摘要目的 了解山东省地方性氟中毒(地氟病)历史重病区改水降氟效果,并分析儿童氟斑牙患病特点及相关影响因素.方法 2015年,根据山东省历年地方病调查结果,采用横断面调查方法,对地氟病历史重病区县的11个村进行水氟检测,包括4个改水降氟水氟达标村(改水水氟合格村)、4个改水降氟水氟未达标村(改水水氟不合格村)和3个未改水村.对调查村7～12岁在校儿童进行氟斑牙检查,并采集即时尿样进行尿氟测定.采用logistic方法 分析影响氟斑牙检出率的相关因素.结果 共检查7～12岁在校儿童732人,氟斑牙总检出率为73.2％ (536/732).其中改水水氟合格村氟斑牙检出率为31.0％ (65/210),改水水氟不合格村为86.7％(176/203),未改水村为92.5％(295/319),三者比较差异有统计学意义(x2=270.498,P＜0.01).女童氟斑牙检出率(77.4％,264/341)高于男童(69.6％,272/391,x2=5.337,P＜0.05);高龄组(10～12岁)儿童氟斑牙检出率(76.9％,382/497)高于低龄组(7～9岁)儿童(65.5％,154/235,x2=10.445,P＜0.05).水氟合格村,女童氟斑牙检出率(40.0％,36/90)高于男童(24.2％,29/120,x2=6.033,P＜0.05);水氟不合格村(包括改水水氟不合格村和未改水村),男、女童氟斑牙检出率[89.7％(243/271)比90.8％(228/251)]比较差异无统计学意义(x2=0.202,P＞ 0.05).氟斑牙儿童尿氟含量高于非氟斑牙儿童[(4.5±2.7)比(1.9±1.5)mg/L,t=-8.125,P＜0.01].logistic分析表明,水氟不合格村儿童氟斑牙检出风险是水氟合格村的14.362倍,高尿氟组儿童氟斑牙检出风险是尿氟正常组的2.497倍.高龄组儿童中重度氟斑牙检出风险是低龄组的2.270倍;女童中重度氟斑牙检出风险是男童的1.988倍;水氟不合格村儿童中重度氟斑牙检出风险是水氟合格村的49.190倍.结论 改水降氟是控制地氟病重病区儿童氟斑牙流行的有效手段.年龄、性别和水氟是儿童氟斑牙患病的影响因素.

abstractsObjective To understand the defluoridation effect in the historical severe endemic fluorosis areas of Shandong Province,and to analyze characteristics of children's dental fluorosis and related factors.Methods In 2015,using cross-sectional survey,11 villages in historical severe endemic fluorosis counties were selected for water fluoride test according to previous investigation of endemic diseases in Shandong Province.In which,4 normal water fluoride villages,4 excessive water fluoride villages and 3 villages without water improvement were included.Dental fluorosis in children aged 7 to 12 was examined and urine fluoride was measured.Logistic regression was used to analyze the related factors affecting the detection rate of dental fluorosis.Results A total of 732 children aged 7 to 12 were examined,with total detection rate of dental fluorosis 73.2％ (536/732).The detection rate of dental fluorosis was 31.0％ (65/210),86.7％ (176/203) and 92.5％ (295/319) in the villages with normal,excessive and without water improvement villages,respectively.And the differences were statistically significant (x2 =270.498,P ＜ 0.01).The prevalence of dental fluorosis in girls (77.4％,264/341) was significantly higher than that in boys (69.6％,272/391,x2 =5.337,P ＜ 0.05),and the dental fluorosis prevalence in elderly group (10-12 years old,76.9％,382/497) was higher than that of younger group (7-9 years old,65.5％,154/235),the difference was statistically significant (x2 =10.445,P ＜ 0.05).In water fluoride normal villages,the detection rate of dental fluorosis in girls (40.0％,36/90) was higher than that in boys (24.2％,29/120,x2 =6.033,P ＜ 0.05).In water fluoride unqualified villages,the dental fluorosis prevalence rates in boys and girls were 89.7％ (243/271) and 90.8％ (228/251),and the difference was not statistically significant (x2 =0.202,P ＞ 0.05).The urinary fluoride content of children with dental fluorosis was higher than that of non-fluorosis children [(4.5 ± 2.7) vs (1.9 ± 1.5) mg/L,t =-8.125,P ＜ 0.01].Logistic analysis showed that the risk of children's dental fluorosis in unqualified water fluoride village was 14.362 times high than that of normal water fluoride villages.The risk of dental fluorosis in children with high urinary fluoride was 2.497 times higher than that in normal urinary fluoride group.The risk of detecting moderate and severe fluorosis in children in the elderly group was 2.270 times higher than that in the younger group.The risk of detecting moderate and severe dental fluorosis in girls was 1.988 times higher than that in boys.The risk of detecting moderate and severe dental fluorosis in children in unqualified water fluoride villages was 49.190 times higher than that in normal water fluoride villages.Conclusions Water-quality-improvement project is an effective means to control the epidemic of dental fluorosis in children in severe fluorosis areas.Age,gender and water fluoride are influencing factors associated with dental fluorosis.