Khandare A L, Harikumar R, Sivakumar B
National Institute of Nutrition (ICMR), Jamia Osmania P.O., 500007, Hyderabad, India.
Calcif Tissue Int. 2005 Jun;76(6):412-8. doi: 10.1007/s00223-005-0233-2. Epub 2005 May 19.
A case-control study was undertaken to understand the etiopathology of the bone deformities among young children in a fluoride-affected village of the Bihar State. Two villages were selected: one village with high fluoride in drinking water (7.9 +/- 4.15 ppm), and the other village with normal levels of fluoride (0.6 +/- 0.31 ppm) as the control village. The source of drinking water was bore wells in both the villages. Two hundred and forty subjects from 54 households (HHs) of the high-fluoride village (HFV) and 1443 subjects from 197 HHs of the control village were selected for the study. Dental mottling (DM) was observed in 50% and skeletal deformities of various forms were observed in 20% of the total population of HFV, whereas, in the control village, DM was 6% and skeletal deformities were absent. The prevalence of both, DM and skeletal deformities was high in the younger age group of 1.5 to 14 years. Genu valgum, genu varum, bowing of tibia, saber shin, and widening of the lower ends of long bones at the wrist were the typical skeletal deformities observed among affected children in the HFV. X-rays of the children with deformities revealed varying degrees of bending of bones and enlargement of epiphyseal ends of metaphyses with fraying of bone and ligamental calcification. A survey indicated significantly low calcium and high phosphorus intake among the population of the HFV as compared to that of the control village, possibly resulting from low intake of milk and high intake of potatoes, respectively. The mean urinary fluoride level was significantly higher in the children of the HPV, both with and without deformities, as compared to that of the control village. The mean serum 25 OHD3 (25 Hydroxy Vitamin D) and calcium levels were significantly lower and alkaline phosphatase activity was significantly higher among the children with deformities as compared to those without deformities from the HFV and the control village. Serum intact parathyroid hormone (IPTH) levels were high in children both with and without deformities in the HFV as compared to those in the control village. No significant differences were observed in the concentration of serum and urinary creatinine, and Cu, and Mg levels between the HFV and the control village. It can be concluded that some of the children from the HFV manifested severe bone deformities (rickets), which were confirmed by the existence of low serum calcium and vitamin D levels.
开展了一项病例对照研究，以了解比哈尔邦一个受氟影响村庄幼儿骨骼畸形的病因病理。选取了两个村庄：一个村庄饮用水氟含量高（7.9±4.15 ppm），另一个氟含量正常（0.6±0.31 ppm）的村庄作为对照村。两个村庄的饮用水源均为井。从高氟村（HFV）的54户家庭中选取了240名受试者，从对照村的197户家庭中选取了1443名受试者进行研究。在HFV总人口中，50%观察到牙齿斑纹（DM），20%观察到各种形式的骨骼畸形，而在对照村，DM为6%，未观察到骨骼畸形。DM和骨骼畸形在1.5至14岁的较年轻年龄组中患病率较高。膝外翻、膝内翻、胫骨弯曲、军刀状胫以及手腕处长骨下端增宽是HFV中受影响儿童观察到的典型骨骼畸形。畸形儿童的X线显示骨骼有不同程度的弯曲，干骺端骨骺端增大，伴有骨质磨损和韧带钙化。一项调查表明，与对照村相比，HFV人群钙摄入量显著较低，磷摄入量较高，这可能分别是由于牛奶摄入量低和土豆摄入量高所致。与对照村相比，HFV中无论有无畸形的儿童尿氟平均水平均显著较高。与HFV和对照村无畸形的儿童相比，畸形儿童的血清25 OHD3（25-羟基维生素D）和钙平均水平显著较低，碱性磷酸酶活性显著较高。与对照村相比，HFV中无论有无畸形的儿童血清完整甲状旁腺激素（IPTH）水平均较高。HFV和对照村之间血清和尿肌酐浓度以及铜和镁水平未观察到显著差异。可以得出结论，HFV的一些儿童表现出严重的骨骼畸形（佝偻病），血清钙和维生素D水平低证实了这一点。
