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中华地方病学杂志
中国疾病预防控制中心地方病控制中心
中华地方病学杂志

中国疾病预防控制中心地方病控制中心

孙殿军

双月刊

2095-4255

cje2005@163.com

0451-86675924

150081

黑龙江省哈尔滨市南岗区保健路157号

中华地方病学杂志/Journal Chinese Journal of EndemiologyCSCD北大核心CSTPCD
查看更多>>中华医学会、哈尔滨医科大学主办。本刊主要报道克山病、大骨节病、碘缺乏病、地方性氟、砷中毒、鼠疫、布鲁杆菌病、寄生虫等疾病的研究成果。主要栏目：述评、综述、专家论坛、论著、现场调查、临床医学、检测方法、卫生管理、学术争鸣、防治经验等。《中国地方病学杂志》被美国《化学文摘》、荷兰《医学文摘》、美国《剑桥科学文摘》和波兰《哥伯尼索引》收录；是中国自然科学、中国生物医学核心期刊，预防医学、卫生学类核心期刊。2008年获中华医学会优秀期刊二等奖，2010年获中华医学会优秀期刊奖。
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    我国地方性氟中毒和砷中毒研究不可忽视的两个方向：低剂量氟、砷远期暴露与非靶器官损伤

    孙殿军李颖
    1-5页
    查看更多>>摘要：随着我国地方性氟中毒（地氟病）、地方性砷中毒（地砷病）防治措施全面落实，按照世界卫生组织（WHO）饮用水推荐标准和我国日人均氟允许摄入量与饮用水砷含量限值标准，我国居民进入了低氟、低砷剂量暴露的时代。但是，迄今国内外对低氟、低砷剂量暴露的远期健康效应的研究不多，更忽视了对非靶器官的研究，结论也不尽一致，亟须开展系统的研究，予以阐明。据此，本文提出了建立低氟、低砷暴露人群队列，系统开展低氟、低砷暴露健康远期效应及其机制研究和向"一带一路"国家推广中国防治经验的建议，旨在为我国新形势下地氟病、地砷病防治策略与措施的制定提供科学依据。 With the comprehensive implementation of prevention and control measures for endemic fluorosis and endemic arsenicosis in China, and in accordance with the World Health Organization (WHO) recommended drinking water standards and the Chinese standards of allowable daily fluoride intake and limit values of arsenic content in drinking water, Chinese residents have entered the era of low-dose fluoride and arsenic exposure. However, there have been few studies focused on the long-term health effects of exposure to low-dose fluoride and arsenic both domestically and internationally. Further more, study on non-target organs of fluoride and arsenic has been neglected. The conclusions are also inconsistent, and there is an urgent need for systematic study to clarify them. Accordingly, this paper proposes to establish a cohort of people exposed to low-dose fluoride and arsenic, systematically carry out study on the long-term health effects and mechanisms of low-dose fluoride and arsenic exposure, and promote China's prevention and control experience to the "the Belt and Road" countries, in order to provide a scientific basis for the formulation of prevention and control strategies and measures for endemic fluorosis and endemic arsenicosis under the new situation in China.

    低氟暴露低砷暴露远期健康效应非靶器官损伤

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    儿童和青少年血浆氟含量、每日钙摄入量与血细胞参数的关联

    夏红霞牛泽源王雅楠王新迎...
    6-12页
    查看更多>>摘要：目的 探讨儿童和青少年血浆氟含量、每日钙摄入量和血细胞参数的关联。 方法 本研究基于2013 - 2016年美国国家健康和营养检查调查（The Ethics Review Board of National Center for Health Statistics，NHANES）数据库，以3 684名6 ~ 19岁儿童和青少年为研究对象，收集数据库中血浆氟含量、每日钙摄入量和血细胞参数信息。使用限制性立方样条分析血浆氟含量、每日钙摄入量与血细胞参数的非线性关系，若存在非线性关系，使用阈值/饱和效应分析法计算最佳拐点；随后利用多重线性回归模型分析三者之间的关联，并分析每日钙摄入量（二分类变量，依据每日钙摄入量的中位数分层）对血浆氟含量与血细胞参数关联的修饰作用。 结果 血浆氟含量与白细胞计数、血红蛋白含量和血小板计数均无非线性关系（均P非线性 > 0.05），而与红细胞计数、红细胞比容均存在非线性关系（均 P非线性 < 0.001），调整混杂因素后，血浆氟含量对红细胞计数和红细胞比容效应的最佳拐点分别为0.54和0.31 μmol/L；每日钙摄入量与各血细胞参数均无非线性关系（均 P非线性 > 0.05）。调整混杂因素后，血浆氟含量每升高1 μmol/L，白细胞计数升高0.49 × 10 9个/L（P = 0.009）；血浆氟含量与红细胞计数和红细胞比容的关联存在饱和效应：血浆氟含量< 0.54 μmol/L时，其含量每升高1 μmol/L，红细胞计数降低0.46 × 1012个/L（P < 0.001）；血浆氟含量< 0.31 μmol/L时，其含量每升高1 μmol/L，红细胞比容降低6.29%（ P = 0.006）；上述关联在血浆氟含量高于最佳拐点后，均无统计学意义（均P > 0.05）。依据每日钙摄入量的中位数分层后，在低钙组（每日钙摄入量< 0.87 g），血浆氟含量每升高1 μmol/L，白细胞计数升高0.77 × 10 9个/L（P = 0.001）；血浆氟含量< 0.54 μmol/L时，其含量每升高1 μmol/L，红细胞计数降低0.41 × 1012个/L（P = 0.002）；血浆氟含量≥0.54 μmol/L时，其含量每升高1 μmol/L，红细胞计数降低0.47 × 1012个/L（P < 0.001）；血浆氟含量< 0.31 μmol/L时，其含量每升高1 μmol/L，红细胞比容降低8.29%（ P = 0.011）；而上述关联在高钙组（每日钙摄入量≥0.87 g）均无统计学意义（均P > 0.05）。每日钙摄入量与血浆氟含量对血小板计数存在交互作用（ P交互 = 0.070），血浆氟含量每升高1 μmol/L，低钙组血小板计数升高12.68 × 109个/L（P = 0.013），高钙组血小板计数降低9.05 × 109个/L（P = 0.035）。 结论 儿童和青少年血细胞参数与血浆氟含量密切相关，而与每日钙摄入量无直接关联；但不同钙摄入人群中血浆氟含量与血细胞参数关联不同，且每日钙摄入量可修饰血浆氟含量与血小板计数的关联。 Objective To investigate the relationship between plasma fluoride content, daily calcium intake and blood cell parameters in children and adolescents. Methods This study was based on the National Health and Nutrition Examination Survey (NHANES) database of the United States from 2013 to 2016, with 3 684 children and adolescents aged 6 - 19 as the research subjects. Information on plasma fluoride content, daily calcium intake and blood cell parameters from the database were collected. Non-linear relationships between plasma fluoride content, daily calcium intake and blood cell parameters were analyzed using restricted cubic splines. If there was a non-linear relationship, the optimal inflection point was calculated using threshold/saturation effect analysis method. Subsequently, multiple linear regression models were used to analyze the associations among the three, and the modification effect of daily calcium intake (binary classification, stratified by median daily calcium intake) on the association between plasma fluoride content and blood cell parameters was analyzed. Results There was no non-linear relationship between plasma fluoride content and white blood cell count, hemoglobin content and platelet count (Pnon-linear > 0.05), but there was a non-linear relationship between plasma fluoride content and erythrocyte count and hematocrit ( Pnon-linear < 0.001). After adjusting for confounding factors, the optimal inflection points of the effects of plasma fluoride content on erythrocyte count and hematocrit were 0.54 and 0.31 μmol/L, respectively. There was no non-linear relationship between daily calcium intake and blood cell parameters ( Pnon-linear > 0.05). After adjusting for confounding factors, for every 1 μmol/L increase in plasma fluoride content, the white blood cell count increased by 0.49 × 10 9/L (P = 0.009). There was a saturation effect in the association between plasma fluoride content, erythrocyte count and hematocrit: when plasma fluoride content was < 0.54 μmol/L, the erythrocyte count decreased by 0.46 × 10 12/L for every 1 μmol/L increase ( P < 0.001). When plasma fluoride content was < 0.31 μmol/L, the hematocrit decreased by 6.29% for every 1 μmol/L increase ( P = 0.006). The above associations were not statistically significant when plasma fluoride content was higher than the optimal inflection points (P > 0.05). After stratification according to the median daily calcium intake, in the low-calcium group (daily calcium intake < 0.87 g), for every 1 μmol/L increase in plasma fluoride content, the white blood cell count increased by 0.77 × 10 9/L (P = 0.001). When plasma fluoride content was < 0.54 μmol/L, the erythrocyte count decreased by 0.41 × 10 12/L for every 1 μmol/L increase ( P = 0.002). When plasma fluoride content was ≥0.54 μmol/L, erythrocyte count decreased by 0.47 × 10 12/L for every 1 μmol/L increase ( P < 0.001). When the plasma fluoride content was < 0.31 μmol/L, the hematocrit decreased by 8.29% for every 1 μmol/L increase ( P = 0.011). The above associations were not statistically significant in the high-calcium group (daily calcium intake ≥0.87 g, P > 0.05). There was an interaction of daily calcium intake and plasma fluoride content on platelet count ( Pinteraction = 0.070), as demonstrated by an increase in platelet count of 12.68 × 109/L (P = 0.013) in the low-calcium group and a decrease in platelet count of 9.05 × 109/L (P = 0.035) in the high-calcium group for every 1 μmol/L increase in plasma fluoride content. Conclusions The blood cell parameters of children and adolescents are closely related to plasma fluoride content, but not directly related to daily calcium intake. However, the correlation between plasma fluoride content and blood cell parameters varies among different calcium intake populations, and daily calcium intake can modify the association between plasma fluoride content and platelet count.

    氟血浆每日钙摄入量血细胞参数美国国家健康和营养检查调查

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    褪黑素对氟暴露子代大鼠学习记忆能力的影响

    杨晓倩毛杰赵倩阎小艳...
    13-20页
    查看更多>>摘要：目的 探讨褪黑素（melatonin，MEL）对氟暴露子代大鼠学习记忆能力的影响及肠道菌群在其中的作用。 方法 选取12只8周龄SD大鼠（雌鼠8只、雄鼠4只），体质量为180 ~ 220 g，采用随机数字表法分为对照组1和染氟组1，每组6只（雌∶雄= 2 ∶ 1），分别自由饮用纯净水和含100 mg/L氟化钠的纯净水。2个月后雌雄大鼠合笼饲养，将子代大鼠出生后（postnatal day，PND）第1天记为PND0。于PND21，采用成组设计将染氟组1子代大鼠分为染氟组（F组，n = 6）和染氟+ MEL组（FM组，n = 6），并继续饮水氟暴露；对照组1子代大鼠分为对照组（C组，n = 6）和MEL组（n = 6）。FM和MEL组给予20 mg/kg MEL灌胃，C和F组给予相同剂量生理盐水灌胃。于PND60，采用新事物识别实验和水迷宫实验观察子代大鼠学习记忆能力，蛋白质印迹法（Western blot，WB）检测子代大鼠海马组织脑源性神经营养因子（brain derived neurotrophic factor，BDNF）蛋白表达水平；并采用16S rDNA测序技术检测粪便样本中肠道菌群结构和组成变化情况。 结果 新事物识别实验结果显示，4组子代大鼠鉴别指数（discrimination index，DI）比较，差异有统计学意义（F = 3.95，P = 0.024），C、FM组DI均高于F组（均P < 0.05）。水迷宫实验结果显示，与C组比较，F组子代大鼠穿越平台次数较少，首次到达平台时间较长（均 P < 0.05）；与F组比较，FM组子代大鼠穿越平台次数较多，首次到达平台时间较短（均 P < 0.05）。WB结果显示，与C组（1.00 ± 0.07）比较，F组BDNF蛋白表达水平（0.68 ± 0.26）较低（ P < 0.05）；与F组比较，FM组BDNF蛋白表达水平（0.99 ± 0.14）较高（ P < 0.05）。Anosim相似性分析显示，4组子代大鼠肠道菌群结构和组成存在显著差异（ R = 0.395 062，P = 0.002）。肠道菌群物种分布特征结果显示，门水平上，与C组比较，F组拟杆菌门相对丰度从14.26%升至37.00%，厚壁菌门相对丰度从68.78%降至45.95%；与F组比较，FM组厚壁菌门相对丰度从45.95%升至65.26%，拟杆菌门相对丰度从37.00%降至23.00%。属水平上，与C组比较，F组乳杆菌属、杜氏菌属、HT002、UCG-005的相对丰度均较低，未分类的Muribaculaceae属相对丰度较高；与F组比较，FM组乳杆菌属、杜氏菌属、HT002、UCG-005的相对丰度均较高，未分类的Muribaculaceae属相对丰度较低。线性判别分析结果显示，候选单胞生糖菌属、毛螺菌属显著富集于C组，未分类的Muribaculaceae属、Muribaculum属显著富集于F组，异根瘤菌-新根瘤菌-副根瘤菌-根瘤菌属显著富集于FM组。 结论 MEL可以改善氟暴露所致的子代大鼠学习记忆能力损伤，可能与改变肠道菌群结构和组成有关。 Objective To investigate the effect of melatonin (MEL) on learning and memory abilities of fluoride-exposed offspring rats and the role of gut microbiota. Methods Twelve 8-week-old Sprague-Dawley (SD) rats (8 females and 4 males) with a body weight ranging from 180 to 220 g were selected and divided into control group 1 and fluoride-exposed group 1 using a random number table method, with 6 rats in each group (female ∶ male = 2 ∶ 1). They were free to drink purified water or purified water containing 100 mg/L sodium fluoride, respectively. After 2 months, male and female rats were raised together in cages, and the first postnatal day (PND) of the offspring rats was recorded as PND0. In PND21, the offspring rats of fluoride-exposed group 1 were divided into fluoride-exposed group (Group F, n = 6) and fluoride + MEL group (Group FM, n = 6) using a group design, and continued to be exposed to fluoride through drinking water. The offspring rats of control group 1 were divided into control group (Group C, n = 6) and MEL group (n = 6). The groups FM and MEL were given 20 mg/kg MEL by gavage, while the groups C and F were given the same dose of normal saline by gavage. In PND60, novel object recognition and Morris water maze tests were used to observe the learning and memory abilities of the offspring rats. Western blotting (WB) was used to detect the expression level of brain derived neurotrophic factor (BDNF) in the hippocampus of the offspring rats. And 16S rDNA sequencing technology was used to detect the changes in the structure and composition of gut microbiota in fecal samples. Results The results of novel object recognition test showed that there was a statistically significant difference in the discrimination index (DI) among the four groups of offspring rats (F = 3.95, P = 0.024). The DI in groups C and FM was higher than that of Group F (P < 0.05). The results of Morris water maze test showed that compared with Group C, the platform-crossing time of the offspring rats of Group F were less and they had a longer time to reach the platform for the first time ( P < 0.05). Compared with Group F, the platform-crossing time of the offspring rats of Group FM were increased and they had a shorter time to reach the platform for the first time ( P < 0.05). The WB results showed that compared with Group C (1.00 ± 0.07), the expression level of BDNF protein in Group F (0.68 ± 0.26) was lower ( P < 0.05). Compared with Group F, the expression level of BDNF protein in Group FM (0.99 ± 0.14) was higher ( P < 0.05). Anosim similarity analysis showed significant differences in the structure and composition of gut microbiota in the four groups of offspring rats ( R = 0.395 062, P = 0.002). The distribution characteristics of gut microbiota species showed that at the phylum level, compared with Group C, the relative abundance of Bacteroidetes in Group F increased from 14.26% to 37.00%, and the relative abundance of Firmicutes decreased from 68.78% to 45.95%. Compared with Group F, the relative abundance of Firmicutes in Group FM increased from 45.95% to 65.26%, and the relative abundance of Bacteroidetes decreased from 37.00% to 23.00%. At the genus level, compared with Group C, the relative abundance of Lactobacillus, Dubosiella, HT002 and UCG-005 in Group F was lower, while the relative abundance of unclassified Muribaculaceae was higher. Compared with Group F, the relative abundance of Lactobacillus, Dubosiella, HT002 and UCG-005 in Group FM was higher, while the relative abundance of unclassified Muribaculaceae was lower. The results of linear discriminant analysis revealed that the Candidatus-Saccharimonas and Incertae-Sedis were significantly enriched in Group C, unclassified Muribaculaceae and Muribaculum were significantly enriched in Group F, and Allorhizobium-Neorhizobium-Pararhizobium-Rhizobium were significantly enriched in Group FM. Conclusion MEL can improve the learning and memory impairment of offspring rats induced by fluoride exposure by changing the structure and composition of gut microbiota.

    氟褪黑素学习记忆损伤肠道菌群

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    氟诱导大鼠脊髓神经细胞凋亡及氧化应激的研究

    毛腾飞杨晓慧杨旭冯立杰...
    21-28页
    查看更多>>摘要：目的 探讨氟对大鼠脊髓神经细胞凋亡及氧化应激水平的影响。 方法 取54只6周龄Sprague-Dawley雌性大鼠，体重为150 ~ 200 g，适应性喂养1周后，采用随机数字表法分为对照组[给予含0 mg/L氟化钠（NaF）去离子水]、低氟组（给予含50 mg/L NaF去离子水）、高氟组（给予含100 mg/L NaF去离子水），每组18只，各组均食用标准饲料。染氟4、8、12周，每组选择6只大鼠观察氟斑牙发生情况，并采用Basso-Beattie-Bresnahan（BBB）评分对大鼠后肢运动功能进行评估；随后腹腔注射5%水合氯醛进行麻醉，经心脏穿刺处死大鼠，采集脊髓组织，检测氧化应激因子超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）活性及丙二醛（MDA）、过氧化氢酶（CAT）含量。染氟12周，利用尼氏（Nissl）染色观察大鼠脊髓神经元形态学变化，原位缺口末端标记法（TUNEL）细胞凋亡检测试剂盒检测脊髓神经细胞凋亡情况，蛋白质印迹法检测大鼠脊髓组织B淋巴细胞瘤-2（Bcl-2）基因相关X蛋白（Bax）、Bcl-2基因相关启动子（Bad）、Bcl-2蛋白表达情况，免疫荧光染色观察脊髓神经元中Bax、Bcl-2蛋白表达情况。 结果 染氟12周，低、高氟组大鼠均发生不同程度氟斑牙；对照、低氟、高氟组大鼠BBB评分比较，差异有统计学意义（F = 14.09，P < 0.001）。染氟12周，对照、低氟、高氟组SOD[（124.04 ± 4.87）、（96.66 ± 15.01）、（91.12 ± 15.87）U/mg prot]、GSH-Px活性[（561.92 ± 59.65）、（456.83 ± 29.51）、（385.07 ± 74.87）U/mg prot]及MDA[（9.96 ± 1.50）、（16.64 ± 2.05）、（20.80 ± 3.37）nmol/mg prot]、CAT含量[（8.97 ± 1.05）、（6.39 ± 0.97）、（6.42 ± 0.83）nmol/mg prot]比较，差异均有统计学意义（ F = 11.17、14.19、30.12、14.52，均P < 0.05）；其中，低、高氟组SOD、GSH-Px活性及CAT含量均低于对照组，MDA含量均高于对照组（均 P < 0.05）；且高氟组GSH-Px活性低于低氟组，MDA含量高于低氟组（均 P < 0.05）。对照组大鼠脊髓神经元结构完整、细胞核清晰可见，Nissl小体染色均匀、数量较多，未见凋亡细胞；低、高氟组大鼠脊髓神经元Nissl小体染色不均匀、数量较少，凋亡细胞较多。对照、低氟、高氟组大鼠脊髓神经细胞凋亡率，脊髓组织Bax、Bad、Bcl-2蛋白表达水平比较，差异均有统计学意义（ F = 272.81、35.53、17.57、92.50，均P < 0.05）。免疫荧光染色显示，对照、低氟、高氟组大鼠脊髓神经元中Bax、Bcl-2蛋白荧光强度比较，差异均有统计学意义（ F = 12.67、22.14，均P < 0.05）。 结论 慢性氟中毒可诱导大鼠脊髓神经抗氧化酶活性降低、脂质过氧化水平升高，神经细胞凋亡增加。 Objective To study the effects of fluoride on apoptosis and oxidative stress levels of spinal cord nerve cells in rats. Methods A total of 54 6-week-old Sprague-Dawley female rats, weighing 150 - 200 g, were selected and fed for 1 week. They were divided into a control group [given deionized water containing 0 mg/L sodium fluoride (NaF)], a low fluoride group (given deionized water containing 50 mg/L NaF), and a high fluoride group (given deionized water containing 100 mg/L NaF) using a random number table method, with 18 rats in each group. All groups received standard feed. After 4, 8, and 12 weeks of fluoride exposure, six rats were selected from each group to observe the occurrence of dental fluorosis, and the motor function of hind limbs in rats was evaluated based on the Basso-Beattie-Bresnahan (BBB) score. Then the rats were anesthetized with 5% chloral hydrate via intraperitoneal injection and euthanized by cardiac puncture. Spinal cord tissue of the rats was collected to detect the activities of oxidative stress factors such as superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), as well as the contents of malondialdehyde (MDA) and catalase (CAT). After 12 weeks of fluoride exposure, morphologic changes in rat spinal cord neurons were observed using Nissl staining, and apoptosis of spinal cord nerve cells was detected using the TdT mediated dUTP nick end labeling (TUNEL) cell apoptosis detection kit. The Western blotting was used to detect the expression of B-lymphoblastoma-2 (Bcl-2) gene related X protein (Bax), Bcl-2 promoter (Bad), and Bcl-2 protein in rat spinal cord tissue immunofluorescence staining was used to observe the expression of Bax and Bcl-2 protein in spinal cord neurons. Results After 12 weeks of fluoride exposure, rats in both the low fluoride and high fluoride groups developed varying degrees of dental fluorosis the differences of BBB scores of rats in the control, low fluoride, and high fluoride groups were statistically significant (F = 14.09, P < 0.001). The differences of SOD [(124.04 ± 4.87), (96.66 ± 15.01), (91.12 ± 15.87) U/mg prot] and GSH-Px activitives [(561.92 ± 59.65), (456.83 ± 29.51), (385.07 ± 74.87) U/mg prot], MDA [(9.96 ± 1.50), (16.64 ± 2.05), (20.80 ± 3.37) nmol/mg prot] and CAT contents [(8.97 ± 1.05), (6.39 ± 0.97), (6.42 ± 0.83) nmol/mg prot] among the control, low fluoride, and high fluoride groups were statistically significant ( F = 11.17, 14.19, 30.12, 14.52, P < 0.05). Among them, the SOD, GSH-Px activities, and CAT content in the low fluoride and high fluoride groups were lower than those in the control group, while the MDA content was higher than that in the control group ( P < 0.05). The GSH-Px activity in the high fluoride group was lower than that in the low fluoride group, and MDA content was higher than that in the low fluoride group ( P < 0.05). The intact neuronal structures and clear visible nuclei were seen, and Nissl bodies were uniformly stained in the spinal cord neurons of the control group rats, with more numbers, and no apoptotic cells were observed the staining of Nissl bodies in the spinal cord neurons of rats was uneven in the low fluoride and high fluoride groups, with fewer numbers, and more apoptotic cells. There were statistically significant differences in the apoptosis rate of spinal cord nerve cells and the expression levels of Bax, Bad, and Bcl-2 protein in the spinal cord tissues of rats in the control, low fluoride, and high fluoride groups ( F = 272.81, 35.53, 17.57, 92.50, P < 0.05). The results of immunofluorescence staining showed that there were statistically significant differences in the fluorescent intensity of Bax and Bcl-2 proteins in the spinal cord neurons of rats in the control, low fluoride, and high fluoride groups ( F = 12.67, 22.14, P < 0.05). Conclusion Chronic fluorosis induces a decrease in antioxidant enzyme activity, an increase in lipid peroxidation levels, and an increase in neuronal apoptosis in the spinal cord of rats.

    氟氧化应激细胞凋亡脊髓

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    我国农村氟中毒地区成人氟暴露、基础代谢率、身体脂肪率与握力的关系研究

    张宣寅郭萌陈瑞琴冯子臣...
    29-34页
    查看更多>>摘要：目的 探讨我国农村氟中毒地区成人氟暴露与握力的关系以及基础代谢率（BMR）和身体脂肪率（BFP）在氟暴露与握力关联中的作用。 方法 2017年4 - 5月，采用整群抽样方法，以河南省开封市饮水型地方性氟中毒流行地区通许县的18 ~ 60岁居民作为调查对象，进行问卷调查、体格检查和生物样本采集。共纳入调查对象1 168人，其中男性427人、女性741人。采用氟离子选择电极法、苦味酸法分别测定尿氟和尿肌酐浓度，并计算尿肌酐调整后尿氟浓度（CUF）；生物电阻抗法测定BMR和BFP；Jamar测力计测量握力。采用广义线性模型分析CUF、BMR、BFP和握力之间的关系，使用中介效应模型分析BMR、BFP在CUF与握力关联中的中介效应。 结果 CUF每升高1.00 mg/L，女性握力降低0.28 kg（P = 0.043），在男性中二者关联无统计学意义（P = 0.744）。无论性别分层与否，BMR与握力均呈正向关联（均P < 0.001）。BFP每升高1.00%，女性握力降低0.18 kg（ P = 0.043）。中介效应模型分析结果显示，BMR、BFP在CUF与女性握力关联中的中介效应比分别为65.1%（P < 0.001）和8.4%（ P = 0.111）。 结论 氟暴露与女性握力改变有关，且BMR改变在氟暴露与女性握力的关联中发挥部分中介作用。 Objective To study the relationship between adult fluoride exposure and grip strength in rural areas of China with fluorosis, as well as the roles of basal metabolic rate (BMR) and body fat percentage (BFP) in the association between fluoride exposure and grip strength. Methods From April to May 2017, a cluster sampling method was used to conduct a questionnaire survey, physical examination, and biological sample collection on residents aged 18 - 60 in Tongxu County, Kaifeng City, Henan Province (epidemic areas of drinking-water-borne fluorosis). A total of 1 168 subjects were included in the study, including 427 males and 741 females. The fluoride ion selective electrode method and the picric acid method were used to determine the concentrations of urine fluoride and urine creatinine, and the adjusted urine fluoride concentration (CUF) was calculated. BMR and BFP were measured by a bioelectrical impendence method, and the grip strength was measured by a Jamar grip dynamometer. The relationship between CUF, BMR, BFP and grip strength were analyzed using a generalized linear model regression. The mediation effect model was used to assess the mediating effect of BMR and BFP on the association between CUF and grip strength. Results Female grip strength decreased by 0.28 kg (P = 0.043) for every 1.00 mg/L increment in CUF. No similar association was found between the two in males (P = 0.744). Regardless of gender stratification, BMR was positively correlated with grip strength (P < 0.001). For every 1.00% increase in BFP, female grip strength decreased by 0.18 kg ( P = 0.043). The mediation effect model analysis results showed that the mediation effect ratios of BMR and BFP in the association between CUF and grip strength in female were 65.1% (P < 0.001) and 8.4% ( P = 0.111), respectively. Conclusion Fluoride exposure is associated with changes in female grip strength, and BMR changes play a partial mediating role in the association between fluoride exposure and female grip strength.

    氟成人握力基础代谢率身体脂肪率

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    内蒙古自治区饮水型地方性氟中毒理化改水病区分布及家庭净水器使用情况调查

    刘一君崔娜常子丽王璇...
    35-38页
    查看更多>>摘要：目的 了解内蒙古自治区饮水型地方性氟中毒理化改水病区分布及家庭净水器使用情况。 方法 2021年4 - 10月，在内蒙古自治区进行理化改水的饮水型地方性氟中毒病区开展调查，调查内容包括病区村的基本情况（常住户数、常住人口数、历史水氟含量）及居民户净水器使用情况；并采集调查家庭末梢水水样，检测水氟含量。计算净水器安装率、正常使用率、正常使用水氟合格率及更换滤芯部门覆盖户数占比。 结果 内蒙古自治区饮水型地方性氟中毒理化改水病区分布在全区11个盟市的2 735个病区村，常住户数192 950户，常住人口数540 216人；各盟市历史水氟含量均值为2.18 mg/L，现水氟含量均值为0.40 mg/L。共安装净水器134 763户，安装率为69.84%（134 763/192 950）。共调查居民10 773户，正常使用10 396户，正常使用率为96.50%（10 396/10 773）；其中，正常使用水氟合格10 158户，水氟合格率为97.71%（10 158/10 396）。10 396户正常使用净水器居民中，3 974户（38.23%）滤芯使用时间在1年之内，水氟合格3 961户，水氟合格率为99.67%（3 961/3 974）；6 422户（61.77%）滤芯使用时间大于1年，水氟合格6 197户，水氟合格率为96.50%（6 197/ 6 422）；不同滤芯使用时间净水器水氟合格率比较，差异有统计学意义（χ2 = 110.73，P < 0.001）。10 773户调查居民中，更换滤芯部门覆盖10 470户，占97.19%（10 470/10 773）。 结论 内蒙古自治区饮水型地方性氟中毒理化改水病区分布广，家庭净水器正常使用率较高，滤芯使用时间大于1年的家庭净水器水氟合格率较低。 Objective To investigate the distribution of physical and chemical water improvement areas of drinking water-borne endemic fluorosis in Inner Mongolia Autonomous Region, as well as the use of household water purifiers. Methods From April to October 2021, a survey was conducted in a drinking water-borne endemic fluorosis areas in Inner Mongolia Autonomous Region where physical and chemical water improvement was carried out. The survey included the basic situation of the affected villages (number of permanent households, number of permanent residents, historical water fluoride content) and the use of residential water purifiers. Household peripheral water samples were collected to test the water fluoride content. Water purifier installation rate, normal usage rate, qualified water fluoride rate in normal usage, and the proportion of households covered by filter replacement departments were calculated. Results In Inner Mongolia Autonomous Region, the physical and chemical water improvement areas of drinking water-borne endemic fluorosis were distributed in 2 735 villages in 11 leagues (cities) throughout the region, with 192 950 permanent households and 540 216 permanent residents. The average historical water fluoride content in all leagues (cities) was 2.18 mg/L, and the current average water fluoride content was 0.40 mg/L. A total of 134 763 water purifiers were installed, with an installation rate of 69.84% (134 763/192 950). A total of 10 773 households were surveyed, with 10 396 households using water purifiers normally and a normal usage rate of 96.50% (10 396/10 773). Among them, 10 158 households had qualified water fluoride of normal usage, with a qualified water fluoride rate of 97.71% (10 158/10 396). Of the 10 396 households using water purifiers normally, 3 974 households (38.23%) had filter cartridges used within one year, and 3 961 households had qualified water fluoride, with a qualified rate of water fluoride of 99.67% (3 961/3 974). Six thousand four hundred and twenty-two households (61.77%) had filter cartridges used for more than one year, with 6 197 households had qualified water fluoride and a qualified rate of water fluoride of 96.50% (6 197/6 422). There was a statistically significant difference in the qualified rate of water fluoride between purifiers with different filter cartridge usage times (χ2 = 110.73, P < 0.001). Among the 10 773 surveyed households, the filter cartridges replacement department covered 10 470 households, accounting for 97.19% (10 470/10 773). Conclusions In Inner Mongolia Autonomous Region, the physical and chemical water improvement areas of drinking water-borne endemic fluorosis are widely distributed, and the normal usage rate of household water purifiers is relatively high. The qualified rate of water fluoride in household water purifiers with filter cartridges used for more than one year is low.

    氟理化改水家庭净水器

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    2022年新疆生产建设兵团饮水型地方性氟中毒监测结果分析

    葛永梅马晓玲李凡卡麻新影...
    39-42页
    查看更多>>摘要：目的 了解新疆生产建设兵团（以下简称兵团）饮水型地方性氟中毒（以下简称饮水型氟中毒）控制情况，找出防治薄弱环节，为兵团饮水型氟中毒精准防控工作提供参考。 方法 自兵团疾病预防控制中心收集2022年1 - 12月兵团饮水型氟中毒病区监测数据，回顾性分析饮用水氟含量超标情况及8 ~ 12岁儿童氟斑牙患病情况。 结果 2022年兵团病区团场的水氟合格率为100.00%（62/62），病区连队的水氟合格率为99.44%（705/709）。病区团场8 ~ 12岁儿童氟斑牙患病率为3.38%（1 412/41 714），各年龄组间氟斑牙患病率比较，差异无统计学意义（χ2 = 6.07，P = 0.194）。水氟超标连队所在团场8 ~ 12岁儿童氟斑牙患病率（6.00%，106/1 768）高于水氟合格连队所在团场氟斑牙患病率（3.27%，1 306/39 946），差异有统计学意义（χ2 = 38.47，P < 0.001）。 结论 2022年兵团饮水型氟中毒达到控制标准，但仍然要重视个别水氟超标连队的改水情况及对改水工程的维护，防止对病区儿童造成持续性氟斑牙损害，巩固防控成果。 Objective To investigate the control situation of drinking water-type endemic fluorosis (hereinafter referred to as drinking water fluorosis) in Xinjiang Production and Construction Corps (hereinafter referred to as the Corps), identify weak links in prevention and control, and provide reference for precise prevention and control of drinking water fluorosis in the Corps. Methods Monitoring data of drinking water fluorosis areas in the Corps from January to December 2022 were collected from the Corps Center for Disease Control and Prevention, the level of fluoride in drinking water and the prevalence of dental fluorosis in children aged 8 - 12 were analyzed retrospectively. Results In 2022, the qualified rate of water fluoride in the disease affected TuanChang of the Corps was 100.00% (62/62), and the qualified rate of water fluoride in the disease affected company was 99.44% (705/709). The prevalence of dental fluorosis in children aged 8 - 12 in the disease affected TuanChang was 3.38% (1 412/41 714), and there was no statistically significant difference in the prevalence of dental fluorosis among different age groups (χ2 = 6.07, P = 0.194). The prevalence of dental fluorosis in children aged 8 - 12 in the TuanChang where the company with water fluoride exceeding standard was located (6.00%, 106/1 768) was higher than that in the TuanChang where the company with qualified water fluoride was located (3.27%, 1 306/39 946, χ 2 = 38.47, P < 0.001). Conclusion In 2022, the drinking water fluorosis in the Corps has reached the control standard, but attention still should be paid to the water improvement situation and maintenance of water improvement projects in some water fluoride exceeding standard companies, in order to prevent sustained dental fluorosis damage to children in the affected areas, and consolidate the achievements of prevention and control.

    水氟氟斑牙

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    《水源性高碘地区和高碘病区的划定》（GB/T 19380-2016）标准实施4年后河南省儿童碘营养状况调查

    朱琳滕妍利衡婧雅郭巧云...
    43-48页
    查看更多>>摘要：目的 了解《水源性高碘地区和高碘病区的划定》（GB/T 19380-2016）标准（以下简称新标准）实施4年后（2021年）河南省儿童碘营养状况和居民户非碘盐食用情况，为科学调整干预策略提供依据。 方法 2021年，按照新标准的要求，并依据河南省2017 - 2020年水碘调查结果，在全省47个存在高碘行政村（居委会，以下简称行政村）的县（市、区，以下简称县）开展水源性高碘地区儿童碘营养状况调查。每个县选取5个水碘中位数> 100 μg/L的行政村作为调查村，采集水样测定水碘含量；每个调查村抽取40名8 ~ 10岁非寄宿学生（年龄均衡、男女各半，不足40名时年龄扩大到6 ~ 12岁）作为调查对象，采集其家中食用盐盐样和随机1次尿样检测盐碘、尿碘含量，同时测量儿童甲状腺容积。并进一步对停供碘盐措施< 4年（新高碘地区）和> 10年地区（原高碘地区）的监测结果进行比较分析。 结果 全省共监测257个行政村，水碘范围为1.6 ~ 609.5 μg/L，中位数为132.5 μg/L。共对8 611名儿童进行盐碘、尿碘、甲状腺容积检测，非碘盐率为58.3%（5 017/8 611），尿碘中位数为342.2 μg/L，甲状腺肿大率为2.9%（250/8 611）。新高碘地区水碘中位数（153.0比118.4 μg/L）、儿童尿碘中位数（371.6比287.7 μg/L）及甲状腺肿大率[3.8%（211/5 537）比1.3%（39/3 074）]均高于原高碘地区，差异均有统计学意义（Z = 583.12、- 14.09，均P < 0.001；χ 2 = 44.40，P < 0.001）；而非碘盐率低于原高碘地区[37.2%（2 057/5 537）比96.3%（2 960/3 074）]，差异有统计学意义（χ 2 = 2 841.37，P < 0.001）。 结论 2021年河南省水源性高碘地区儿童碘营养处于过量状态，但居民户非碘盐率较低。应全力保障新标准实施后高碘地区非碘盐的精准供应，并加强重点人群碘营养监测和健康教育工作，防止高碘危害。 Objective To investigate the iodine nutritional status of children and the consumption condition of non-iodized salt in Henan Province after implementation of the new standard of "Definition and demarcation of water-borne iodine-excess areas and iodine-excess endemial areas" (GB/T 19380-2016, hereinafter referred to as new standard) for four years (2021), and to provide a basis for scientific adjustment of intervention strategies. Methods In 2021, according to the requirements of the new standard and based on the results of the water iodine survey in Henan Province from 2017 to 2020, a survey was conducted on the iodine nutrition status of children in water-borne high iodine areas in 47 counties (cities, districts, hereinafter referred to as counties) with high iodine administrative village (neighborhood committee, hereinafter referred to as administrative village). In each county, 5 administrative villages with median water iodine > 100 μg/L were selected as the investigation villages, and water samples were collected to determine the water iodine value. Forty non-boarding students aged 8 - 10 (age balanced, half male and half female, age increased to 6 - 12 when less than 40) were selected from each village as investigation subjects. Salt samples from their homes and urine samples were collected to detect salt iodine and urine iodine content, and thyroid volume of children was measured. And the monitoring results of areas where the supply of iodized salt had been suspended for less than 4 years (in newly high iodine areas) and more than 10 years (in previously high iodine areas) were further compared and analyzed. Results A total of 257 administrative villages in the province were monitored, and the range of water iodine was 1.6 - 609.5 μg/L, with a median of 132.5 μg/L. A total of 8 611 children were tested for salt iodine, urine iodine and thyroid volume. The non-iodized salt rate was 58.3% (5 017/8 611), and the median urine iodine was 342.2 μg/L, thyroid enlargement rate was 2.9% (250/8 611). The median water iodine (153.0 vs 118.4 μg/L), the median urine iodine in children (371.6 vs 287.7 μg/L) and the goiter rate [3.8% (211/5 537) vs 1.3% (39/3 074)] in the newly high iodine areas were higher than those in the previously high iodine areas, and the differences were statistically significant (Z = 583.12, - 14.09, P < 0.001 χ 2 = 44.40, P < 0.001) the non-iodized salt rate was lower than that of the previously high iodine areas [37.2% (2 057/5 537) vs 96.3% (2 960/3 074)], and the difference was statistically significant (χ2 = 2 841.37, P < 0.001). Conclusions The iodine nutrition level of children in water-borne high iodine areas of Henan Province in 2021 is at an excess level, but the non-iodized salt rate in residential households is low. We should make every effort to ensure the precise supply of non-iodized salt in high iodine areas after implementation of the new standard, and strengthen iodine nutrition monitoring and health education for key populations to prevent the occurrence of high iodine hazards.

    碘儿童饮用水尿盐类甲状腺肿

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    杭州市孕妇碘营养状况及影响因素分析

    赵婷婷霍亮亮张旭慧朱冰...
    49-55页
    查看更多>>摘要：目的 了解杭州市孕妇碘营养状况，并分析其影响因素，为指导杭州市孕妇科学补碘提供依据。 方法 采用分层随机抽样方法，于2018年3 - 10月对杭州市1 400名孕妇进行问卷调查，采集孕妇随机尿样和家中食用盐盐样，分别采用砷铈催化分光光度法和直接滴定法检测尿碘、盐碘含量。分析不同基本特征、膳食水平的孕妇尿碘分布水平差异（Kruskal-Wallis检验）及尿碘水平主要影响因素（有序多分类logistic回归法）。 结果 孕妇尿碘中位数为135.00 μg/L，合格碘盐食用率为83.36%（1 167/1 400）。基本特征方面，是否有孩子，怀孕次数、分娩次数、自然流产次数不同的孕妇尿碘分布水平比较，差异均有统计学意义（均P < 0.05）。膳食方面，食用牛奶、酸奶、肉类频率不同的孕妇，以及是否食用卷心菜、白菜、菜花或绿花椰菜的孕妇尿碘分布水平比较，差异均有统计学意义（均 P < 0.05）。有序多分类logistic回归分析显示，怀孕2次的孕妇尿碘水平高于≥3次的孕妇（ OR = 1.64，P = 0.003）；从不或偶尔食用酸奶的孕妇尿碘水平低于≥2瓶/d的孕妇（OR = 0.53，P = 0.044）；从不或偶尔和1次/周食用肉类的孕妇尿碘水平均高于≥2次/周的孕妇（OR = 1.40、1.47，均P < 0.05）。 结论 杭州市孕妇整体碘营养处于缺乏水平，妊娠经历和膳食水平是孕妇碘营养的影响因素。应深入开展针对孕妇的健康教育，完善孕期饮食结构，改善孕妇碘营养状况。 Objective To investigate the iodine nutritional status of pregnant women in Hangzhou City and analyze its influencing factors, in order to provide a basis for guiding pregnant women in Hangzhou City to supplement iodine scientifically. Methods A stratified random sampling method was used to conduct a questionnaire survey on 1 400 pregnant women in Hangzhou City from March to October 2018. Random urine samples and household salt samples from pregnant women were collected, and the levels of urine iodine and salt iodine were measured using arsenic cerium catalytic spectrophotometry and direct titration, respectively. The iodine nutritional status of pregnant women with different basic characteristics and dietary levels were analyzed and compared (Kruskal-Wallis test), and the main influencing factors affecting the urinary iodine concentration level of pregnant women were identified (the ordinal multiple classification logistic regression analysis). Results The median urinary iodine of pregnant women was 135.00 μg/L, and the qualified iodized salt consumption rate of pregnant women was 83.36% (1 167/1 400). In terms of basic characteristics, there were statistically significant differences in the distribution level of urine iodine among pregnant women with different pregnancy frequency, delivery frequency, and natural abortion frequency ( P < 0.05). In terms of diet, the frequency of consuming milk, yogurt, meat, and whether pregnant women consumed cabbage and cauliflower showed statistically significant differences in urinary iodine distribution levels ( P < 0.05). Ordinal multiple classification logistic regression analysis showed that the urine iodine levels of pregnant women who were pregnant twice were higher than those who were pregnant ≥3 times ( OR = 1.64, P = 0.003). Pregnant women who never or occasionally consumed yogurt had lower urine iodine levels than or equal to those who consumed 2 bottles of yogurt per day (OR = 0.53, P = 0.044). Pregnant women who never or occasionally consumed meat and those who consumed meat once a week had higher urinary iodine levels than that who consumed meat ≥2 times per week (OR = 1.40, 1.47, P < 0.05). Conclusions The overall iodine nutrition of pregnant women in Hangzhou City is at an deficiency level. Pregnancy experience and dietary level are influencing factors on iodine nutrition of pregnant women. It is necessary to carry out in-depth health education for pregnant women, improve the dietary structure during pregnancy, and improve the abnormal iodine nutrition of pregnant women.

    碘营养尿影响因素

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    2021年福州市重点人群碘营养状况调查

    廖静岚曹祥玉徐幽琼陆璐...
    56-60页
    查看更多>>摘要：目的 了解福州市重点人群碘营养状况，为调整干预策略提供科学依据。 方法 2021年3 - 10月，在福州市12个县（市、区）开展重点人群碘营养状况调查。每个县（市、区）按东、西、南、北、中方位划分5个抽样片区，每个片区抽取1个乡镇（街道），每个乡镇（街道）抽取1所小学的40名8 ~ 10岁非寄宿制儿童（年龄均衡、男女各半）和20名孕妇（孕早、中、晚期均衡）作为调查对象。采集调查对象家庭食用盐盐样和随机尿样，采用直接滴定法、砷铈催化分光光度法分别检测盐碘、尿碘含量；B超法测定儿童甲状腺容积。同时，采用与福州市妇幼保健院合作方式，收集福州市2021年足月顺产新生儿足跟血促甲状腺激素（thyroid stimulating hormone，TSH）检测结果。 结果 共对2 400名儿童进行盐碘、尿碘、甲状腺肿大监测，盐碘中位数为24.40 mg/kg，碘盐覆盖率为93.04%（2 233/2 400），碘盐合格率为97.40%（2 175/2 233），合格碘盐食用率为90.62%（2 175/2 400）；尿碘中位数为181.47 μg/L；甲状腺肿大率为1.04%（25/2 400）。共对1 200名孕妇进行盐碘、尿碘监测，盐碘中位数为24.10 mg/kg，碘盐覆盖率为91.08%（1 093/1 200），碘盐合格率为97.90%（1 070/1 093），合格碘盐食用率为89.17%（1 070/1 200）；尿碘中位数为128.10 μg/L。14 242份新生儿足跟血TSH水平中位数为3.38 mU/L，TSH水平> 5 mU/L的比例为30.96%（4 410/14 242）。 结论 2021年，福州市儿童处于碘适宜水平，但孕妇碘营养不足。应继续保持以食盐加碘为主的综合防治措施，针对孕妇开展健康教育，同时加强新生儿TSH水平监测。 Objective To investigate the iodine nutrition status of key population in Fuzhou City, and to provide scientific basis for adjusting intervention strategies. Methods From March to October 2021, a survey was conducted on iodine nutrition status of key population in 12 counties (cities, districts) of Fuzhou City. Each county (city, district) was divided into 5 sampling areas according to the east, west, south, north and middle directions. One township (street) was selected from each area, and 40 non-boarding children aged 8 - 10 (age balanced, half male and half female) from one primary school and 20 pregnant women (early, middle and late pregnancy balanced) were selected as survey subjects. Household salt samples and random urine samples were collected, and the salt iodine and urine iodine levels were tested by direct titration and arsenic and cerium catalytic spectrophotometry, respectively. Children's thyroid volume was measured by B-ultrasonography. At the same time, in cooperation with Fuzhou Maternal and Child Health Hospital, the thyroid stimulating hormone (TSH) testing results of heel blood of full-term natural delivery newborns in Fuzhou City in 2021 were collected. Results A total of 2 400 children were monitored for salt iodine, urine iodine and goiter. The median salt iodine was 24.40 mg/kg, with an iodine salt coverage rate of 93.04% (2 233/2 400), a qualified rate of iodized salt of 97.40% (2 175/2 233), and a consumption rate of qualified iodized salt of 90.62% (2 175/2 400). The median urine iodine was 181.47 μg/L. The rate of goiter was 1.04% (25/2 400). A total of 1 200 pregnant women were monitored for salt iodine and urine iodine. The median salt iodine was 24.10 mg/kg, the coverage rate of iodized salt was 91.08% (1 093/1 200), the qualified rate of iodized salt was 97.90% (1 070/1 093), and the consumption rate of qualified iodized salt was 89.17% (1 070/1 200). The median urine iodine was 128.10 μg/L. The median TSH level in the heel blood of 14 242 newborns was 3.38 mU/L, and the proportion of TSH level > 5 mU/L was 30.96% (4 410/14 242). Conclusions In 2021, children in Fuzhou City are at an appropriate level of iodine, but pregnant women are insufficient of iodine. We should continue to maintain comprehensive prevention and control measures mainly based on salt iodization, provide health education for pregnant women, and strengthen monitoring of TSH level in newborns.

    碘儿童孕妇盐类尿甲状腺肿促甲状腺激素

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