摘要目的 调查西安市饮水型氟中毒病区儿童氟斑牙病情和智力水平,为制订防治策略提供科学依据.方法 2016年,以西安市6个饮水型氟中毒历史病区村和1个非病区村作为调查点,并根据历史儿童氟斑牙检出率及流行强度,将6个病区村分为3组,其中轻病区为惠东村和行南村,中病区为柳林村和下朱村,重病区为河头村和晓阳村;邓家村为非病区村.采用横断面调查,在每个村采集3份末梢水水样检测水氟含量;对病区村所有8～ 12岁在校儿童,以及100名非病区村8～ 12岁在校儿童,进行氟斑牙检查和智力测试.结果 非病区村水氟含量均值为(0.25±0.01)mg/L,病区村水氟含量均值为(0.78±0.43) mg/L,其中2个病区村的水氟含量超过1.20 mg/L.8～12岁儿童氟斑牙检出率病区村(30.32％,67/221)明显高于非病区村(2.00％,2/100),二者比较差异有统计学意义(x2=31.32,P＜ 0.01).非病区村和轻、中、重病区村的儿童智商(IQ)均值分别为108.68±10.83、102.54±12.54、101.70±14.85、93.45±10.84,儿童智力水平随着氟斑牙病情的加重而下降,各病区村儿童IQ均显著低于非病区(P均＜0.05);病区村儿童IQ≤89所占比例显著高于非病区(x2=22.02,P＜ 0.01).病区村67例氟斑牙患儿IQ均值为94.96±13.75,154例非患儿IQ均值为10526±10.19,二者比较差异有统计学意义(t=5.61,P＜0.01);且随着氟斑牙病情加重IQ值逐渐降低,不同分度间比较差异有统计学意义(F=7.42,P＜0.05);IQ≤89所占比例,不同分度间比较差异有统计学意义(x2=45.70,P＜ 0.01).结论 低水氟暴露仍可对儿童氟斑牙的患病情况和智力发育产生不利影响,仍应继续加强改水与监测,保护儿童健康.

abstractsObjective To investigate the dental fluorosis and intelligence level of children in drinking water-type of endemic fluorosis areas in Xi'an,and to provide a scientific basis for development of prevention and control strategies.Methods In 2016,six drinking water-type of endemic fluorosis villages and one non-diseased village were selected as investigation sites in Xi'an.According to the detection rate and prevalence of dental fluorosis in children,six diseased villages were divided into three groups,the disease light-affected areas were Huidong and Xingnan,the moderate-affected areas were Liulin and Xiazhu,and the serious-affected areas were Hetou and Xiaoyang;and the Deng village was the non-diseased.A cross-sectional survey was conducted to collect 3 tap water samples in each village to test the fluorine content in water.For all children aged 8 to 12 years in diseased villages and 100 children aged 8 to 12 years in non-diseased villages,dental fluorosis examination and intelligence test were carried out.Results Mean value of water fluoride in non-diseased village and endemic fluorosis areas were (0.25 ± 0.01),(0.78 ± 0.43) mg/L,and the water fluoride content in two diseased villages was over 1.20 mg/L.The detection rate of dental fluorosis in children aged 8 to 12 (30.32％,67/221) in diseased areas was significantly higher than that in non-diseased area (2.00％,2/100;x2 =31.32,P ＜ 0.01).Children's IQ scores in the four groups were 108.68 ± 10.83,102.54 ± 12.54,101.70 ± 14.85,93.45 ± 10.84,and the IQ scores were decreased with the severity of dental fluorosis,the difference in IQ scores was significant between the endemic fluorosis areas and non-endemic fluorosis area (P ＜ 0.05);the percentage of children with IQ≤89 in endemic fluorosis areas was significantly higher than that in non-endemic fluorosis area (x2 =22.02,P ＜ 0.01).The IQ scores of children with dental fluorosis was 94.96 ± 13.75,and the IQ was 105.26 ± 10.19 in children with normal condition,the difference was significant (t =5.61,P ＜ 0.01),the mean value of IQ was decreased with the severity of dental fluorosis (F =7.42,P ＜ 0.05),the percentage of children with IQ≤89 in patient was higher than that in normal children,the difference was significant (x2 =45.70,P ＜ 0.01).Conclusion Low level of water fluoride still has negative influence on children's dental health and intelligence,water improving and surveillance should be strengthened to ensure the health of children.