CAJ | 학술논문

目的观察陕西省饮水型及燃煤型地方性氟中毒病区人群x线征象的特点,为下一步修订氟骨症X线诊断标准提供理论依据.方法收集2008-2011年中央补助地方公共卫生专项资金地方病防治项目中,陕西省拍摄的氟中毒病区人群的X线资料,对X线征象、年龄及性别分布与检出率进行统计分析,氟骨症诊断依据氟骨症诊断标准(WS 192-2008).结果共收集2 525人的X线片,拍摄部位为前臂和小腿.在X线征象中,以桡骨嵴增大边缘硬化表面增粗、前臂骨间膜骨化和前臂骨间膜钙化呈幼芽破土征检出率最高,分别占29.91％(242/809)、17.92％(145/809)和17.69％(143/809),这三项X线征象都发生在前臂,前臂X线征象总检出率为88.12％ (721/809).检出氟骨症病例682例,检出率为27.01％ (682/2 525),其中轻度病例检出401例,占15.88％(401/2 525);中度病例检出236例,占9.35％ (236/2 525);重度病例检出45例,占1.78％(45/2525).随着年龄的增长,检出率也逐渐增加,55岁以后进入高发期,不同年龄段间检出率比较差异有统计学意义(x2=228.58,P＜0.05);男性组和女性组总检出率比较,差异无统计学意义(x2=0.74,P＞0.05).结论氟骨症随着年龄的增长,检出率逐渐增加.X线征象前臂发生率高且有特异性,在诊断标准修订中,建议用前臂X线征象诊断氟骨症,以减少经费投入、工作量和X线对病人的辐射水平.
목적 관찰합서성음수형급연매형지방성불중독병구인군x선정상적특점,위하일보수정불골증X선진단표준제공이론의거.방법 수집2008-2011년중앙보조지방공공위생전항자금지방병방치항목중,합서성박섭적불중독병구인군적X선자료,대X선정상、년령급성별분포여검출솔진행통계분석,불골증진단의거불골증진단표준(WS 192-2008).결과 공수집2 525인적X선편,박섭부위위전비화소퇴.재X선정상중,이뇨골척증대변연경화표면증조、전비골간막골화화전비골간막개화정유아파토정검출솔최고,분별점29.91％(242/809)、17.92％(145/809)화17.69％(143/809),저삼항X선정상도발생재전비,전비X선정상총검출솔위88.12％ (721/809).검출불골증병례682례,검출솔위27.01％ (682/2 525),기중경도병례검출401례,점15.88％(401/2 525);중도병례검출236례,점9.35％ (236/2 525);중도병례검출45례,점1.78％(45/2525).수착년령적증장,검출솔야축점증가,55세이후진입고발기,불동년령단간검출솔비교차이유통계학의의(x2=228.58,P＜0.05);남성조화녀성조총검출솔비교,차이무통계학의의(x2=0.74,P＞0.05).결론 불골증수착년령적증장,검출솔축점증가.X선정상전비발생솔고차유특이성,재진단표준수정중,건의용전비X선정상진단불골증,이감소경비투입、공작량화X선대병인적복사수평.
Objective To investigate the characteristics of X-ray signs of water-related and coal-burning borne endemic fluorosis in Shaanxi Province,so as to provide a theoretical basis for revising X-ray diagnostic criteria of skeletal fluorosis in the future.Methods The X-ray data of 2 525 cases of patients with endemic fluorosis from the central subsidies to local public health programs were collected from 2008 to 2011,and the X-ray signs,age,gender distribution,detection rate were analyzed statistically ; skeletal fluorosis was diagnosed on the basis of skeletal diagnostic criteria(WS 192-2008).Results The 2 525 cases observed were taken X-ray film on forearm and shank.In the X-ray signs of patients from fluorosis areas,the detection rates were higher,and these signs were mainly radial crest of increase,marginal sclerosis,surface thickening and forearm interosseous membrane ossification and forearm interosseous membrane calcification which showed bud break ground sign,which accounted for 29.91％(242/809),17.92％(145/809) and 17.69％ (143/809),respectively.Three X-ray signs occurred in the forearm,and the total detection rate based on the forearm signs was 88.12％ (721/809); 682 cases of skeletal fluorosis were detected and the detection rate was 27.01％ (682/2 525),including 401 mild cases accounting for 15.88％ (401/2 525); 236 moderate cases that accounted for 9.35％ (236/2 525); 45 severe cases accounted for 1.78％(45/2 525).With age,the prevalence increased gradually.After the age of 55 reached the peak,and the difference was significant statistically between different ages (x2 =228.58,P ＜ 0.05).The total prevalence was not significantly different between male group and female group (x2 =0.74,P ＞ 0.05).Conclusions With age,the prevalence of skeletal fluorosis is increased,and the skeletal fluorosis is not different between different sexes.The X-ray sign results have showed that the prevalence based on forearm signs is high and specific.We suggest to diagnose skeletal fluorosis by the X-ray signs of the forearm in the diagnostic standard revision,so as to reduce financial input,workload and radiation level to the patient.