CAJ | 학술논문

目的探讨燃煤污染型地方性氟中毒(简称地氟病)发病的危险因素,为制订预防控制策略提供科学依据.方法 2010年,在重庆市渝东北燃煤污染型地氟病流行区的巫山、奉节县,选择100名氟斑牙儿童及30名成人氟骨症患者作为病例组,在非地氟病人群中选择100名儿童、30名成人以及在非地氟病区的渝北区选择30名成人作为对照组.根据知情同意原则,抽取研究对象空腹静脉血,测定血中锌(Zn)、铜(Cu)、钙(Ca)、镁(Mg)、铁(Fe)含量；收集尿液,检测尿氟.并对100名氟斑牙儿童及100名对照儿童进行氟污染情况及地氟病相关知识知晓情况的问卷调查,比较病例组与对照组的差异.结果病例组儿童血Zn[(70.88±9.28)μmol/L]低于对照组[(75.53±10.78)μmol/L,P＜0.05]；病例组儿童血Cu[(30.28±2.58)μmol/L]及尿氟[(0.74±0.36) mg/L]高于对照组[(28.45±4.05) μmol/L、(0.48±0.21)mg/L,P均＜0.05].病例组成人血Zn[(91.13±10.29)μmol/L]低于对照组[(99.57±11.73) μmol/L,P＜0.05)]；病例组成人血Mg[(1.57±0.19)mmol/L]、Fe[(8.17±1.01)mmol/L]及尿氟[(2.37±1.01)mg/L]高于对照组[(1.46±0.16) mmol/L、(7.72±0.96)mmol/L、(0.92±0.85)mg/L,P均＜0.05].用煤取暖、炉灶改良、食用煤火烘烤食物、知道地氟病危害人体、知道地氟病可预防、知道食用烘烤食物引起地氟病、知道喝牛奶预防地氟病、吃钙片习惯是重要的相关因素,比值比(OR)分别为2.7335、0.3339、2.8428、0.4633、0.5439、0.4009、0.4805、0.3994(P均＜0.05).结论除主要致病元素氟外,两县燃煤污染型地氟病发病与机体Zn含量关系密切,地氟病患者体内普遍缺Zn,提示缺Zn可能是氟致病的辅助因素.减少使用当地煤取暖、不食用煤火烘烤食物、改良炉灶、了解有关地氟病的知识,食用抗氟元素可降低地氟病发病的危险.
목적 탐토연매오염형지방성불중독(간칭지불병)발병적위험인소,위제정예방공제책략제공과학의거.방법 2010년,재중경시투동북연매오염형지불병류행구적무산、봉절현,선택100명불반아인동급30명성인불골증환자작위병례조,재비지불병인군중선택100명인동、30명성인이급재비지불병구적투북구선택30명성인작위대조조.근거지정동의원칙,추취연구대상공복정맥혈,측정혈중자(Zn)、동(Cu)、개(Ca)、미(Mg)、철(Fe)함량；수집뇨액,검측뇨불.병대100명불반아인동급100명대조인동진행불오염정황급지불병상관지식지효정황적문권조사,비교병례조여대조조적차이.결과 병례조인동혈Zn[(70.88±9.28)μmol/L]저우대조조[(75.53±10.78)μmol/L,P＜0.05]；병례조인동혈Cu[(30.28±2.58)μmol/L]급뇨불[(0.74±0.36) mg/L]고우대조조[(28.45±4.05) μmol/L、(0.48±0.21)mg/L,P균＜0.05].병례조성인혈Zn[(91.13±10.29)μmol/L]저우대조조[(99.57±11.73) μmol/L,P＜0.05)]；병례조성인혈Mg[(1.57±0.19)mmol/L]、Fe[(8.17±1.01)mmol/L]급뇨불[(2.37±1.01)mg/L]고우대조조[(1.46±0.16) mmol/L、(7.72±0.96)mmol/L、(0.92±0.85)mg/L,P균＜0.05].용매취난、로조개량、식용매화홍고식물、지도지불병위해인체、지도지불병가예방、지도식용홍고식물인기지불병、지도갈우내예방지불병、흘개편습관시중요적상관인소,비치비(OR)분별위2.7335、0.3339、2.8428、0.4633、0.5439、0.4009、0.4805、0.3994(P균＜0.05).결론 제주요치병원소불외,량현연매오염형지불병발병여궤체Zn함량관계밀절,지불병환자체내보편결Zn,제시결Zn가능시불치병적보조인소.감소사용당지매취난、불식용매화홍고식물、개량로조、료해유관지불병적지식,식용항불원소가강저지불병발병적위험.
Objective To explore the risk factors of coal-burning-borne endemic fluorosis (endemic fluorosis) and to provide a scientific basis for making prevention and control strategy.Methods One hundred children with dental fluorosis and 30 adults with skeletal fluorosis who lived in Wushan county and Fengjie county,the endemic fluorosis regions northeast of Chongqing were randomly selected as the case group in 2010.One hundred healthy children and 30 healthy adults were selected from the population where the cases were selected from as the control group and 30 healthy external adults control were selected from Yubei district,a non-endemic fluorosis area.Fasting venous blood was draw from all subjects and the content of zinc (Zn),copper(Cu),calcium (Ca),magnesium(Mg),and ferrum(Fe) in venous blood was measured by atomic spectrophotometric.Instant urine was collected from all subjects and urinary fluorine was measured by fluorine selective electrode.We also did questionnaire survey to 100 dental fluorosis children and 100 control children about their situation of fluorine pollution and knowledge related to endemic fluorosis.Results Children's blood Zn of the ease group[(70.88 ±9.28) μmol/L] was lower than that of the control group [(75.53 ± 10.78)μmol/L],and the difference was statistically significant(P ＜ 0.05).But the average blood Cu content[(30.28 ± 2.58)μ mol/L] and the average urinary fluorine of the case group [(0.74 ± 0.36)mg/L] were significantly higher than that [Cu (28.45 ± 4.05)μmol/L and urinary fluorine (0.48 ± 0.21)mg/L] of the control group in children,respectively,and the differences was statistically significant(P ＜ 0.05).The average blood Zn content of adults in the case group[(91.13 ± 10.29)μ mol/L] was lower than that of the control group[(99.57 ± 11.73)μmol/L],and the difference was statistically significant (P ＜ 0.05).The average content of Mg[(1.57 ± 0.19)mmol/L],Fe[(8.17 ± 1.01) mmol/L] and urinary fluorine[(2.37 ± 1.01)mg/L] in the case group were higher than that [Mg(1.46 ± 0.16) mmol/L,Fe(7.72 ± 0.96) mmol/L and urinary fluorine(0.92 ± 0.85)mg/L] of the control group,respectively,and the differences were statistically significant(P ＜0.05).In the questionnaire survey,we found that the following were important related factors (OR values were 2.7335,0.3339,2.8428,0.4633,0.5439,0.4009,0.4805 and 0.3994,P ＜ 0.05) between the case group and the control group:using local coal for heating,furnaces and stoves improvement,eating local coal fire baked food,knowing the harm of endemic fluorosis to the health of human body,knowing endemic fluorosis can be prevented,knowing consuming baked food can cause endemic fluorosis,knowing drinking milk can prevent endemic fluorosis and having the habit of eating calcium tablets.Conclusions In addition to the main pathogenic element of fluorine,body Zn content is closely related to the process of coal-burning-borne endemic fluorosis in the two counties,fluorosis patients have lower blood Zn levels,Zn deficiency is an auxiliary factor in the etiology of fluorosis.Reduce the use of local coal for heating,do not consume the baked food,improve stoves,learn more knowledge about endemic fluorosis and ingest anti-fluoride elements can reduce the risk of endemic fluorosis.