地方性氟中毒病区居民膳食构成对氟骨症患病情况的影响

Influence of dietary composition of residents in endemic fluorosis area on the prevalence of skeletal fluorosis

目的探讨地方性氟中毒病区居民膳食构成与氟骨症的关系。方法采用病例对照研究,分析氟骨症患者(病例组)与未患病居民(对照组)的膳食构成差别。2019年8月,以山西省吕梁市文水县饮水型地方性氟中毒病区为调查现场,采用整群抽样方法,抽取年龄≥18岁当地居民,并以面对面访谈的方式展开问卷调查,调查内容包括性别、年龄及各类食物进食频次等;采用二元logistic回归分析食物进食频次与氟骨症的关系。利用便携式直接数字化X射线摄影系统(DR)拍摄前臂和小腿X线片,结合临床体征,根据《地方性氟骨症诊断标准》(WS/T 192-2008)进行氟骨症判定。结果本研究共纳入1061例研究对象,病例组376例、对照组685例。病例组患者年龄构成(≤60、>60岁:162、214例)与对照组(≤60、>60岁:423、261例)比较差异有统计学意义(χ^(2)=34.52,P<0.001),性别比例比较差异无统计学意义(χ^(2)=1.37,P=0.251)。病例组患者食用肉类、蛋类频次>1次/周的比例均低于对照组(χ^(2)=8.06、5.46,均P<0.05),食用奶类频次>1次/周的比例高于对照组(χ^(2)=4.01,P=0.046),食用海鲜类频次≥1次/周的比例低于对照组(χ^(2)=4.16,P=0.046)。二元logistic回归分析结果显示,校正年龄、性别、尿氟后,食用肉类、蛋类或奶类频次>1次/周以及食用海鲜类频次≥1次/周均与氟骨症患病风险无关(均P>0.05);但在≤60岁群体中,食用蛋类频次>1次/周与氟骨症患病风险相关[比值比(OR)=0.59,95%置信区间(CI):0.39,0.88]。结论肉类、蛋类、奶类和海鲜类食物进食频次在氟骨症患者和对照人群之间存在差异;在≤60岁群体中,食用蛋类频次>1次/周可能会降低氟骨症患病风险。

Objective To analyze the relationship between dietary composition of residents in endemic fluorosis areas and skeletal fluorosis.Methods A case-control study was used to analyze the difference of dietary composition between patients with skeletal fluorosis(case group)and residents without skeletal fluorosis(control group).In August 2019,taking the drinking water-borne endemic fluorosis area in Wenshui County,Lvliang City,Shanxi Province as the survey site,a cluster sampling method was adopted to select local residents aged over 18 years old,and a questionnaire survey was conducted by face-to-face interview.The survey contents included gender,age and consumption frequency of various foods.Binary logistic regression was used to analyze the relationship between food consumption frequency and skeletal fluorosis.The diagnosis of skeletal fluorosis was made by using portable digital radiography(DR)to take X-ray films of forearm and lower leg,combining with clinical signs,and according to the Diagnostic Standard for Endemic Skeletal Fluorosis(WS/T 192-2008)to determine.Results A total of 1061 subjects were included in this study,including 376 in the case group and 685 in the control group.The age composition of patients in the case group(≤60,>60 years old:162,214 cases)was significantly different from that in the control group(≤60,>60 years old:423,261 cases,χ^(2)=34.52,P<0.001).There was no statistically significant difference in gender ratio(χ^(2)=1.37,P=0.251).The proportion of patients in the case group who ate meat and eggs>1 time/week was lower than that in the control group(χ^(2)=8.06,5.46,P<0.05),the proportion of patients who ate milk>1 time/week was higher than that in the control group(χ^(2)=4.01,P=0.046),and the proportion of patients who ate seafood≥1 time/week was lower than that in the control group(χ^(2)=4.16,P=0.046).The results of binary logistic regression analysis showed that after adjusting for age,sex,and urinary fluoride,the frequency of eating meat,eggs or milk>1 time/week and the frequency of eating seafood≥1 time/week were not related to the risk of skeletal fluorosis(P>0.05);however,in the group≤60 years old,the frequency of eating eggs>1 time/week was associated with the risk of skeletal fluorosis[odds ratio(OR)=0.59,95%confidence interval(CI):0.39,0.88].Conclusions The consumption frequency of meat,milk,eggs and seafood is significantly different between the skeletal fluorosis patients and the control people.In the population≤60 years old,consumption frequency of eggs>1 time/week may reduce the risk of skeletal fluorosis.