对现阶段我国砖茶氟的安全风险评估及其限量的思考与建议

Safety risk assessment of fluoride in brick-tea and consideration and suggestions on its limit in China at the present stage

饮茶型地方性氟中毒(地氟病)是由居民长期大量饮用含氟量较高的砖茶水、奶茶、酥油茶等茶饮料,导致体内摄入过量氟而引起的一种慢性氟中毒,主要分布于我国西藏自治区、青海省、四川省、新疆维吾尔自治区、内蒙古自治区、甘肃省、宁夏回族自治区,共7个西部省(自治区)。为了规范砖茶的生产和销售,控制饮茶型地氟病的流行,我国原卫生部于2005年发布了国家标准《砖茶含氟量》(GB 19965-2005),规定每1 kg砖茶含水溶性无机氟的总量不超过300 mg。近20年过去了,我国饮茶型地氟病流行范围逐渐清晰,病区居民饮茶习惯也发生了一定变化。本文综述了砖茶氟摄入量与氟骨症的剂量效应关系,分析了现阶段病区居民砖茶消耗情况,对病区居民砖茶氟暴露的安全风险进行了评估,确认≤300 mg/kg的砖茶氟限量对于目前我国饮茶型地氟病的防治仍是适宜的。

Drinking brick-tea type of endemic fluorosis is a kind of chronic fluorosis caused by excessive intake of fluoride into the body from long-term and high consumption of brick-tea,milk tea,butter tea,or other tea drinks with high fluoride content.It mainly distributes in seven western provinces of China,including Tibet Autonomous Region,Qinghai Province,Sichuan Province,Xinjiang Uygur Autonomous Region,Inner Mongolia Autonomous Region,Gansu Province,and Ningxia Hui Autonomous Region.In order to govern the production and sale of brick-tea and control the epidemic of drinking brick-tea type of endemic fluorosis,the former Ministry of Health of China issued the national standard"Fluoride Content of Brick-tea"(GB 19965-2005)in 2005,which stipulated that the total amount of water-soluble inorganic fluorine in brick-tea should not exceed 300 mg/kg.In the past 20 years,the prevalence of drinking brick-tea type of endemic fluorosis in China became clear gradually,and the habit of drinking brick-tea of residents in the epidemic fluorosis area also changed to some extent.In this paper,the dose-effect relationship between fluoride intake from brick-tea and skeletal fluorosis is reviewed,the brick-tea consumption of residents in the endemic fluorosis areas is analyzed,and the safety risk of brick-tea fluoride exposure is evaluated.It is suggested that the fluoride limit of brick-tea,≤300 mg/kg,is still suitable for the prevention and control of drinking brick-tea type of endemic fluorosis in China at the present stage.