摘要
目的了解西安市饮水型氟中毒病区改水后儿童氟斑牙患病情况及其影响因素。方法2017年从西安市疾病预防控制中心历年饮水型氟中毒调查资料中收集病区改水后2013年调查资料,按水氟含量将氟中毒病区村分为0.0~、0.2~、0.5~、1.0~、≥1.5mg/L组,在每个组内选取4个病区村,共20个村作为调查点。对调查点水氟、8~12岁儿童氟斑牙患病情况和尿氟再次进行现场调查,并与2013年调查结果进行比较分析。另外,按儿童尿氟水平分为0.0^(对照)、0.4~、0.8~、1.2~、≥1.6mg/L5个组,进行氟斑牙患病风险的单因素logistic回归分析。结果2017年5个水氟组调查点水氟含量与2013年比较,差异无统计学意义(P均>0.05)。2013、2017年20个调查点儿童氟斑牙总检出率分别为25.35%(200/789)和20.58%(164/797),二者比较差异有统计学意义(χ^2=5.11,P<0.05)。随着水氟升高,2013、2017年儿童氟斑牙检出率[3.52%(9/256)、13.28%(17/128)、31.62%(43/136)、37.82%(45/119)、57.33%(86/150),4.02%(10/249)、11.82%(13/110)、18.05%(24/133)、29.13%(37/127)、44.94%(80/178)]及病情严重程度均显著上升,呈线性变化趋势(χ^2=168.02、117.83,P均<0.01)。其中,2013年水氟0.5~、1.0~、≥1.5mg/L组儿童氟斑牙检出率均超过了30%,而2017年均有不同程度降低,水氟0.5~、1.0~<1.5mg/L组降至30%以下,但水氟≥1.5mg/L组仍超过了40%。2013、2017年儿童尿氟几何均数分别为1.02、0.67mg/L,二者比较差异有统计学意义(t=10.24,P<0.01)。2013、2017年各水氟组儿童尿氟比较,差异有统计学意义(F=85.36、151.14,P均<0.01)。随着尿氟水平增加,儿童氟斑牙患病风险显著增加,尿氟0.8~、1.2~、≥1.6mg/L组2013、2017年的比值比(OR)分别是5.26、7.83、13.28,5.18、7.65、13.36,差异有统计学意义(P均<0.05)。结论西安市饮水型氟中毒病区改水后,水氟现状和儿童氟斑牙病情仍不容乐观,需进一步落实改水降氟措施,对病区实施分类管理。
Objective To assess the effects of defluoridation on prevalence of children's dental fluorosis in Xi'an City and study related influencing factors. Methods In 2017, the survey results of 2013 were collected from the previous investigation of drinking water type fluorosis in Xi'an Center for Disease Control and Prevention, and villages from drinking water type fluorosis areas were divided into five groups: 0.0 -, 0.2 -, 0.5 -, 1.0 -, and ≥1.5 mg/L, according to the fluoride concentrations of water. Four villages were randomly selected from each group, a total of 20 villages were selected as the investigation sites. A cross-sectional analytical study was conducted in the 20 villages, the fluoride in drinking water, the dental fluorosis of children aged 8 - 12 years and fluoride content in urine were detected, and the survey results were compared with those of 2013. Children were divided into five groups according to urinary fluoride contents as: 0.0 -(control), 0.4 -, 0.8 -, 1.2 -, and ≥1.6 mg/L, and the logistic regression model was used to evaluate the risk of dental fluorosis. Results There were no significant differences in water fluoride content between 2013 and 2017 (P > 0.05). The rates of dental fluorosis among the study population in 2013 and 2017 were 25.35%(200/789) and 20.58%(164/797), and the difference was significant (χ^2 = 5.11, P < 0.05). The prevalence rate and severity of dental fluorosis in 2013 [3.52%(9/256), 13.28%(17/128), 31.62%(43/136), 37.82%(45/119), 57.33%(86/150)] and 2017[4.02%(10/249), 11.82%(13/110), 18.05%(24/133), 29.13%(37/127), 44.94%(80/178)] were significantly increased with increase of water fluoride concentration (χ^2 = 168.02, 117.83, P < 0.01). The prevalence rate of dental fluorosis was higher than 30% in the three groups with water fluoride content 0.5 -, 1.0 - and ≥1.5 mg/L in 2013, and the prevalence rates were decreased in these groups in 2017. The prevalence rate of dental fluorosis was lower than 30% in the groups with water-fluorine content of 0.5 -, 1.0 -< 1.5 mg/L, while the rate of dental fluorosis in the group with water-fluorine content of higher than 1.5 mg/L was still over 40%. The geometric mean of urinary fluoride of children in 2013 and 2017 were 1.02, 0.67 mg/L, and the difference was significant (t = 10.24, P < 0.01). There were significant differences in children urinary fluoride between water fluoride groups in 2013 and 2017 (F = 85.36, 151.14, P < 0.01). The risk of dental fluorosis increased with increase of urinary fluoride content, the odds ratio (OR) values were 5.26, 7.83 and 13.28 in the three groups with the urinary fluoride 0.8 -, 1.2 -,≥1.6 mg/L in 2013;the OR values in 2017 were 5.18, 7.65 and 13.36, the differences were statistically significant (P < 0.05). Conclusions The situation of water fluoride and dental fluorosis are not optimistic after defluoridation of drinking water. It is necessary to reinforce the measures of water defluoridation, and carry out classified management in endemic fluorosis areas.
作者
董璐
姚培杰
陈伟
时学花
李平
何姗姗
Dong Lu;Yao Peijie;Chen Wei;Shi Xuehua;Li Ping;He Shanshan(Department of Endemic Disease,Xi'an Center for Disease Control and Prevention,Xi'an 710054,China)
出处
《中华地方病学杂志》
CAS
CSCD
北大核心
2019年第9期710-714,共5页
Chinese Journal of Endemiology
关键词
饮水
氟中毒
牙
尿
Drinking
Fluorosis, dental
Urine
