摘要目的 调查山东省鲁南地区地方性氟中毒流行现状,为氟中毒防治工作提供依据.方法 2009年,根据山东省地方性氟中毒病区分布现状,按照“山东省地方性氟中毒防治项目技术方案”的要求,在山东省的鲁南地区,选择临沂市的河东、兰山,枣庄市的台儿庄,济宁市的任城、金乡、鱼台、嘉祥、梁山,菏泽市的曹县、牡丹、单县、巨野、郓城,共13个县(区)为监测县(区).在各监测县(区),按氟中毒病情分为轻、中、重三层,每层抽取1个病区村作为调查点.调查内容为饮水含氟量、儿童氟斑牙与成人临床氟骨症患病情况及人群尿氟水平.水、尿氟检测采用氟离子选择电极法；8～ 12岁儿童氟斑牙诊断采用Dean法；成人氟骨症诊断采用《地方性氟骨症诊断标准》(WS 192-2008).结果 在13个县(区)的39个村,有改水后供水正常村26个,未改水或改水后水井报废村13个.检查水样172份,含氟量超过国家标准(＞ 1.0 mg/L)的有74份,其中51份来自13个未改水村,23份来自6个供水正常村,水氟超标率为43.02％.水氟＞2.0 ～ 4.0 mg/L的水样有24份,＞4.0mg/L的有3份,水氟最大值为7.76 mg/L.检测尿样1882份,其中儿童1118份,成人764份,尿氟几何均数分别为1.82、1.98 mg/L.对1908名8～12岁儿童进行氟斑牙检查,氟斑牙检出率为45.18％(862/1908),牙齿缺损率为9.12％(174/1908),氟斑牙指数为1.07.调查25 296名成人,临床氟骨症检出率为5.96％(1509/25296),其中检出中、重度病例670例.结论 山东省鲁南地区水氟超标仍较严重,以未改水病村(包括改水后报废病村)为主；尿氟水平仍维持在较高水平,氟斑牙与氟骨症仍存在一定程度流行,高氟危害依然在一定范围存在.应尽快落实科学有效的改水降氟措施,控制氟中毒的流行.

abstractsObjective To investigate the prevailing status of endemic fluorosis in the south area of Shandong province and to provide a scientific basis for formulating control measures against the disease.Methods According to the present distribution of fluorosis areas in the south area of Shandong province and "the Shandong Province Technical Scheme for Endemic Disease Control",13 counties(districts) in the south area of Shandong province were selected as the survey counties in 2009.Based on the state of endemic fluorosis,the disease was classified into light,moderate and severe types in the 13 monitoring counties (districts),and one diseased village was selected from each type as the survey spots.The drinking water fluoride level,the prevalence of dental fluorosis of children aged 8-12,adult clinical skeletal fluorosis and urinary fluoride level of the children and adults were surveyed in the 39 villages selected.The content of fluoride in drinking water and urine was dctermined by F-ion selective electrode while dental fluorosis of the children aged 8-12 was diagnosed by Dean method and adults skeletal fluorosis by the national standard for "Diagnosis of Endemic Skeletal Fluorosis" (WS 192-2008).Results A total of 172 water samples were tested in the 39 villages(26 villages with improved water and 13 villages with unimproved water) of the 13 counties(districts),the fluoride content of the 74 water samples(51 from 13 villages with unimproved water and 23 from 6 villages with improved water) exceeded the national standard(＞ 1.0 mg/L),and the rate of exceeded the standard was 43.02％(74/172) with 24 of ＞ 2.0-4.0 mg/L and 3 of ＞ 4.0 mg/L,and the maximum value of the water fluoride was 7.76 mg/L.A total of 1118 copies of children urine samples were tested,geometric mean of urinary fluoride was 1.82 mg/L; 764 copies of adults' urine samples were tested,geometric mean of urinary fluoride was 1.98 mg/L.A total of 1908 children aged 8-12 were examined of dental fluorosis,the detection rate was 45.18％ (862/1908),tooth defection rate was 9.12％ (174/1908),and dental fluorosis index was 1.07.A total of 25 295 adults were checked of clinical skeletal fluorosis,the detection rate was 5.96％(1509/25 296) with 670 moderate or scrious cases.Conclusions In the south area of Shandong province,excessive water fluoride is still serious,mainly in the diseased villages with unimproved water(including water improvement villages discarded water improvement thereafter).Urine fluoride remains at a relatively high level,and the dental and skeletal fluorosis are still comparatively serious.High tluoride hazard still exists to a certain degree.Therefore,the scientific control measures need to be strengthened to control the prevalent of endemic fluorosis.