准(<1.0 mg/L);采集砖茶样品1644份,16周岁以上常住人口年人均砖茶消耗量为1.05 kg。不同品牌茶氟含量均值范围为601.99~991.38 mg/kg;根据茶氟检测结果,筛查出日均茶氟摄入量>3.5 mg/d的行政村16个,旦马乡土塔村最低(4.91 mg/d),毛藏乡华山村最高(18.98 mg/d);调查14个行政村的8~12岁常住儿童253人,查出氟斑牙极轻度3例、轻度2例、中度1例,总体氟斑牙检出率为4.74%(12/253);对15个行政村25周岁以上(不包括25周岁)常住成人(3100人)进行骨关节症状、体征临床检查,对有明确氟骨症临床症状或体征的患者(104例)进行骨和关节的X线检查,诊断氟骨症患者6例,其中轻度3例、重度3例,年龄在56~76岁;共采集尿样3100份,调查村尿氟均值范围为0.73~4.74 mg/L。按照饮茶型氟中毒病区判定及划分标准,判定旦马乡土塔村、大红沟镇西顶村、抓喜秀龙镇代乾村为饮茶型地氟病轻病区村,抓喜秀龙镇南泥沟村为饮茶型地氟病中病区村。结论甘肃省天祝县有饮茶型地氟病流行,需采取针对性的防控措施。

Objective To further investigate the prevalence of tea-drinking-borne endemic fluorosis in Tianzhu Tibetan Autonomous County(referred to as Tianzhu)Gansu Province,to accurately master the information of patients with tea-drinking-borne endemic fluorosis,and to provide scientific basis for popularizing low fluoride brick tea and carrying out patient rescue and treatment.Methods From 2019 to 2020,according to the"Investigation Plan of Tea-drinking-borne Endemic Fluorosis in Gansu Province in 2019",in the administrative villages with the habit of drinking and selling tea,drinking water samples of local residents were collected to detect the fluorine content of water in Tianzhu,10 families were randomly selected in each village,basic situation of each family member and the drinking situation of tea were investigated,and tea samples were collected to determine the fluorine content.At the same time,all children aged 8-12 in the investigation village were examined for dental fluorosis;clinical examination of bone and joint symptoms and signs was conducted for permanent residents over the age of 25 in the investigation village(excluding 25 years old),X-ray examination of bone and joint was conducted for patients with clear clinical symptoms or signs of skeletal fluorosis,and urine samples were collected to detect urinary fluorine.Ion selective electrode method was used to detect fluorine in water,tea and urine,and dental fluorosis was diagnosed by"Diagnosis of Dental Fluorosis"(WS/T 208-2011),and the"Diagnostic criteria for Endemic Skeletal Fluorosis"(WS 192-2008)was used for the diagnosis of skeletal fluorosis.Results A total of 161 water samples were collected,and the fluorine content in water was from 0.07 to 0.68 mg/L,which met the domestic drinking water standard(<1.0 mg/L).A total of 1644 side-tea samples were collected,and the annual per capita consumption of side-tea of permanent residents over 16 years old was 1.05 kg.The average fluoride content of tea was 601.99-991.38 mg/kg.According to the detection results of tea fluorine,16 administrative villages with an average daily intake of tea fluorine more than 3.5 mg/d were screened,the lowest intake was 4.91 mg/d in Tuta Village Danma Township,and the highest intake was 18.98 mg/d in Huashan Village Maozang Township.A total of 253 children aged 8-12 years old in 14 administrative villages were investigated.There were 3 cases of very mild dental fluorosis,2 cases of mild dental fluorosis,and 1 case of moderate dental fluorosis.The overall prevalence of dental fluorosis was 4.74%(12/253).The clinical examination of bone and joint symptoms and signs was carried out for 3100 permanent adults over the age of 25(excluding the age of 25)in 15 administrative villages.The X-ray examination of bone and joint was carried out for 104 patients with definite clinical symptoms and/or signs of skeletal fluorosis.Six patients with skeletal fluorosis were diagnosed,including 3 mild and 3 severe,aged 56-76 years.The average urinary fluorine in the investigated villages was 0.73-4.74 mg/L(the number of investigated was 3100).According to the determination and classification standards of tea-drinking-borne fluorosis area,Tuta Village Danma Township,Xiding Village Dahonggou Township and Daiqian Village Zhuaxixiulong Township were determined to be in the mild area of tea-drinking-borne endemic fluorosis,while Nannigou Village Zhuaxixiulong Township was in the moderate area of tea-drinking-borne endemic fluorosis.Conclusion Tea-drinking-borne endemic fluorosis is prevalent in Tianzhu,Gansu Province,and targeted prevention methods and control measures need to be taken.