总摄氟量与成人血清骨钙素的相关关系及其基准剂量
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摘要
目的探讨总摄氟量与血清骨钙素的剂量-效应关系及总摄氟量的基准剂量(benchmark dose,BMD),为氟骨症防治及总摄氟量标准的修订提供参考。方法选择瓦庙村和新淮村为调查点,以家庭手压井饮水氟含量为依据,分别从瓦庙村和新淮村分层随机抽取103名和43名成年常住居民为被调查对象,调查内容包括家庭饮水和食物中氟含量,每日各种食物、饮水的摄入量,检测室内外空气中氟含量和血清骨钙素含量。计算每日总摄氟量,并根据每日总摄氟量将被调查对象分为四组:A组的总摄氟量为≤1. 16 mg/(人·d)、B组> 1. 16 mg/(人·d)、C组> 3. 48 mg/(人·d)、D组>4. 99 mg/(人·d),分别统计各组血清骨钙素含量及血清骨钙素的异常率。结果瓦庙村居民的总摄氟量和血清骨钙素显著高于新淮村(P<0. 01)。随着总摄氟量的增加,血清骨钙素含量逐渐增加,血清骨钙素的异常率也逐渐增加,总摄氟量与血清骨钙素及血清骨钙素异常率有显著的剂量-效应关系。依据血清骨钙素的异常率计算的总摄氟量的基准剂量和基准剂量下限(benchmark dose lower limitation,BMDL)分别为1. 00 mg/(人·d)和0. 67 mg/(人·d)。结论骨钙素可能是氟接触人群骨损伤早期筛查的敏感指标;按照骨钙素计算的总摄氟量的BMDL显著低于国家总摄氟量标准。
Objective To explore the dose-response relationship between total fluoride intake and serum osteocalcin and the benchmark dose( BMD) of total fluoride intake so as to provide references for prevention and control of endemic skeletal fluorosis and revision of the national standard for total fluoride intake. Methods Wamiao and Xinhuai villages were selected as the investigation sites. Based on the fluoride concentration in drinking water in the household hand-pressed wells,a stratified random sampling method was used to recruit 103 adult permanent residents from Wamiao village and 43 from Xinhuai village. The surveyed contents included fluoride concentration in drinking water and food,daily intake of various foods and drinking water,and detection of fluoride in indoor and outdoor air and serum osteocalcin level. The daily total fluoride intake was calculated,and then all the subjects were divided into four groups( including groups A,B,C and D with the total fluoride intake≤1. 16 mg/( person·day),>1. 16 mg/( person·day),>3. 48 mg/( person·day) and >4. 99 mg/( person·day) respectively) according to the daily total fluoride intake. The serum osteocalcin level and the abnormal rate of serum osteocalcin in each group were statistically analyzed.Results The total fluoride intake and serum osteocalcin in the residents of Wamiao village were significantly higher than those in the residents of Xinhuai village( both P<0. 01). Serum osteocalcin level and the abnormal rate of serum osteocalcin gradually increased with the increment of total fluoride intake. There was a significant dose-response relationship between the total fluoride intake and serum osteocalcin,serum osteocalcin abnormal rate. The BMD and the benchmark dose lower limitation( BMDL) of total fluoride intake calculated based on the abnormal rate of serum osteocalcin were 1. 00 mg/( person · day) and0. 67 mg/( person·day) respectively. Conclusions Osteocalcin may be a sensitive indicator for early screening of bone injury in people exposed to fluoride. The BMDL of total fluoride intake calculated according to osteocalcin is significantly lower than that of the national standard.
Objective To explore the dose-response relationship between total fluoride intake and serum osteocalcin and the benchmark dose( BMD) of total fluoride intake so as to provide references for prevention and control of endemic skeletal fluorosis and revision of the national standard for total fluoride intake. Methods Wamiao and Xinhuai villages were selected as the investigation sites. Based on the fluoride concentration in drinking water in the household hand-pressed wells,a stratified random sampling method was used to recruit 103 adult permanent residents from Wamiao village and 43 from Xinhuai village. The surveyed contents included fluoride concentration in drinking water and food,daily intake of various foods and drinking water,and detection of fluoride in indoor and outdoor air and serum osteocalcin level. The daily total fluoride intake was calculated,and then all the subjects were divided into four groups( including groups A,B,C and D with the total fluoride intake≤1. 16 mg/( person·day),>1. 16 mg/( person·day),>3. 48 mg/( person·day) and >4. 99 mg/( person·day) respectively) according to the daily total fluoride intake. The serum osteocalcin level and the abnormal rate of serum osteocalcin in each group were statistically analyzed.Results The total fluoride intake and serum osteocalcin in the residents of Wamiao village were significantly higher than those in the residents of Xinhuai village( both P<0. 01). Serum osteocalcin level and the abnormal rate of serum osteocalcin gradually increased with the increment of total fluoride intake. There was a significant dose-response relationship between the total fluoride intake and serum osteocalcin,serum osteocalcin abnormal rate. The BMD and the benchmark dose lower limitation( BMDL) of total fluoride intake calculated based on the abnormal rate of serum osteocalcin were 1. 00 mg/( person · day) and0. 67 mg/( person·day) respectively. Conclusions Osteocalcin may be a sensitive indicator for early screening of bone injury in people exposed to fluoride. The BMDL of total fluoride intake calculated according to osteocalcin is significantly lower than that of the national standard.
引文
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[11]中国老年学学会骨质疏松委员会.中国人骨质疏松症建议诊断标准(第二稿)[J].中国骨质疏松杂志,2000,6(1):4-6.
[12]中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊治指南(2011年)[J].中华骨质疏松和骨矿盐疾病杂志,2011,4(1):2-17.
[13]Gaylor D,Ryanl,Kerwski D,et al. Procedures for calculation bench-mark doses for health risk assessment[J]. Regul Toxicol Pharmacol,1998,28(2):150-164.
[2]李广生,井玲,徐辉.地方性氟中毒发病机制的研究进展[J].中华病理学杂志,2005,34(10):632-634.
[3]马子阳,吴献毅,张彦军,等.胰岛素样生长因子1对2型糖尿病合并骨质疏松中骨钙素表达的影响[J].中国骨质疏松杂志,2018,24(5):686-689.
[4]Crump KS. A new method for determining allowable daily intakes[J].Fundam Appl Toxicol,1984,4(5):854-871.
[5]王广吉,高明献,张明访,等.总摄氟量与儿童智商的相关性研究[J].东南大学学报(医学版),2012,31(6):743-746.
[6]Xiang QY,Chen LS,Chen XD,et al. Serum fluoride and skeletal fluo-rosis in two villages in Jiangsu Province,China[J]. Fluoride,2005,38(3):199-205.
[7]黄长青.地方性氟骨症的X线诊断[J].中国地方病防治杂志,2011,26(1):21-25.
[8]钱海雷,向全永,陈连生,等.基准剂量在氟接触人群骨效应评价中的应用[J].环境与职业医学,2007,24(1):12-15.
[9]马国福.氟骨症临床与影像学诊断[J].影像研究与医学应用,2017,12(1):55-56.
[10]刘仲宇,叶瑜,戎利民.原发性骨质疏松症患者与对照人群血清骨钙素水平比较的Meta分析[J].中国骨质疏松杂志,2017,23(10):1280-1285.
[11]中国老年学学会骨质疏松委员会.中国人骨质疏松症建议诊断标准(第二稿)[J].中国骨质疏松杂志,2000,6(1):4-6.
[12]中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊治指南(2011年)[J].中华骨质疏松和骨矿盐疾病杂志,2011,4(1):2-17.
[13]Gaylor D,Ryanl,Kerwski D,et al. Procedures for calculation bench-mark doses for health risk assessment[J]. Regul Toxicol Pharmacol,1998,28(2):150-164.