儿童氟斑牙与尿氟相关性及尿氟基准剂量分析

A benchmark dose analysis for children urinary fluoride and it's correlation with the prevalence of dental fluorosis

摘要:

目的 掌握天津市饮水型氟中毒病区病情情况，探讨尿氟的基准剂量，为尿氟值标准更新提供科学依据。方法 在天津市选择3个病区，每个区选择3个病区村，调查其水氟含量、8-12周岁儿童氟斑牙患病情况及尿氟含量。结果 水氟超标村儿童氟斑牙患病率和尿氟含量显著高于水氟合格村，差异具有统计学意义（c2=88.821,P＜0.001；Z=6.089,P＜0.001）。儿童年龄越低，氟斑牙患病率越低、患病程度越轻（c2趋势=14.584，P<0.001；c2趋势=20.525，P<0.001）。不同性别儿童之间患病率和患病程度均不存在显著差异（c2=0.736，P=0.391；c2=3.649，P=0.456）。不同年龄和性别儿童间尿氟值存在显著差异（H=14.768，P=0.011；Z=-2.526，P=0.012）。按尿氟分组后，随着尿氟浓度的升高，儿童氟斑牙患病率逐渐升高，差异有统计学意义（c2趋势=16.348，P<0.001），存在剂量-效应关系。采用BMDS基于儿童氟斑牙患病率计算得出尿氟的BMD和BMDL分别为2.20mg/L和1.54mg/L。 结论 天津市改水降氟取得一定成效；儿童尿氟与氟斑牙患病率存在剂量-效应关系，参考剂量值稍高于现行标准，提示我们可适时进行更新修订。

Abstract:

Objective To investigate the situation of drinking water fluorosis in Tianjin, to study the benchmark dose of urinary fluoride, and to provide a reference for the formulation of the standard for urinary fluoride. Methods Three fluorosis endemic areas were selected in Tianjin, and three villages in each area were selected in this study. The water fluoride was detected, and the prevalence of dental fluorosis and the urinary fluoride of children aged 8-12 years old were investigated. Results The prevalence of dental fluorosis and urinary fluoride content in children in the villages with water fluoride exceeding the standard were significantly higher than those in the villages with water fluoride qualified, and the difference was statistically significant (c2=88.821, P＜0.001; Z=6.089, P＜0.001). The analysis of the prevalence of dental fluorosis in children showed that the younger the age, the lower the prevalence and severity of dental fluorosis (c2trend = 14.584, P<0.001; c2trend= 20.525, P<0.001). There were no significant differences in the prevalence and severity of dental fluorosis among children of different genders (c2=0.736, P=0.391; c2=3.649, P=0.456). There were significant differences in urinary fluoride between children with different ages and genders (H=14.768, P=0.011; Z=-2.526, P=0.012). According to the level of urinary fluoride, the children were divided into 5 groups. With the increase of urinary fluoride concentration, the prevalence of dental fluorosis gradually increased and the difference was statistically significant (c2trend=16.348, P<0.001), showing a dose-effect relationship. Based on the prevalence of dental fluorosis in children, BMDS was used to calculate the BMD and BMDL, which were 2.20 mg/L and 1.54 mg/L, respectively. Conclusion The water reform and fluoride reduction in Tianjin has achieved certain results. There is a dose-effect relationship between urinary fluoride and prevalence of dental fluorosis in children, and the reference dose value is slightly higher than the current standard, suggesting that the current standard can be updated timely.