2008年青海省饮水型地方性氟中毒病情调查分析

目的 掌握2008年青海省地方性氟中毒病情,为地方性氟中毒防治提供科学依据.方法 将青海省所有地方性氟中毒病村以改水前的水氟分为轻、中、重3类,分别抽取2、4、4个调查村.对未改水的村按东、西、南、北、中5个方位采集5份水样,测定水氟;对已改水病村,抽检3份末梢水样和1份水源水样测定水氟,水氟测定用<地方性氟中毒病区饮水氟化物的测定方法>;用Dean法对调查村所有8～12岁儿童进行氟斑牙检查,并按年龄段各抽检6人的尿氟;尿氟测定采用离子选择电极法;对调查村16岁及以上成人进行临床氟骨症检查,在中等病区和重病区调查村,每村按年龄段抽取约20人进行X线氟骨症检查.结果 共检查8～12岁儿童562名,氟斑牙检出率为43.59%(245/562);检测300例8～12岁儿童尿样,尿氟为1.52 mg/L:对3144名16岁以上成人进行临床氟骨症检查,临床氟骨症检出率为50.32%(1582/3144);对163名成人进行了X线拍片检查,氟骨症检出率为29.45%(48/163).结论 青海省地方性氟中毒病情仍然很严重,并且有回升趋势,须进一步加强防治措施.     

2005-2007年陕西省饮用水含氟量和地方性氟中毒病情调查

目的 调查2005-2007年陕西省饮用水含氟量和地方性氟中毒病情,评价改水工程降氟效果.方法 根据以往调查资料,在陕西省选择地方性氟中毒病情流行的10个市作为调查地区,以村为调查点,每村按东、西、南、北、中5个方位抽取水源水5份,同时采集每个改水工程水源水1份、出厂水1份和末梢水2份,采用氟离子选择电极法或氟试剂分光光度法测定水氟;在饮用水含氟量>1.00 mg/L的人群中进行地方性氟中毒流行病学调查,采用Dean法进行8～12岁儿童氟斑牙诊断,成人氟骨症按<地方性氟骨症临床分度诊断>(GB16396-1996)诊断.结果 共测定6390个村的水源水含氟量,其中水氟在1.00～<2.00 mg/L的有2619个村,暴露人口为1 654 998人;水氟在2.00～<4.00 mg/L的有845个村,暴露人口为355 623人;水氟≥4.00mg/L的有272个村,暴露人口为111 466人.全省水氟中位数为1.15 mg/L.渭南、咸阳和榆林3个市水氟中位数>1.00 mg/L,为高氟水集中分布的地区.共检测了3115个改水工程水氟,其中水氟在1.00～<2.00 mg/L的有1269个,暴露人口为1 415 877人;水氟在2.00～<4.00 mg/L的有120个,暴露人口为43 888人:水氟≥4.00 mg/L的有14个,暴露人口为5960人.44 081名8～12岁儿童进行氟斑牙临床检查,检出16 489例氟斑牙患者,检出率为37.4%(16 489/44 081);对310 993名成人进行氟骨症临床检查,检出15 877例Ⅱ度以上氟骨症患者,检出率为5.1%(15 877/310 993).结论 高氟水在陕西省广泛分布,地方性氟中毒流行较严重,降氟改水工程质量有待进一步提高.     

辽宁省饮水型地方性氟中毒病区病情调查

目的掌握辽宁省饮水型地方性氟中毒的流行现况,评价改水措施的防病效果。方法按病区分层抽取的85个病区村进行8-12岁儿童氟斑牙、16岁以上成人临床氟骨症的普查,采集饮用水和儿童尿样进行氟含量的检测。结果抽样病区8-12岁儿童氟斑牙检出率为16.74%,尿氟几何均值0.97 mg/L。8-12岁儿童氟斑牙检出率重病区高于中病区,中病区高于轻病区,未改水病区儿童尿氟水平明显高于改水病区。16岁以上人群临床氟骨症检出率为4.98%,随着年龄的增长氟骨症检出率逐渐升高。结论地方性氟中毒病情随着病区水氟含量的增高而逐渐加重。     

2006年甘肃省地方性氟中毒防治现状调查

目的 了解甘肃省地方性氟中毒(简称地氟病)病区分布和改水降氟工程运行现状.方法 2006年在甘肃省地氟病病区,对未改水村进行水源水氟检测:对已改水村进行降氟改水工程运行情况调查和水氟测定;在已查出的高氟村,对儿童进行氟斑牙和成人氟骨症患病情况调查.水氟测定采用氟离子选择电极法,儿童氟斑牙调查采用Dean法,氟骨症诊断执行<地方性氟骨症临床分度诊断>(GB 16396-1996)标准.结果 共调查了26个县、1997个村的不同类型饮用水源,水源水含氟量>1.0 mg/L的村占29.94%(598/1997).共调查各类改水工程1215处.能正常供水的工程占工程总数的94.90%(1153/1215),间歇供水工程和已报废工程分别占工程总数的2.96%(36/1215)和2.14%(26/1215).出厂水水氟均值≤1.0 mg/L的工程占检测工程数的90.79%(1084/1194),末梢水水氟均值≤1.0 mg/L的工程占检测工程数的91.75%(1068/1164).共检查8～12岁儿童86 390人,儿童氟斑牙检出率为22.47%(19 414/86 390).共检查16岁以上成人142 211人,临床Ⅱ度及以上氟骨症检出率为4.20%(5967/142 211).结论 甘肃省少部分病区高氟水源依然存在,降氟改水工程报废和超标现象普遍;部分病区儿童氟斑牙和成人氟骨症尚在流行,防治任务依然艰巨,应加大改水力度,提高防病改水效益.     

2008年福建省饮水型地方性氟中毒病区监测结果分析

目的了解福建省地方性氟中毒轻、中病区现状。方法按照分层整群抽样的原则,抽取轻病区村6个,中病区村4个作为调查点,每个调查点测定饮用水氟、8～12岁儿童氟斑牙和尿氟、对16岁及以上成人进行临床氟骨症检查和X线检查。结果10个病区村饮水氟均值均低于1.0 mg/L,9个村儿童氟斑牙低于30%,10个病区村儿童尿氟几何均数均未超过1.4 mg/L。临床氟骨症检出率4.42%,X线氟骨症检出率19.82%。结论饮水型氟中毒实施改水措施效果显著,临床与X线氟骨症诊断标准的衔接还有待于进一步探讨。     

辽宁省地方性氟中毒的流行和防治现状

目的 了解辽宁省地方性氟中毒(简称地氟病)流行现状和防治措施落实情况.方法 对改水和未改水饮水型地氟病病区分层抽样开展饮用水含氟量筛查和8-12岁儿童氟斑牙,16岁以上成人临床氟骨症病情普查,检测8-12岁儿童志愿者尿氟.结果 全省普查842个未改水村(屯)和1829个改水村(屯),未改水村(屯)居民饮用水水氟0.01-7.10 mg/L,平均(0.96±0.64)mg/L,29.2%(246/842)的未改水村(屯)饮用水含氟量＞1.2 mg/L,在1829个改水村(屯)中调查了1234个降氟改水工程,水氟0.06-7.67 mg/L,工程正常运行且水氟≤1.2 mg/L的工程占调查工程的68.31%(843/1234),已改水村(屯)有31.69%(391/1234)的工程没有发挥其降氟改水作用.普查12127名8-12岁儿童和85 636名16岁以上成人,儿童氟斑牙检出率为24.4%(2960/12 127),成人临床Ⅱ度及以上氟骨症检出率为2.22%(1900/85 636).轻,中,重病区儿童氟斑牙检出情况比较,差异有统计学意义(X2＝19.25,P＜0.01),重病区儿童氟斑牙检出率较高,个别未改水的重病区村(屯)儿童氟斑牙检出率达到100%,成人临床Ⅱ度及以上氟骨症检出率为18.03%(97/538).重病区和轻病区(未改水及工程报废)儿童尿氟中位数分别为2.01,2.00 mg/L.结论 辽宁省未改水的饮水型地氟病中,重病区的病情仍然十分严重,工程停运或报废病区仍亟须落实降氟改水防治措施.     

2010年全国饮水型地方性氟中毒监测报告

目的 监测我国饮水型氟中毒病区改水工程的运行情况,了解病情变化趋势,评价防控措施效果,为制订防治措施提供依据.方法 按照《饮水型地方性氟中毒监测方案(试行)的通知》规定的方法和要求,在全国27个省(区、市)和新疆生产建设兵团,抽取136个监测县,每个监测县抽取10个改水工程,调查改水工程运行情况,监测改水工程水含氟量;每个监测县抽取3个病区村作为固定监测村,检测饮水含氟量,水氟检测采用《生活饮用水标准检验方法》.采用Dean法检查监测村所有8～12岁学生氟斑牙患病情况;每个监测村按照年龄分层随机抽样,采用《地方性氟骨症诊断标准》,对50名25岁以上成人进行X线检查.结果 ①共监测改水工程1398个,正常运转、间歇运转和报废工程分别占93.35％( 1305/1398)、5.29％( 74/1398)和1.36％(19/1398),水含氟量合格率为69.96％(978/1398).②在开展监测的327个已改水村中,改水工程水氟合格率为76.15％( 249/327);在开展病情监测的84个未改水村中,水氟＞1.2 mg/L且≤2.0 mg/L、＞2.0 mg/L且≤4.0 mg/L、＞ 4.0 mg/L的村分别占未改水监测村的57.14％(48/84)、32.14％(27/84)和10.71％(9/84).③在监测的195个改水工程水质合格且能够正常运行的改水村中,儿童氟斑牙检出率为25.03％(3851/15387),缺损型氟斑牙检出率为1.88％(289/15 387);监测的82个水含氟量超标自然村的儿童氟斑牙检出率为56.27％(3384/6014),缺损型氟斑牙检出率为10.92％(657/6014).④在监测的195个改水工程水质合格且能够正常运行的改水村中,X线氟骨症检出率为19.11％(1465/7667);监测的79个水氟含量超标的自然村,X线氟骨症检出率为17.47％(634/3630).结论 我国饮水型地方性氟中毒病区改水工程运行情况以及水质质量还需改善;改水对控制饮水型氟中毒病情起到了一定的作用,但还需要长期巩固.     

2009年河南省许昌市饮水型地方性氟中毒监测结果分析

目的 了解许昌市地方性氟中毒的病情动态,评价防治措施的落实效果.方法 2009年,在河南省许昌市,抽取长葛市、许昌县作为监测县(市),调查监测县(市)的改水工程运行情况及水含氟量,并选择10个病区村作为监测村,调查8～ 12岁儿童氟斑牙及尿含氟量,16岁成人临床氟骨症及尿含氟量.结果 2个监测县所有改水村中,改水工程正在使用的村有97个,占61.39％(97/158),报废的村有61个,占38.61％(61/158).在10个监测村中,9个未改水村,水氟均值范围为1.32 ～ 2.25 mg/L;1个已改水村,末梢水水氟为0.44 mg/L;8～12岁儿童氟斑牙检出率为38.65％(80/207),儿童的尿氟几何均数为1.65 mg/L;成人临床氟骨症检出率为0.30％(9/2982),成人尿氟几何均数为2.09 mg/L.结论 许昌市属于地方性氟中毒轻中度流行区,病情尚未得到有效控制,需进一步加大防治力度.     

南水北调中线工程的实施与河北省地方性氟中毒防治

目的调查掌握南水北调中线工程河北省供水区供水前地方性氟中毒的流行范围、危害程度及改水降氟现状,探讨南水北调中线工程的实施对河北省地方性氟中毒防治的影响.方法按南水北调中线供水区地方性氟中毒调查实施方案要求,对所途经的河北省7个地市106个县27 891个村的水氟含量和改水现状进行普查,对饮水含氟量超过1.0mg/L病区村按轻、中、重分层,随机抽取51个村进行重点调查,调查氟斑牙和氟骨症患病情况.结果地方性氟中毒在南水北调中线供水区流行分布广泛,一些地区改水降氟成效显著,但低氟水源难寻,改水难度大的地区,病情较为严重.结论南水北调中线工程实施后为河北省改水难度大的地区彻底改水降氟提供了可能.     

2007年青海省地方性氟中毒国家监测点监测报告

目的 掌握青海省地方性氟中毒病区改水降氟措施落实进度和病情现状及发展趋势,为政府部门制订防治措施提供依据.方法 在青海省互助县普查改水防氟工程使用情况,同时以互助县蔡家堡乡岩崖村作为监测点,检测该村生活饮用水,8-12岁儿童及16岁以上成人氟斑牙和尿氟,成人临床及X线氟骨症.水氟和尿氟测定采用氟离子电极法,氟斑牙诊断用Dean法,氟骨症诊断按国标(GB 16396-1996,WS 192-1999)进行.结果 互助县有60个病区村,其中有36个村实施了改水,改水率为60%.监测点岩崖村水氟均值为1.25 mg/L(国家标准＜0.05 mg/L),儿童氟斑牙检出率为90.20%(46/51),成人为88.89%(48/54),儿童氟斑牙指数为1.77,成人为2.95,儿童尿氟几何均数为2.27 mg/L,成人为2.00 mg/L,成人氟骨症临床检出53例,检出率为98.15%(53/54),X线检出10例,检出率为18.87%(10/53).结论 青海省地方性氟中毒病情重,降氟措施落实缓慢.     

2010年山东省地方性氟中毒病情调查

目的了解山东省地方性氟中毒的病情现状,为制定防制策略提供科学依据。方法按照国家《2009年地方病防治项目技术实施方案》和《饮水型地方性氟中毒监测方案(试行)》的要求,选择10个县,每个县选择3个村,测定饮用水含氟量,检查8～12岁儿童氟斑牙和≥25岁成人氟骨症。水氟含量测定采用氟离子选择电极法,8～12岁儿童氟斑牙诊断采用Dean’s法,氟骨症诊断执行地方性氟骨症诊断标准(WS 192-2008)。结果在10个县中,共调查26个已改水村和4个未改水村。在26个已改水村中,水氟均值≤1.20 mg/L的村15个,占57.69%;>1.20 mg/L的村11个,占42.31%,水氟最大值为5.58 mg/L。在4个未改水村中,水氟均值≤1.20 mg/L的村1个,占25.00%,>1.20 mg/L的村3个,占75.00%,水氟最大值为2.92 mg/L。检查已改水村8～12岁儿童1 331人,氟斑牙检出率为59.73%,氟斑牙指数为1.17,缺损率为10.14%。检查未改水村8～12岁儿童138人,氟斑牙检出率为51.45%,氟斑牙指数为0.95,缺损率为0.72%。已改水村和未改水村≥25岁成人的氟骨症X线检出率分别为8.80%和3.05%。结论山东省改水降氟工程水氟超标严重,地方性氟中毒病情尚未得到有效控制,须进一步加大防制力度。     

2009年青海省湟源县地方性氟中毒病情监测结果分析

目的 掌握青海省湟源县饮水型地方性氟中毒病情变化和防治措施落实效果.方法 2009年将湟源县所有地方性氟中毒病区村按改水前水含氟量分为轻、中两类,分别抽取1、2个病区村作为监测点,共抽取3个监测村;每村采集出厂水和末梢水水样进行水氟测定;对监测村所有8～12岁儿童进行氟斑牙检查,并按年龄组采集儿童尿样进行尿氟测定;对监测村16岁及以上成人进行临床氟骨症检查,并采集20人份的尿样,检测尿氟;在3个监测村中选择1个村进行X线氟骨症检查.按照<生活饮用水标准检验方法非金属指标>(GB/T 5750.6-2006)测定水氟,尿氟测定采用氟离子选择电极法(WS/T 89-1996),氟斑牙诊断采用Dean法,成人氟骨症诊断按<地方性氟骨症临床诊断标准>(WS 192-2008).结果 共检测12份水样,水氟为(0.35 ±0.43)mg/L.共检查8～12岁儿童122名,氟斑牙检出率为34.43%(42/122);检测96例儿童尿样,尿氟几何均数为0.89 mg/L.对834名16岁及以上成人进行氟骨症检查,临床氟骨症检出率为47.72%(398/834):检测65例成人尿样,尿氟几何均数为1.10 mg/L;对甘沟村35名成人进行了X线氟骨症检查,检出率为31.4%(11/35).结论 湟源县的3个监测村饮用水含氟量正常,但氟中毒病情仍然很严重,应密切监测,分析原因,改进防治措施.

Abstract：

Objective To investigate the prevalence change of drinking water type of endemic fluorosis and the effect of control measures implemented in Huangyuan county of Qinghai province. Methods In 2009, all the endemic fluorosis villages in Huangyuan county were divided into two degrees, light and medium, according to the water fluorosis content before implementing the improving water project, 1 to 2 villages were selected from each degree village, respectively,as monitoring sites, and a total of 3 villages were selected. Source water and tap water samples were collected from each village and water fluoride concentration was determined. Dental fluorosis of all children aged 8 to 12 of monitoring villages was examined, and urine samples were collected by age group of children for determination of urinary fluoride. Clinical skeletal fluorosis of adults over 16 years of age was examined, and 20 copies of adults urine samples were collected to determine urinary fluoride. One village was selected in the 3 villages monitored to conduct X-rays examination of skeletal fluorosis. Water fluoride was tested in accordance with the "Non-metallic Targets Test Methods for Drinking Water" (GB/T 5750.6-2006); urinary fluoride was tested by fluoride ion-selective electrode method (WS/T 89-1996); dental fluorosis was diagnosed using Dean method;adult skeletal fluorosis was diagnosed by "Clinical Diagnostic Criteria for Endemic Skeletal Fluorosis"(WS 192-2008). Results Twelve water samples were assayed, water fluoride was (0.35 ± 0.43) mg/L. The detectable rate of dental fluorosis of 122 children aged 8-12 was 34.43%(42/122) and the geometric mean urinary fluoride was 0.89 mg/L of the 96 children. Of the 834 adults aged 16 and over, clinical detection of skeletal fluorosis was 47.72% (398/836) and geometric mean urinary fluoride was 1.10 mg/L of the 65 cases of adult urine samples assayed, detection rate of X-rays was 31.4% (11/35) in Gangou village of the 35 adults examined.Conclusions In Huangyuan county, water fluoride of the 3 surveyed villages are normal but the endemic fluorosis is still serious. It should strengthen monitoring and analyze the causes and improve prevention measures.     

2009年青海省饮水型地方性氟中毒监测结果分析

目的 掌握青海省饮水型地方性氟中毒病情变化和防治措施落实效果,为防治工作提供依据。方法 2009年,采用单纯随机抽样方法选择6个监测县,每个县根据历史资料将病区村分成轻、中、重3个类型,每个类型抽取1个病区村作为监测村。在已改水病区村采集出厂水1份和末梢水3份,在未改水病区村按东、西、南、北、中5个方位各采集1份水样,水氟测定按照《生活饮用水标准检验方法》(GB/T 5750--2006)。对监测村全部8～ 12岁儿童进行氟斑牙检查,氟斑牙诊断采用Dean法。对监测村全部16岁以上常住人口进行临床氟骨症检查,选择其中2个村,对有临床氟骨症症状的成人进行X线氟骨症检查,氟骨症诊断采用地方性氟骨症诊断标准(WS 192-2008)。每个监测村采集儿童尿样30份、成人尿样20份,采用尿中氟化物的测定离子选择电极法(WS/T 89-2006)检测尿氟。结果 6个县18个病区村中,14个村已落实改水项目,改水率为77.78％(14/18),其中5个改水工程供水正常、9个间歇供水;共检测水样75份,水氟均值为0.48 mg/L。8～ 12岁儿童氟斑牙检出率为31.95％(285/892);16岁以上人群临床氟骨症检出率为36.55％(1570/4295),X线氟骨症检出率为25.64％(20/78)。共检测儿童尿样571份,尿氟几何均数为1.04 mg/L;共检测成人尿样370份,尿氟几何均数为1.52 mg/L。结论 青海省饮水型氟中毒流行仍然较为严重,改水防氟措施应进一步加强和完善。     

2008年江苏省苏北地区饮水型地方性氟中毒病情监测结果分析

目的 掌握江苏省苏北地区饮水型地方性氟中毒(简称地氟病)病情及降氟改水工程使用情况.为进一步开展地氟病的防治工作提供科学依据.方法 2008年,在徐州、连云港、宿迁市的10个饮水型地氟病重点县(区),按照以往水氟调查资料,采用分层抽样的方法,抽取40个病区村,对所有8～12岁儿童进行氟斑牙检查;对所有16岁以上成人进行临床氟骨症检查.在40个病区村中,抽取30%的病区村,每个病区村选择20名16岁以上成人进行X线氟骨症检查,抽取50%病区村,每个村采集30名8～12岁儿童的任意一次尿样 检测尿氟.在每个市,选择1个县,对分层抽样方法抽取剑的病区村的改水工程现状、供水能力及覆盖范围等进行调查.结果 共计对3560名8～12岁儿童进行氟斑牙检查,检出率为38.51%(1371/3560).缺损率为5.34%(190/3560),氟斑牙指数为0.8;共抽取708份尿样,尿氟中位数为1.47 mg/L,范围为0.08～10.08 mg/L;16岁以上成人临床氟骨症检出率为21.3%(1294/6083),X线氟骨症检出率为39.2%(123/314).共调查了248个集中式改水设施,无经费运行或损坏的有49个,水氟>1.0 mg/L的有18个.结论 江苏省苏北地区饮水型地氟病病情尚未完全控制,并有回升趋势,须进一步加强降氟改水监管力度.

Abstract：

Objective To investigate the state of endemic fluorosis, running status of water improvement project to reduce fluoride in Jiangsu province, and to provide a scientific basis for prevention and control of endemic fluorosis. Methods In 2008, in the ten key counties of endemic fluorosis (zone), in Xuzhou,Lianyungang and Suqian, a stratified sampling method was employed to select 40 diseased villages according to their past water fluoride survey data. All children aged 8 to 12 were examined dental fluorosis, and all adults over 16 years were examined clinical skeletal fluorosis. Thirty per cent of the 40 diseased villages were selected, and 20 adults over the age of 16 in each selected village were examined by X-ray, respectively;50% of the 40 diseased villages were selected, and 30 any time urine samples of children aged 8 to 12 in each diseased village were tested urine fluoride. In each city, select a county, the status of water improvement project to reduce fluoride, water supply capacity and coverage in the county were investigated. Results A total of 3560 children aged 8 to 12 were examined, the detection rate of dental fluorosis was 38.51% (1371/3560), tooth defect rate was 5.34% (190/3560), and dental fluorosis index was 0.8. Seven hundred and eight urine samples were tested, the median urinary fluoride was 1.47 mg/L and the range was 0.08 ~ 10.08 mg/L. Clinical detection of skeletal fluorosis was 21.3% among adults over the age of 16, and X-ray detection rate of skeletal fluorosis was 39.2% (123/314).Investigated a total of 248 facilities of centralized water improvement projects, no funds to run or damaged 49, the water fluoride > 1.0 mg/L was 18. Conclusions Endemic fluorosis in Northern Jiangsu province has not been controlled completely, but has a rising trend, we should further strengthen the supervision of water fluoride reduction.     

2009年河北省饮水型地方性氟中毒病情调查

目的 了解饮水型地方性氟中毒的病情动态和评价防治措施的落实效果,为及时调整防治策略提供科学依据.方法 2009年,采用单纯随机抽样的方法,在河北省饮水型氟中毒病区县中抽取38个县(市、区),采用系统抽样方法,将各病区县所有病区村分成轻、中、重3类,从每类病区村中各抽取1个病区村,对全部病区村进行水氟监测;调查病区村全部8～12岁儿童氟斑牙患病情况,从每个年龄段选择6人,检测尿氟;对各病区村全部16岁以上常住人口开展临床氟骨症检查,并检测20人份(男、女各半)尿氟.结果 共调查112个病区村,其中改水村66个,未改水村46个.采集改水工程水样236份,水氟范围为0.1～4.3 mg/L,有20个工程水氟＞1.2 mg/L,占总数的33.3%(20/60);采集未改水村水样230份,水氟范围为0.2～4.6 mg/L,水氟＞1.2 mg/L的水源数占总数的76.1%(35/46).共对5169名8～12岁儿童进行了氟斑牙患病情况调查,氟斑牙检出率为36.43%(1883/5169),氟斑牙指数为0.81.调查16岁以上成人71 497人,临床氟骨症检出率为4.81%(3438/71 497),中度以上临床氟骨症检出率为1.56%(1114/71 497).分别测定了2876和2021份儿童和成人尿氟,几何均数分别为2.30、3.32 mg/L.结论 水氟＜1.2 mg/L的已改水村儿童氟斑牙检出率均在30%以下,儿童氟斑牙检出率和成人临床氟骨症检出率随着改水时间的延长呈现逐渐下降的趋势.未改水病区,儿童氟斑牙检出率和成人临床氟骨症病情随水氟升高而上升.河北省饮水型氟中毒流行仍然较为严重,应该加快改水降氟进度并提高改水工程合格率.

Abstract：

Objective To understand the status of drinking-water-borne endemic fluorosis and the effect of preventive measure in Hebei province, so as to provide a basis to prevent and cure the disease. Methods Thirtyeight affected counties(cities, districts) with drinking-water-borne endemic fluorosis were sampled by random sampling in Hebei in 2009. All affected villages in every county were divided into mild, moderate and severe endemic fluorosis areas and a village was randomly selected from each category of the area to carry out the monitoring of endemic fluorosis. Dental fluorosis of children aged 8 - 12 were examined and 6 copies of urine samples were randomly collected in each age group in the above-mentioned villages. Clinical skeletal fluorosis was diagnosed among adults aged 16 and over and 20 copies of urine samples were tested for fluorosis in every village.Results A total of 112 affected villages were investigated, among which the drinking water quality of 66 villages were improved and 46 villages were not improved. A total of 236 copies of water samples from the 66 villages were measured and the fluoride content ranged from 0.1 to 4.3 mg/L, among which 20 copies of water samples exceeded the fluorine standard of 1.2 mg/L, accounting for 33.3%. A total of 230 copies of water samples were collected in the 46 villages and the fluoride content ranged from 0.2 to 4.6 mg/L, among which 76.1% (35/46) of the water samples exceeded the fluorine standard of 1.2 mg/L. A total of 5169 children aged 8 - 12 were examined of dental fluorosis, the dental fluorosis rate was 36.43%(1883/5169) and the dental fluorosis index was 0.81. A sum of 71 497 adults aged over 16 years were examined, and the rate of skeletal fluorosis was 4.81%(3438/71 497), moderate or severe clinical detection rate of skeletal fluorosis was 1.56%( 1114/71 497). A total of 2876 copies of children urine samples and 2021 copies of adult urine samples were tested and the geometric mean of fluoride content was 2.30,3.32 mg/L, respectively. Conclusions The prevalence of dental fluorosis of children in the areas with improved water is less than 30% and the rate of dental fluorosis and skeletal fluorosis decline gradually with time.The rate of dental fluorosis and skeletal fluorosis increases with the increase of water fluoride in the water quality not improved areas. The endemic fluorosis is still comparatively serious in Hebei. The progress of improving water quality in the areas with endemic fluorosis should be accelerated and the acceptability of improved water should be enhanced.     

2009年西藏自治区饮水型氟中毒病情监测结果分析

目的 了解西藏饮水型地方性氟中毒的病情动态,评价防治措施的效果,为及时调整防治策略提供科学依据.方法 按照"2008年中央补助地方公共卫生专项资金西藏饮水型氟中毒防治项目"技术方案,于2009年9-10月选取日喀则谢通门和林芝察隅两县作为项目县,在每个项目县采用单纯随机抽样的方法选择3个项目村,以自然村为单位,对改水及改水工程运转情况、饮水含氟量、儿童氟斑牙和成人临床氟骨症进行调查.按照<生活饮用水标准检验方法非金属指标>(GB/T 5750.6-2006)测定水氟;尿中氟化物的测定采用离子选择电极法(WS/T 89-1996);氟斑牙诊断采用Dean法;成人氟骨症诊断按<地方性氟骨症临床诊断标准>(WS192-2008)进行.结果 已改水病区水氟均值在0.18～0.34 mg/L,未改水病区水氟均值在0.70～2.13 mg/L;已改水病区8～10岁儿童氟斑牙检出率为50.78%(65/128),氟斑牙指数为1.04,儿童尿氟均值为1.64 mg/L,未改水病区氟斑牙检出率为80.65%(25/31),氟斑牙指数为1.50,儿童尿氟均值为2.08;已改水病区成人氟骨症患病率为38.7%(104/269),尿氟为1.61 mg/L,未改水病区成人氟骨症患病率为15.4%(18/117),尿氟为3.54mg/L.结论 改水降氟使氟斑牙的检出率降低至控制水平,严重程度也在降低,改水病区尿氟低于未改水病区,说明改水仍对消除氟中毒的危害有重要意义,但氟骨症患病率出现了在改水病区反而高于未改水病区的现象.

Abstract：

Objective To find out the dynamics of drinking water borne endemic fluorosis in Tibet's, to evaluate the effect of control measures, and to provide a scientific basis for the timely adjustment of control strategies. Methods During september to october 2009, according to the "2008 Central Government Special Funds to Subsidize Local Public Health in Drinking Water Borne Fluorosis in Tibet", Xigaze Xietongmen and Nyingchi Zayu were selected as project counties, three project villages were selected with simple random sampling method in each county, the functioning of water improvement projects, drinking water fluoride content, children's dental fluorosis and adult skeletal fluorosis were investigated. Water fluoride was detected by the "standard examination methods for drinking water the non-metallic targets"(GB/T 5750.6-2006) determination of fluoride; urinary fluoride was tested by ion selective electrode (WS/T 89-1996); dental fluorosis was diagnosed using Deans method; adult skeletal fluorosis was diagnosed by "endemic skeletal fluorosis clinical diagnostic criteria" (WS 192-2008). Results Mean water fluoride was 0.18 - 0.34 mg/L in drinking water changed areas, and 0.70 - 2.13 mg/L in not changed areas; prevalence of dental fluorosis of children 8 - 10 was 50.78% (65/128), dental fluorosis index was 1.04,mean urinary fluoride was 1.64 mg/L in drinking water changed areas; prevalence of dental fluorosis of children 8 -10 years old was 80.65%(25/31 ) in not changed areas, dental fluorosis index was 1.50, mean urinary fluoride of children was 2.08; adult clinical skeletal fluorosis was 38.7%(104/269) in drinking water changed areas, the mean urinary fluoride was 1.61 mg/L, prevalence of skeletal fluorosis was 15.4% (18/117) in not changed areas, mean urinary fluoride was 3.54 mg/L. Conclusions The method of change the water to reduce fluoride decreases dental fluorosis to control levels, and severity is also reduced, urinary fluoride is decreased. However, the prevalence of skeletal fluorosis is higher than that of drinking water not changed areas.     

2008年重庆市燃煤型氟中毒病区环境氟调查分析

目的 了解重庆市燃煤型氟中毒病区环境氟分布特征,为制订科学防治措施提供科学依据.方法 2008年,根据重庆市的历史资料,以巫山县凌云村、栗子村和彭水县太平村、大青村4个病区村和永川区的双楼村、现龙村2个非病区村为调查村.对4个病区村所有8～12岁儿童进行氟斑牙检查,对16岁以上人群进行临床氟骨症检查.6个调查村每村抽取5户居民,每户采集1份家中所用煤、拌煤土、混土煤、煤渣、土壤,每份500 g;每村抽取15户居民,每户采集玉米、大米、土豆、蔬菜,粮食和蔬菜样品各1份,每份500 g,干辣椒样品1份,每份100 g;每户采集1份饮用水水样,每份250 ml;有饮茶习惯的居民村,每村采集茶叶15户以上,每户采集50 g茶叶和600 ml茶水测定含氟量;每村抽取5户居民,测旺火时的室内、外空气含氟量.结果 病区村儿童氟斑牙检出率为74.65%(736/986),成人氟骨症检出率为7.20%(75/1592);病区村煤、拌煤土、混土煤、煤渣、土壤含氟量分别为(310.56±209.46)、(360.51±224.96)、(293.62±65.15)、(186.59±133.66)、(497.54±294.70)mg/kg;非病区村分别为(48.68±10.62)、(275.66±62.69)、(152.20±34.43)、(209±14±188.66)、(269.98±58.21)mg/kg,病区村均显著高于非病区村(t=7.67、31.54、5.82、5.82,P均<0.05);病区村饮用水、玉米、辣椒、大米、土豆、蔬菜含氟量分别为(0.30±0.14)、(1.83±2.67)、(23.50±91.80)、(0.77±0.25)、(0.44±0.11)、(0.48±0.18)mg/kg,非病区村分别为(0.18±0.06)、(2.21±0.46)、(2.82±2.51)、(1.31±0.21)、(0.64±0.41)、(1.10±0.77)mg/kg;饮用水、辣椒含氟量病区村显著高于非病区村(t=7.79、2.33,P均<0.05);大米、土豆、蔬菜含氟量非病区村显著高于病区村(t=39.29、4.69、4.01,P均<0.05);病区村茶叶、茶叶水含氟量[(99.41±55.83)、(1.59±0.91)mg/L]与非病区村[(79.95±43.78)、(1.80±1.16)mg/L]比较,差异无统计学意义(t=1.01、0.27,P均>0.05);但病区人均饮茶水量[(1.45±0.68)L/d]显著高于非病区村[(1.00±0.47)L/d,t=4.27,P<0.05].病区村室内空气氟[(12.77±8.08)μg/m3]显著高于非病区村[(1.16±1.08)μg/m3,t=9.49,P<0.01],病区村室外空气氟[(1.10±1.57)μg/m3]与非病区村[(0.39±0.31)μg/m3]比较,差异无统计学意义(t=2.01,P>0.05).结论 重庆市氟中毒病区的氟源为煤和拌煤土,氟进入人体的途径主要为呼吸道,从食物摄入量很少,干辣椒含氟量虽高,但居民不食用;防治措施应以控制室内空气氟为主.饮茶可能为氟中毒的因素之一,须在深入研究基础上采取相应措施.