饮水型氟中毒病区改水后学龄期儿童氟斑牙患病情况与血清矿物质及微量元素的关系

Prevalence of dental fluorosis and its relationship with serum minerals and trace elements in school-age children after water improvement in fluorosis areas of drinking water type

目的 探讨饮水型氟中毒病区改水后学龄期儿童氟斑牙患病情况与血清矿物质及微量元素的关系。方法 采取分层抽样法,将本市饮水型氟中毒病区按照改水时间分为1~、5~、10~、≥15年,每个层级随机抽取2个病区自然村进行调查。采集每个调查的自然村末梢水300 ml并分为3份,根据《生活饮用水卫生标准》(GB 5749-2006)中的操作规范,测定水氟含量。对学龄期儿童进行氟斑牙检测,检查操作和诊断依据《氟斑牙诊断》(WS/T 208-2011);采集被调查儿童空腹外周静脉血,检测矿物质及微量元素含量。结果 儿童性别、年龄在不同改水时间病区之间比较差异均无统计学意义(均P>0.05);不同改水时间病区水氟含量之间比较差异有统计学意义(P<0.01),随着改水时间延长,水氟含量逐渐减少。调查的196例儿童中检出氟斑牙52例(氟斑牙组),氟斑牙检出率为26.53%;未检出氟斑牙的144例儿童归入对照组。不同改水时间病区儿童的氟斑牙检出率之间比较差异有统计学意义(P<0.01),随着改水时间的延长,儿童氟斑牙检出率逐渐降低。氟斑牙组儿童血清钙、铁、锌、镁、镍的含量明显低于对照组儿童,差异均有统计学意义(均P<0.05);氟斑牙组儿童血清氟含量明显高于对照组儿童,差异有统计学意义(P<0.01)。血清碘、铜、铅、硒含量在氟斑牙组与对照组儿童之间比较差异均无统计学意义(均P>0.05)。结论 改水降氟能够有效降低饮水型氟中毒病区学龄期儿童氟斑牙检出率,随着改水时间延长效果逐渐显现。病区儿童矿物质及微量元素缺乏与氟斑牙发生密切相关,应给予重视。

Objective This paper aims to investigate the prevalence of dental fluorosis in school-age children in fluorosis area of drinking water type and its relationship with serum minerals and trace elements.Methods Stratified sampling method was adopted. The fluorosis areas of drinking water type in the city were stratified according to the water improvement time: 1-, 5-, 10-, ≥ 15 years. Two natural villages in each level were randomly selected for investigation. 300 ml peripheral water from each investigated natural village were collected and divided into 3 parts. According to the operation specifications in the Hygienic Standard for Drinking Sater(GB 5749-2006), the fluorine content in the water was determined and dental fluorosis detection to school-age children was carried out based on Dental Fluorosis Diagnosis(WS/T 208-2011).The fasting peripheral venous blood of investigated children was collected, and minerals and trace elements were detected. Results There was no significant difference as for gender and age of children between the wards at different water improvement time(P>0.05);There was significant difference in water fluoride content between the disease areas at different water improvement times(P<0.01). With the extension of water improvement, the water fluoride content gradually decreased. Among 196 children investigated, 52 cases of dental fluorosis were detected, and the detection rate of dental fluorosis was 26.53%. There was significant difference in the detection rate of dental fluorosis among children in the disease area at different water improvement times(P<0.01). With the extension of water improvement, the detection rate of dental fluorosis in children decreased gradually. The contents of serum calcium, iron, zinc, magnesium and nickel in the dental fluorosis group were significantly lower than those in the control group(P<0.05);The serum fluorine content of children in dental fluorosis group was significantly higher than that of children in control group(P<0.01).Conclusion Water improvement and fluoride reduction can effectively reduce the detection rate of dental fluorosis in school-age children in fluorosis areas of drinking water type, and the effect becomes clearer with the extension of water improvement;The children in the ward have the problem of trace element deficiency, which is worth attention.