摘要:
Objective Explore the impact factor of children's dental fluorosis,to provide a theoretical basis for prevention and control of dental fluorosis.Methods The 29 villages with water improvement projects for more than 5 years were selected as survey villages in Jiangsu,Shandong,Hebei,Anhui,Henan,Shaanxi Provinces by multi-stage random sampling.The investigation contents:①basic information:including village annual income per capita,water fluoride,the term of water supply improvement;②the water quality test:the levels of chloride,sulfate,total dissolved solids and so on in water were analyzed;③the dental fluorosis:dental fluorosis of children aged 8-12 was examined with Dean method;④the dietary survey:the dietary nutritional status of 8-12 years old children was surveyed by duplicate portion study,and dietary fluorine was analyzed.Single factor regression analysis was adopted to analyze the relationship of average water quality index between every village,dietary nutrition and so on as independent variables respectively and 8-12 years old children's dental fluorosis prevalence rate and degree as dependent variable.Impact factors were selected by backward elimination method.Statistical significant indicators were further analyzed by multivariate regression analysis,and then multiple regression models were established.Results A total of 3 043 children aged 8 to 12 were investigated in 29 villages,and 270 children were in dietary survey.The average prevalence rate of dental fluorosis was 30.2% (919/3 043),in the range of 2.0% (2/100)-71.4%(30/42).The prevalence index of dental fluorosis was 0.55,ranging from 0.04 to 1.59.Dietary protein (X16) and VE (X17) were identified as the protective factors of dental fluorosis,and the standard partial regression coefficients (SPRC) were-1.537 4 and-0.695 1,respectively,according to multiple factors regression analysis.Water fluoride (X11) and chloride (X12),dietary fluoride (X13),copper (X14) and zinc (X15) were identified as risk factors of dental fluorosis (SPRC were 0.549 7,0.432 7,0.329 8,1.400 9 and 1.023 3,respectively).The regression equation of the prevalence of dental fluorosis was:Ydertal Oucrosis =-54.854 3 + 19.770 6X11 + 0.121 3X12 + 4.280 2X13 + 30.773 5X14 +9.264 9X15-1.332 7X16-2.384 1X17.The standard partial regression analysis showed riboflav (X26) can reduce the risk of dental fluorosis (SPRC =-0.930 2).Fluoride (X21) and chloride of water (X22),fluoride (X23),phosphorus (X24),zinc (X25) of dietary can aggravate the severity of dental fluorosis (SPRC were 0.357 0,0.548 1,0.262 6,0.899 9 and 0.662 1,respectively).The regression equation of the prevalence of dental fluorosis popular index was:Ydental Ouorosis popular index =-1.090 5 + 0.210 2X21 + 0.002 0X22 + 0.057 6X23 + 0.001 1X24 + 0.089 0X25-1.473 3X26.Conclusion The increase of protein,VE and riboflav intaking can reduce or relieve the prevalence and severity of dental fluorosis.%目的 探讨影响儿童氟斑牙患病程度的因素,为氟斑牙的防治提供理论依据.方法 采用多阶段随机抽样方法,在江苏、山东、河北、安徽、河南、陕西6个省份抽取29个改水年限在5年以上村作为调查村.调查内容:①基本情况:包括年人均收入、水氟、改水年限等;②水质检测:测定各村饮水氯化物、硫酸盐、溶解性总固体等常规指标;③氟斑牙检查:按Dean法检查8~ 12岁儿童氟斑牙患病情况;④膳食调查:对8~ 12岁儿童采用双份饭法调查3d膳食营养状况,并测定膳食氟含量.将各村水质指标、膳食营养素均值等作为自变量,8~ 12岁儿童氟斑牙患病率、氟斑牙流行指数为因变量,分别进行单因素回归分析;再采用向后剔除法进行影响因素的选择;对有统计学意义的指标再进行多重线性回归分析,建立多因素回归模型.结果 29个村共调查8~12岁儿童3 043名,其中膳食营养调查270名.29个村儿童氟斑牙平均患病率为30.2%(919/3 043),范围为2.0%(2/100) ~ 71.4%(30/42);氟斑牙流行指数为0.55,范围为0.04~ 1.59.膳食蛋白质(X16)和维生素E(X17)为氟斑牙患病的保护因素,多重线性回归分析的标准偏回归系数分别为-1.537 4和-0.695 1.饮水氟化物(X11)、氯化物(X12),膳食氟(X13)、铜(X14)、锌(X15)为氟斑牙患病的危险因素,标准偏回归系数分别为0.549 7、0.432 7、0.329 8、1.400 9、1.023 3,氟斑牙患病的回归方程为:Y氟斑牙患病率=-54.854 3+19.770 6X11+0.121 3X12+ 4.280 2X13+ 30.773 5X14+ 9.264 9X15-1.332 7X16-2.384 1X17.膳食核黄素(X26)摄入的增加可减轻氟斑牙的患病程度,标准偏回归系数为-0.930 2.饮水氟化物(X21)、氯化物(X22),膳食氟(X23)、磷(X24)、锌(X25)的增加会加重氟斑牙的患病程度,标准偏回归系数分别为0.357 0、0.548 1、0.262 6、0.899 9、0.662 1.氟斑牙流行指数的回归方程为:Y氟斑牙流行指数=-1.090 5+0.210 2X21+0.002 0X=+ 0.057 6X23+ 0.001 1X24+0.089 0X25-1.473 3X26.结论 蛋白质、维生素E、核黄素的摄入增加可有效减少氟斑牙的发生或减轻其病损程度.