阿坝州水文地球化学环境、生活习惯与地氟病患病率关系的研究

Study on the Relationship between Hydrogeochemical Environment, Lifestyle Habits, and the Incidence of Endemic Fluorosis in Aba Prefecture, China

摘要: 目的：探讨阿坝州地氟病流行的原因与水文地球化学环境、生活习惯之间的关联性，分析水质、氟含量、生活习惯对地氟病患病率的影响。方法：从阿坝州生态环境局、阿坝州卫健委、疾控慢病所、州医院等部门，取得历年来水文地球化学环境监测数据、州内地氟病流行病学情况，对阿坝州各县氟病区160人通过面对面访谈、义诊咨询、问卷调查，获取不同年龄段人群饮食结构、饮水习惯、饮茶情况等生活习惯，利用统计学方法，包括相关性分析、方差分析等，探讨了水文地球化学环境成分、水质类型、生活习惯与地氟病发病率之间的关联性。结果：阿坝州饮水源氟均为II类以上，氟含量稍高于其他地区的，主要集中在草原牧区，但数值均低于标准1 mg/L；不同县市的氟含量存在明显差异，高氟地区的氟含量明显高于国家卫生标准，主要是矿区、污水垃圾处理厂、供暖厂、水电厂、化工厂及企业事业单位污水排出口附近，以茂县、汶川、小金数据偏高。不同县市的地氟病患病率存在显著差异，从水源地监测看，阿坝州各县市地氟病和水源相关性不明显，但饮茶型地氟病发病率较高，达45.125% (其中氟斑牙检出率18.125%，氟骨症检出率23.750%，急性氟中毒检出率3.125%，慢性氟中毒检出率41.875%)，饮食结构、习惯导致以氟骨症患者最多，其次是氟斑牙和氟中毒(包括不限于尿氟、肾衰等)。结论：阿坝州人们的生活习惯，尤其是对饮食和饮水的选择，对地氟病的发生和发展起到了关键作用，为了降低地氟病的患病率，应加强水质监测、改善饮水水源、提倡健康的生活习惯，并采取有效的干预措施。

Abstract: Objective: This study aims to explore the association between the prevalence of endemic fluorosis in Aba Prefecture, the hydrogeochemical environment, and lifestyle habits. We analyze the impact of water quality, fluoride content, and lifestyle habits on the incidence of endemic fluorosis. Methods: We obtained hydrogeochemical monitoring data from the Aba Prefecture Ecological Environment Bureau, Aba Prefecture Health Commission, Disease Control and Chronic Disease Prevention Institute, and the Prefecture Hospital. Besides, we conducted face-to-face interviews, free clinics, and questionnaire surveys with 160 individuals from fluorosis-prone areas in various counties of Aba Prefecture. Then we collected information on dietary structure, drinking water habits, tea consumption, and other lifestyle habits across different age groups. Statistical methods, including correlation analysis and variance analysis, were employed to investigate the association between hydrogeochemical environmental components, water quality types, lifestyle habits, and the incidence of endemic fluorosis. Results: The fluoride content in drinking water sources in Aba Prefecture is classified as Class II or higher, slightly higher than in other regions, and primarily concentrated in grassland pastoral areas. However, the values are below the standard of 1 mg/L. Significant differences in fluoride content exist among different counties and cities, with high-fluoride areas notably exceeding national health standards. High-fluoride areas are primarily located near mining areas, sewage treatment plants, heating stations, hydropower plants, chemical plants, and wastewater discharge outlets of enterprises and institutions, with relatively higher fluoride content observed in Mao County, Wenchuan, and Xiaojin. The incidence of endemic fluorosis varies significantly among different counties and cities. From the perspective of water source monitoring, the correlation between endemic fluorosis and water sources in Aba Prefecture is not evident. However, the incidence of tea-induced endemic fluorosis is relatively high, reaching 45.125% (including 18.125% with dental fluorosis, 23.750% with skeletal fluorosis, 3.125% with acute fluoride poisoning, and 41.875% with chronic fluoride poisoning, including but not limited to urinary fluoride and renal failure). Dietary structure and habits primarily contribute to skeletal fluorosis, followed by dental fluorosis and fluoride poisoning. Conclusion: The lifestyle habits of people in Aba Prefecture, particularly their choices regarding diet and drinking water, play a crucial role in the occurrence and development of endemic fluorosis. To reduce the incidence of endemic fluorosis, it is necessary to strengthen water quality monitoring, improve drinking water sources, promote healthy lifestyle habits, and implement effective intervention measures.