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Article(id=1240413928069583550, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412275, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1734105600000, receivedDateStr=2024-12-14, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773667326227, onlineDateStr=2026-03-16, pubDate=1754755200000, pubDateStr=2025-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773667326227, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773667326227, creator=13701087609, updateTime=1773667326227, updator=13701087609, issue=Issue{id=1240413921266429979, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='15', pageStart='2689', pageEnd='2880', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773667324606, creator=13701087609, updateTime=1773667356299, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240414054267802325, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240414054267802326, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2700, endPage=2705, ext={EN=ArticleExt(id=1240413928346407628, articleId=1240413928069583550, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Characteristics and health risks of fluoride in drinking water and the epidemic status of dental fluorosis in Huanggang City from 2020 to 2024, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the concentration characteristics of fluoride in drinking water and the health risk of population exposure in Huanggang City, analyze the epidemic status of dental fluorosis in Huanggang City, and provide scientific basis for the prevention and control of endemic fluorosis.

Methods

Drinking water samples were collected from water quality monitoring sites in 10 counties of Huanggang City from 2020 to 2024, and the prevalence of dental fluorosis in children aged 8 to 12 years was randomly sampled from 24 villages in the drinking-water fluorosis area of Huanggang City. Excel 2016 and SPSS 20.0 were used to analyze the data. The health risk assessment model recommended by the United States Environmental Protection Agency (US EPA) was used for population health risk assessment.

Results

A total of 3 850 drinking water samples were monitored in Huanggang City from 2020 to 2024. The median fluoride concentration was 0.19 mg/L, and the concentration range was 0.03-0.86 mg/L. There were significant differences in fluoride concentration among different years, water periods, disinfection methods and regions (χ2=60.695, Z=-8.908, χ2= 19.585, χ2=3 754.425; all P<0.001). Water fluorine was strongly correlated with pH, total dissolved solids and chloride (r=0.619, 0.520, 0.516, respectively; all P<0.001). The median and maximum hazard quotient (HQ) values for non-carcinogenic health risk from fluoride exposure through drinking water intake were less than 1, and the difference of non-carcinogenic health risk values among different regions was statistically significant (H=77.626, P=0.027). A total of 5 667 children from infected villages in Huanggang City were monitored from 2020 to 2024. The average annual detection rate of dental fluorosis was 0.49%, and the detection rate in five years ranged from 0.11%to 0.74%, with statistically significant differences among different regions (χ2=123.584, P<0.001).

Conclusion

From 2020 to 2024, the qualified rate of fluoride content in drinking water in Huanggang City was 100%, and the detection rate of dental fluorosis was less than 30%, which met the national standard of elimination of endemic fluorosis, but there are obvious differences between regions. Relevant departments need to focus on the health risk of fluoride exposure and the epidemic trend of dental fluorosis in Hong’an and Wuxue areas. We will take targeted measures to prevent and control endemic fluorosis.

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目的

掌握黄冈市生活饮用水中氟化物含量特征及人群健康风险，分析黄冈市氟斑牙流行现状，为地方性氟中毒防治工作提供科学依据。

方法

2020—2024年，于黄冈市10县区水质监测点采集饮用水样本，在黄冈市饮水型氟中毒病区的24个病村随机抽检8～12岁儿童氟斑牙患病情况。采用Excel 2016及SPSS 20.0软件统计分析数据。采用美国环保署（United States Environmental Protection Agency，US EPA）推荐的健康风险评估模型进行人群健康风险评价。

结果

2020—2024年共监测黄冈市饮用水3 850份，氟化物含量中位数0.19 mg/L，含量范围0.03 ~ 0.86 mg/L。不同年份、水期、消毒方式、地区的氟化物含量差异具有统计学意义（χ2=60.695，Z=-8.908，χ2=19.585，χ2=3 754.425；P均<0.001）。水氟与pH值、溶解性总固体、氯化物相关性较强（r=0.619、0.520、0.516，P均<0.001）。人群经饮水摄入途径的氟化物暴露非致癌健康风险危害系数中位数及最大值均小于1，不同地区人群非致癌健康风险差异具有统计学意义（H=77.626，P=0.027）。2020—2024年共监测黄冈市病村儿童5 667人，氟斑牙年均检出率为0.49%，五年间检出率范围为0.11%～0.74%，不同地区氟斑牙检出率差异具有统计学意义（χ2=123.584，P<0.001）。

结论

2020—2024年黄冈市生活饮用水氟化物指标合格率100%，氟斑牙检出率低于30%，符合国家地方性氟化病消除标准，但存在地区间的明显差异，有关部门需重点关注红安、武穴地区的人群氟暴露健康风险与氟斑牙流行趋势，实行针对性的地方性氟中毒防治措施。

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郑懿，E-mail: ；
王红亮，E-mail: ；
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郑懿与王红亮为共同通信作者

刘雪芹（1984—），女，硕士，主管技师，研究方向：食品安全及理化检验

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刘雪芹（1984—），女，硕士，主管技师，研究方向：食品安全及理化检验

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Analysis of Monitoring Results of Drinking Water Type Endemic Fluorosis in Changchun City from 2019 to 2023[J]. Chinese Journal of Endemic Disease Prevention and Control,2025, 40(2): 133-134.(In Chinese), articleTitle=Analysis of Monitoring Results of Drinking Water Type Endemic Fluorosis in Changchun City from 2019 to 2023, refAbstract=null), Reference(id=1240424358741594928, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413928069583550, doi=null, pmid=null, pmcid=null, year=2024, volume=16, issue=10, pageStart=55, pageEnd=56, 37, url=null, language=null, rfNumber=[19], rfOrder=35, authorNames=包慧, journalName=中国农村卫生, refType=null, unstructuredReference=包慧.呼和浩特市2023年饮水型地方性氟中毒调查[J].中国农村卫生，2024，16（10）：55-56, 37., articleTitle=呼和浩特市2023年饮水型地方性氟中毒调查, refAbstract=null), Reference(id=1240424358850646842, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413928069583550, doi=null, pmid=null, pmcid=null, year=2024, volume=16, issue=10, pageStart=55, pageEnd=56, 37, url=null, language=null, rfNumber=[19], rfOrder=36, authorNames=Bao H, journalName=China Rural Health, refType=null, unstructuredReference=Bao H. Survey on drinking water type endemic fluorosis in Hohhot City in 2023[J]. China Rural Health, 2024, 16(10): 55-56, 37.(In Chinese), articleTitle=Survey on drinking water type endemic fluorosis in Hohhot City in 2023, refAbstract=null), Reference(id=1240424359916000061, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413928069583550, doi=null, pmid=null, pmcid=null, year=2024, volume=41, issue=9, pageStart=783, pageEnd=787, url=null, language=null, rfNumber=[20], rfOrder=37, authorNames=周蓉, 杨敏, 丁琼洁, journalName=环境与健康杂志, refType=null, unstructuredReference=周蓉，杨敏，丁琼洁，等.2023年陕西省饮水型地方性氟中毒病区儿童氟斑牙和龋齿患病调查结果分析[J].环境与健康杂志，2024，41（9）：783-787., articleTitle=2023年陕西省饮水型地方性氟中毒病区儿童氟斑牙和龋齿患病调查结果分析, refAbstract=null), Reference(id=1240424360033440580, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413928069583550, doi=null, pmid=null, pmcid=null, year=2024, volume=41, issue=9, pageStart=783, pageEnd=787, url=null, language=null, rfNumber=[20], rfOrder=38, authorNames=Zhou R, Yang M, Ding QJ, journalName=Journal of Environment and Health, refType=null, unstructuredReference=Zhou R, Yang M, Ding QJ, et al. Investigation of dental fluorosis and dental caries among children in drinking water-borne endemic fluorosis areas of Shaanxi province in 2023[J]. Journal of Environment and Health, 2024, 41(9): 783-787.(In Chinese), articleTitle=Investigation of dental fluorosis and dental caries among children in drinking water-borne endemic fluorosis areas of Shaanxi province in 2023, refAbstract=null)], funds=[Fund(id=1240424353045729823, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413928069583550, awardId=鄂卫通2021-40号, language=CN, fundingSource=湖北省公共卫生青年拔尖人才项目(鄂卫通2021-40号), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240424346901074068, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413928069583550, xref=null, ext=[AuthorCompanyExt(id=1240424346909462678, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413928069583550, companyId=1240424346901074068, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Huanggang Center for Disease Control and Prevention, Huanggang, Hubei 438000, China), AuthorCompanyExt(id=1240424346917851287, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413928069583550, companyId=1240424346901074068, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=黄冈市疾病预防控制中心，湖北 黄冈 438000)])], figs=[ArticleFig(id=1240424351955210702, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413928069583550, language=EN, label=Figure 1, caption=Correlation between fluoride in drinking water and other monitoring indicators in Huanggang City from 2020 to 2024, figureFileSmall=vIv6uqzt5wzqpX0f6WIRmg==, figureFileBig=laPBCkVyYLtaX1OeT6goSw==, tableContent=null), ArticleFig(id=1240424352122982871, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413928069583550, language=CN, label=图1, caption=2020—2024年黄冈市生活饮用水中水氟与其他监测指标相关性

注：*表示P<0.001。

, figureFileSmall=vIv6uqzt5wzqpX0f6WIRmg==, figureFileBig=laPBCkVyYLtaX1OeT6goSw==, tableContent=null), ArticleFig(id=1240424352269783523, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413928069583550, language=EN, label=Figure 2, caption=Adult fluoride HQ in drinking water of Huanggang City from 2020 to 2024, figureFileSmall=WychmkkSY7yDy7dk/uIppw==, figureFileBig=WZorfCtooCh6r4XD8Dp0jA==, tableContent=null), ArticleFig(id=1240424352399806956, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413928069583550, language=CN, label=图2, caption=2020—2024年黄冈市生活饮用水成人氟化物HQ

注：箱式图中上下端分别代表P75、P25，横线代表P50即中位数；须线上下端代表最大值、最小值。

, figureFileSmall=WychmkkSY7yDy7dk/uIppw==, figureFileBig=WZorfCtooCh6r4XD8Dp0jA==, tableContent=null), ArticleFig(id=1240424352487887350, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413928069583550, language=EN, label=Figure 3, caption=Detection rate of dental fluorosis in Huanggang City, 2020—2024, figureFileSmall=9KAbXq1rZU/5jL3yavDfeg==, figureFileBig=GNRoX3/CpzfHO8btK73a3A==, tableContent=null), ArticleFig(id=1240424352613716480, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413928069583550, language=CN, label=图3, caption=2020—2024年黄冈市氟斑牙检出率

注：A为不同年度、地区、年龄人群氟斑牙检出率（%）；B为2020—2024年红安、武穴、其他县区、黄冈市整体平均氟斑牙检出率（%）。

, figureFileSmall=9KAbXq1rZU/5jL3yavDfeg==, figureFileBig=GNRoX3/CpzfHO8btK73a3A==, tableContent=null), ArticleFig(id=1240424352680825353, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413928069583550, language=EN, label=Table 1, caption=

The concentration and distribution characteristics of fluoride in drinking water in Huanggang City from 2020 to 2024

, figureFileSmall=null, figureFileBig=null, tableContent=
分组份数氟化物含量（mg/L）统计量χ2/Z值P值
含量范围M（IQR）
年度（年）
2020765ND～0.670.20（0.03-0.23）60.695<0.001
2021771ND～0.860.18（0.03-0.23）
2022768ND～0.860.20（0.13-0.23）
2023771ND～0.610.21（0.13-0.25）
2024775ND～0.740.17（0.11-0.22）
水期
枯水期1 926ND～0.860.19（0.10-0.23）-8.908<0.001
丰水期1 924ND～0.750.20（0.09-0.23）
水样类型
出厂水1 179ND～0.750.18（0.03-0.23）2.5430.280
末梢水2 334ND～0.860.20（0.12-0.23）
二次供水337ND～0.590.20（0.03-0.30）
消毒方式
不消毒91ND～0.580.20（0.03-0.25）19.585<0.001
次氯酸钠658ND～0.410.16（0.03-0.22）
液氯562ND～0.640.21（0.19-0.25）
漂白粉706ND～0.860.19（0.03-0.26）
复合二氧化氯1 560ND～0.860.18（0.10-0.22）
高纯二氧化氯276ND～0.840.21（0.18-0.25）
采样类型
城市水1 058ND～0.840.20（0.17-0.23）-0.2160.829
农村水2 792ND～0.860.18（0.03-0.23）
水源类型
地下水156ND～0.580.18（0.03-0.23）11.5610.073
浅井44ND～0.570.08（0.03-0.21）
深井55ND～0.580.26（0.20-0.36）
泉水57ND～0.330.03（0.03-0.14）
地表水3 694ND～0.860.19（0.10-0.23）
江河1 803ND～0.840.20（0.17-0.24）
湖泊101ND～0.560.18（0.10-0.23）
水库1 790ND～0.860.16（0.03-0.22）
供水规模
I型2 036ND～0.860.18（0.03-0.23）8.5610.121
II型543ND～0.640.19（0.03-0.23）
III型1 147ND～0.860.20（0.17-0.23）
IV型124ND～0.350.16（0.05-0.18）
地区
黄州6960.11～0.840.21（0.19-0.24）3 754.425<0.001
麻城366ND～0.280.20（0.03-0.21）
团风2610.14～0.860.28（0.22-0.42）
红安360ND～0.670.14（0.03-0.28）
英山361ND～0.600.14（0.03-0.20）
蕲春3600.11～0.800.22（0.19-0.24）
浠水361ND～0.410.12（0.03-0.19）
罗田340ND～0.420.15（0.03-0.20）
武穴3670.10～0.420.20（0.17-0.24）
黄梅378ND～0.340.12（0.03-0.22）
合计3 850ND～0.860.19（0.12-0.23）
), ArticleFig(id=1240424352777294355, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413928069583550, language=CN, label=表1, caption=

2020—2024年黄冈市饮用水氟化物含量及分布特征

, figureFileSmall=null, figureFileBig=null, tableContent=
分组份数氟化物含量（mg/L）统计量χ2/Z值P值
含量范围M（IQR）
年度（年）
2020765ND～0.670.20（0.03-0.23）60.695<0.001
2021771ND～0.860.18（0.03-0.23）
2022768ND～0.860.20（0.13-0.23）
2023771ND～0.610.21（0.13-0.25）
2024775ND～0.740.17（0.11-0.22）
水期
枯水期1 926ND～0.860.19（0.10-0.23）-8.908<0.001
丰水期1 924ND～0.750.20（0.09-0.23）
水样类型
出厂水1 179ND～0.750.18（0.03-0.23）2.5430.280
末梢水2 334ND～0.860.20（0.12-0.23）
二次供水337ND～0.590.20（0.03-0.30）
消毒方式
不消毒91ND～0.580.20（0.03-0.25）19.585<0.001
次氯酸钠658ND～0.410.16（0.03-0.22）
液氯562ND～0.640.21（0.19-0.25）
漂白粉706ND～0.860.19（0.03-0.26）
复合二氧化氯1 560ND～0.860.18（0.10-0.22）
高纯二氧化氯276ND～0.840.21（0.18-0.25）
采样类型
城市水1 058ND～0.840.20（0.17-0.23）-0.2160.829
农村水2 792ND～0.860.18（0.03-0.23）
水源类型
地下水156ND～0.580.18（0.03-0.23）11.5610.073
浅井44ND～0.570.08（0.03-0.21）
深井55ND～0.580.26（0.20-0.36）
泉水57ND～0.330.03（0.03-0.14）
地表水3 694ND～0.860.19（0.10-0.23）
江河1 803ND～0.840.20（0.17-0.24）
湖泊101ND～0.560.18（0.10-0.23）
水库1 790ND～0.860.16（0.03-0.22）
供水规模
I型2 036ND～0.860.18（0.03-0.23）8.5610.121
II型543ND～0.640.19（0.03-0.23）
III型1 147ND～0.860.20（0.17-0.23）
IV型124ND～0.350.16（0.05-0.18）
地区
黄州6960.11～0.840.21（0.19-0.24）3 754.425<0.001
麻城366ND～0.280.20（0.03-0.21）
团风2610.14～0.860.28（0.22-0.42）
红安360ND～0.670.14（0.03-0.28）
英山361ND～0.600.14（0.03-0.20）
蕲春3600.11～0.800.22（0.19-0.24）
浠水361ND～0.410.12（0.03-0.19）
罗田340ND～0.420.15（0.03-0.20）
武穴3670.10～0.420.20（0.17-0.24）
黄梅378ND～0.340.12（0.03-0.22）
合计3 850ND～0.860.19（0.12-0.23）
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2020—2024年黄冈市饮用水氟化物特征、氟斑牙流行现状及健康风险
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刘雪芹 , 赵旭军 , 郑懿 , 王红亮 , 李聪 , 王芬
现代预防医学 | 流行病与统计方法 2025,52(15): 2700-2705
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现代预防医学 | 流行病与统计方法 2025, 52(15): 2700-2705
2020—2024年黄冈市饮用水氟化物特征、氟斑牙流行现状及健康风险
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刘雪芹, 赵旭军, 郑懿 , 王红亮 , 李聪, 王芬
作者信息
  • 黄冈市疾病预防控制中心，湖北 黄冈 438000

    • 刘雪芹（1984—），女，硕士，主管技师，研究方向：食品安全及理化检验

通讯作者:

郑懿，E-mail: ；
王红亮，E-mail: ；
Characteristics and health risks of fluoride in drinking water and the epidemic status of dental fluorosis in Huanggang City from 2020 to 2024
Xue-qin LIU, Xu-jun ZHAO, Yi ZHENG , Hong-liang WANG , Cong LI, Fen WANG
Affiliations
  • Huanggang Center for Disease Control and Prevention, Huanggang, Hubei 438000, China
出版时间: 2025-08-10 doi: 10.20043/j.cnki.MPM.202412275
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摘要
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目的

掌握黄冈市生活饮用水中氟化物含量特征及人群健康风险，分析黄冈市氟斑牙流行现状，为地方性氟中毒防治工作提供科学依据。

方法

2020—2024年，于黄冈市10县区水质监测点采集饮用水样本，在黄冈市饮水型氟中毒病区的24个病村随机抽检8～12岁儿童氟斑牙患病情况。采用Excel 2016及SPSS 20.0软件统计分析数据。采用美国环保署（United States Environmental Protection Agency，US EPA）推荐的健康风险评估模型进行人群健康风险评价。

结果

2020—2024年共监测黄冈市饮用水3 850份，氟化物含量中位数0.19 mg/L，含量范围0.03 ~ 0.86 mg/L。不同年份、水期、消毒方式、地区的氟化物含量差异具有统计学意义（χ2=60.695，Z=-8.908，χ2=19.585，χ2=3 754.425；P均<0.001）。水氟与pH值、溶解性总固体、氯化物相关性较强（r=0.619、0.520、0.516，P均<0.001）。人群经饮水摄入途径的氟化物暴露非致癌健康风险危害系数中位数及最大值均小于1，不同地区人群非致癌健康风险差异具有统计学意义（H=77.626，P=0.027）。2020—2024年共监测黄冈市病村儿童5 667人，氟斑牙年均检出率为0.49%，五年间检出率范围为0.11%～0.74%，不同地区氟斑牙检出率差异具有统计学意义（χ2=123.584，P<0.001）。

结论

2020—2024年黄冈市生活饮用水氟化物指标合格率100%，氟斑牙检出率低于30%，符合国家地方性氟化病消除标准，但存在地区间的明显差异，有关部门需重点关注红安、武穴地区的人群氟暴露健康风险与氟斑牙流行趋势，实行针对性的地方性氟中毒防治措施。

饮用水  /  氟化物  /  地方性氟中毒  /  健康风险评价
Objective

To understand the concentration characteristics of fluoride in drinking water and the health risk of population exposure in Huanggang City, analyze the epidemic status of dental fluorosis in Huanggang City, and provide scientific basis for the prevention and control of endemic fluorosis.

Methods

Drinking water samples were collected from water quality monitoring sites in 10 counties of Huanggang City from 2020 to 2024, and the prevalence of dental fluorosis in children aged 8 to 12 years was randomly sampled from 24 villages in the drinking-water fluorosis area of Huanggang City. Excel 2016 and SPSS 20.0 were used to analyze the data. The health risk assessment model recommended by the United States Environmental Protection Agency (US EPA) was used for population health risk assessment.

Results

A total of 3 850 drinking water samples were monitored in Huanggang City from 2020 to 2024. The median fluoride concentration was 0.19 mg/L, and the concentration range was 0.03-0.86 mg/L. There were significant differences in fluoride concentration among different years, water periods, disinfection methods and regions (χ2=60.695, Z=-8.908, χ2= 19.585, χ2=3 754.425; all P<0.001). Water fluorine was strongly correlated with pH, total dissolved solids and chloride (r=0.619, 0.520, 0.516, respectively; all P<0.001). The median and maximum hazard quotient (HQ) values for non-carcinogenic health risk from fluoride exposure through drinking water intake were less than 1, and the difference of non-carcinogenic health risk values among different regions was statistically significant (H=77.626, P=0.027). A total of 5 667 children from infected villages in Huanggang City were monitored from 2020 to 2024. The average annual detection rate of dental fluorosis was 0.49%, and the detection rate in five years ranged from 0.11%to 0.74%, with statistically significant differences among different regions (χ2=123.584, P<0.001).

Conclusion

From 2020 to 2024, the qualified rate of fluoride content in drinking water in Huanggang City was 100%, and the detection rate of dental fluorosis was less than 30%, which met the national standard of elimination of endemic fluorosis, but there are obvious differences between regions. Relevant departments need to focus on the health risk of fluoride exposure and the epidemic trend of dental fluorosis in Hong’an and Wuxue areas. We will take targeted measures to prevent and control endemic fluorosis.

Drinking water  /  Fluoride  /  Endemic fluorosis  /  Health risk assessment
刘雪芹, 赵旭军, 郑懿, 王红亮, 李聪, 王芬. 2020—2024年黄冈市饮用水氟化物特征、氟斑牙流行现状及健康风险. 现代预防医学, 2025 , 52 (15) : 2700 -2705 . DOI: 10.20043/j.cnki.MPM.202412275
Xue-qin LIU, Xu-jun ZHAO, Yi ZHENG, Hong-liang WANG, Cong LI, Fen WANG. Characteristics and health risks of fluoride in drinking water and the epidemic status of dental fluorosis in Huanggang City from 2020 to 2024[J]. Modern Preventive Medicine, 2025 , 52 (15) : 2700 -2705 . DOI: 10.20043/j.cnki.MPM.202412275
正文
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地方性氟中毒（简称地氟病）是一种因人群长期氟摄入过量而引起的慢性全身性疾病，人体在氟元素长期过量暴露下会在牙齿及骨关节发生病变，主要表现为氟斑牙和氟骨症[1]。地氟病的发生与地理环境中氟元素的丰度密切相关，有研究表明，饮用水是人体氟元素的主要来源之一，其中儿童约40%～70%、成人约60%氟来源于饮用水[2]。在典型饮水型氟中毒病区，儿童氟的来源中饮用水占比更高，可达80%以上[3]，因此，地氟病常见的一种患病原因是饮水型氟摄入过量[1，4]。我国地氟病分布广泛，几乎各省市自治区均有地氟病集中流行区[1-4]。湖北省曾为饮水型氟中毒流行区，其中黄冈市有111个氟病区，且水中氟化物（简称水氟）含量水平中位数高达2 mg/L[5-7]，超过《生活饮用水卫生标准》(GB 5749—2006、GB 5749—2022)规定中生活饮用水氟化物的含量限值1.0 mg/L。多年来湖北省实施以安全饮水工程为主的地氟病综合防治措施[7]，为了解黄冈市地氟病防治效果，对2020—2024年黄冈市饮用水水氟含量特点进行监测与系统分析，进一步掌握本地区人群氟斑牙患病率变化趋势，为实行有针对性的地氟病防治措施提供数据支撑。
1　材料与方法
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1.1　数据来源
数据来源于“2020—2024年湖北省及黄冈市生活饮用水水质监测和湖北省及黄冈市氟斑牙监测项目”。根据2020—2024年湖北省及黄冈市生活饮用水水质监测方案，2020—2024年共收集黄冈市10县区生活饮用水水质监测点的各类水样3 850份，每年水质监测点基本一致，分别于枯水期（4—5月）及丰水期（9—10月）各采集一次，检测水样中氟化物及其他指标。根据2020—2024年湖北省及黄冈市地方病防治方案，2020—2024年共监测黄冈市24个地氟病病村的8～12岁儿童5 667人牙齿健康状况，监测氟斑牙发病情况。
1.2　评价标准
按照《生活饮用水标准检验方法》（GB/T 5750—2006）、（GB/T 5750—2023）对饮用水水样常规指标进行检测[8-9]。水氟含量限值参考《生活饮用水卫生标准》（GB 5749—2006）、（GB 5749—2022）[10-11]。按照《氟斑牙诊断》（WS/T 208—2011）对8～12岁儿童牙齿患病情况进行评价。按照《地方性氟中毒病区控制标准》（GB 17017—2010）判断黄冈市地氟病流行情况，同时满足以下两点，即为实现控制目标：（1）农村大中型集中式供水水氟≤1.0 mg/L，农村小型集中式供水水氟≤1.2 mg/L；（2）当地出生居住的8～12周岁儿童氟斑牙患病率≤30%。
1.3　健康风险评价
氟化物目前尚无确切证据证实其致癌效应，因此主要评估人群经饮水摄入氟化物所致的非致癌健康风险。根据美国国家环境保护署（United States Environmental Protection Agency，US EPA）推荐的非致癌物健康风险评价模型[12]，结合《化学物质环境健康风险评估技术指南》（WS/T 777—2021）[13]，对水样数据按不同类型进行分组分层评价，以危害系数（hazard quotient，HQ）评估水氟的人群非致癌健康风险，若HQ≤1表示非致癌风险较低，若HQ>1表示存在较高非致癌风险。
其计算公式如下：
式中：ADD为日均暴露量，mg/（kg·d）；C为氟化物的含量，mg/L；IR为经口日均摄入量，L/d；EF为每年暴露频率，d，取值为365 d；ED为暴露周期；BW为人体体重，kg；AT为平均时间，d，非致癌效应的平均时间为ED对应的天数，即ED×365；IR和BW取值均来源于2013年中国环境出版社出版的《中国人群暴露参数手册》，其中0～5岁和6～17岁儿童以及成人的IR取值分别为0.795、1.496和2.796 L/d，Bw取值分别为14.3、43.6和64.1 kg[14]。根据美国环保局综合风险信息查询系统（IRIS），氟化物经口摄入途径非致癌参考剂量（RfD）为0.060 mg/（kg·d）。
1.4　统计学分析
采用Excel 2016软件收集与整理数据，采用SPSS 20.0软件进行统计学分析，采用Origin 2018绘图。因饮用水中氟化物经Kolmogorov-Smirnov检验均呈偏态分布，因此采用中位数及四分位数间距M（IQR）进行统计学描述。未检出的数据以1/2检出限纳入计算分析。对率的计数资料进行比较采用χ2检验，趋势分析采用χ2趋势检验；水氟含量两组间差异比较采用Mann-Whitney U检验，多组间差异比较采用Kruskal-Wallis H检验，饮用水不同监测指标间的相关性采用Spearman分析，检验水准α=0.05。
2　结果
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2.1　饮用水氟化物含量水平及分布特征
2020—2024年黄冈市饮用水水氟检出率91.26%，合格率100.00%，含量范围在0.03～0.86 mg/L，中位数0.19 mg/L。不同年份、水期、消毒方式、地区的水氟含量比较，差异具有统计学意义。水氟含量在五年内呈下降趋势（χ2=60.695，P<0.001）；枯水期高于丰水期（Z=-8.908，P<0.001）；不同消毒方式水氟含量比较，不消毒方式最高，复合二氧化氯消毒方式最低（χ2=19.585，P<0.001）。区域间水氟含量差异显著（χ2=3754.425，P<0.001），团风水氟含量较高，麻城、黄梅水氟含量偏低，最大值分布在团风。不同水样类型、采样类型、水源类型、供水规模的水氟含量差异无统计学意义（χ2或Z=2.543、-0.216、11.561、8.561，P=0.280、0.829、0.073、0.121）。见表1。
2.2　相关性分析
Spearman相关性分析结果显示，水氟主要与pH值、溶解性总固体、氯化物相关性较强，r值均在0.5以上（r=0.619、0.520、0.516，P均<0.001）。水氟与氨氮、色度、硫酸盐、硝酸盐氨有一定的相关性，r值均在0.2～0.5之间（r=0.374、0.268、0.261、0.235，P均<0.001）。水氟与其他指标相关性较弱或负相关。结果见图1。
2.3　氟化物健康风险评估
在不同年度、地区、水样类型、采样类型、水源类型的水氟经口摄入暴露途径下，不同年龄段人群非致癌健康风险值HQ均小于1。健康风险最高的群体为0～5岁儿童，健康风险最低群体为6～17岁儿童。不同地区间人群非致癌健康风险差异具有统计学意义（H=77.626，P=0.027），团风水氟HQ中位数最高，最大值也是较高的几个地区之一。浠水、黄梅水氟HQ中位数及最大值均较低。不同年度、水样类型、采样类型、水源类型水氟HQ差异均无统计学意义（H=0.181、3.185，Z=-0.161、-0.242，P=0.996、0.211、0.872、0.718）。结果见图2。
2.4　氟斑牙流行趋势
黄冈市地氟病主要流行病征为氟斑牙。对黄冈市24个地氟病病村8～12岁儿童开展氟斑牙患病情况调查，2020—2024年累积调查5 667人，检出可疑人数39人，确诊人数28人，其中极轻19人、轻度7人、中度2人。氟斑牙年均检出率为0.49%，五年检出率范围为0.11%～0.74%；不同年份、年龄氟斑牙检出率差异无统计学意义（χ2=7.111、6.535，P=0.130、0.258）；不同地区氟斑牙检出率差异具有统计学意义（χ2 =123.584，P<0.001）；红安最高，武穴次之，其余地区均未发现氟斑牙患者。见图3。
2020—2024年红安氟斑牙年平均检出率3.47%，五年氟斑牙检出率范围为0～6.58 %；武穴氟斑牙年平均检出率0.51 %，五年氟斑牙检出率范围为0～1.03 %。红安不同年份氟斑牙检出率差异具有统计学意义（χ2=8.767，P=0.033），呈下降趋势（χ2趋势=5.285，P=0.022）；武穴不同年份氟斑牙检出率差异无统计学意义（χ2=4.642，P=0.326），无明显变化趋势（χ2趋势=3.373，P=0.066）。见图3。
3　讨论
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湖北省曾为饮水性氟中毒重度流行区域，黄冈市饮用水水氟平均值曾达2.0 mg/L以上，农村地区氟斑牙检出率高达45%以上[5-7]。随着《湖北省地方病防治工作计划》实施，农村安全饮水工程覆盖率达100%，地氟病的防治工作取得了阶段性成果[15]，但是黄冈地区水氟含量分布特征及地氟病的流行情况尚无报道。监测表明，黄冈市在实施集中病区饮水改造工程后，不同类型饮用水水氟含量中位数及最大值均小于国家标准限值，合格率达100%。人群经饮水摄入途径的水氟暴露非致癌健康风险较低，人群地氟病检出率小于1%，处于低流行水平，说明黄冈市地氟病防治工作效果显著，但地区间差异明显。
监测结果表明，团风县饮用水水氟含量中位数明显高于其他区县，而黄梅、浠水等地的水氟含量最低，中位数在0.20mg/L以下。有研究表明，饮用水与龋齿发病率、氟中毒发病率呈U型曲线关系，过低的氟化物含量反而对牙齿健康存着不利影响[16]。当前，黄冈市饮用水水氟整体处于低值，需要关注龋齿的流行趋势。黄冈市饮用水水氟主要与pH值、氯化物、溶解性总固体存着正相关关系，这可能与pH值较高，水环境趋向碱性时有利于氟的富集有关[16-17]。水氟与氯化物、溶解性总固体的正相关关系以及其他指标间的负相关关系原因不明。
监测结果表明，黄冈市氟斑牙检出率0.49%，低于长春市的4.98%[18]、呼和浩特市的1.7%[19]、陕西省的5.69%[20]。氟骨症未有近五年新发病例，大部分县区未检出地氟病，氟斑牙病例集中在红安、武穴两地。红安2023年氟斑牙检出率骤降至零，这可能与红安检测人数历年在百人规模，样本量较少影响整体数据的代表性，以及与儿童超12岁未纳入监测范围、人口流动等因素有关。武穴自2022年持续发现氟斑牙患者，但武穴水氟含量未超标，可能与非饮水型氟中毒有关，有关部门应加强关注。
本研究仍具有一定的局限性：（1）人群氟化物非致癌健康风险评价依赖于国外参考值，人群饮用水摄入量与体重参考全国平均值，与黄冈市实际情况可能存在差异；（2）未考虑水氟经皮肤接触暴露途径所致健康风险；（3）特定县区人群氟斑牙抽检样本较少，需要扩大检测覆盖面，增强数据代表性。总之，黄冈市饮用水氟化物含量低于国家限值，地氟病检出率低于30%，符合地氟病消除标准，但要注意部分县区的流行情况，扩大样本检测，深入掌握人群饮用水氟化物暴露风险变化趋势，关注氟斑牙流行趋势。
基金
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  • 湖北省公共卫生青年拔尖人才项目(鄂卫通2021-40号)
文献
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2025年第52卷第15期
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doi: 10.20043/j.cnki.MPM.202412275
  • 接收时间：2024-12-14
  • 首发时间：2026-03-16
  • 出版时间：2025-08-10
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  • 收稿日期：2024-12-14
基金
湖北省公共卫生青年拔尖人才项目(鄂卫通2021-40号)
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    黄冈市疾病预防控制中心，湖北 黄冈 438000

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2种不同金属材料的力学参数
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Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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