地(di)(di)(di)方病(bing)與飲(yin)用(yong)水水質(zhi)的關(guan)系是(shi)一個非常典(dian)型(xing)的問題。由(you)(you)飲(yin)用(yong)水所導(dao)致(zhi)的地(di)(di)(di)方病(bing)是(shi)由(you)(you)于(yu)水中某些微量元素(su)(su)過多或(huo)嚴重缺乏而引起的地(di)(di)(di)方性非傳染(ran)性疾病(bing)。這些化學元素(su)(su)是(shi)人(ren)體中激(ji)素(su)(su)、酶(mei)和維生素(su)(su)的組成成分或(huo)是(shi)人(ren)體組織(zhi)或(huo)器官不可缺少(shao)的成分，因此過多或(huo)過少(shao)，均可引起疾病(bing)。

我(wo)國(guo)常見(jian)的(de)(de)與飲(yin)用水有關(guan)的(de)(de)生物地(di)(di)球化學性疾病是地(di)(di)方性氟(fu)中毒、地(di)(di)方性甲(jia)狀腺(xian)腫和地(di)(di)方性砷中毒。

(1)地方性氟中毒

地(di)(di)方性(xing)(xing)(xing)氟(fu)(fu)(fu)(fu)(fu)中(zhong)(zhong)毒(du)(du)是人(ren)體(ti)從(cong)水(shui)(shui)(shui)、食物(wu)、空(kong)氣中(zhong)(zhong)攝(she)入過量(liang)的(de)(de)(de)氟(fu)(fu)(fu)(fu)(fu)而引(yin)起(qi)的(de)(de)(de)一(yi)種(zhong)慢(man)性(xing)(xing)(xing)全(quan)身(shen)性(xing)(xing)(xing)疾病(bing)(bing)。主(zhu)要(yao)表(biao)現(xian)為氟(fu)(fu)(fu)(fu)(fu)斑牙(ya)(ya)(ya)和氟(fu)(fu)(fu)(fu)(fu)骨(gu)(gu)癥(zheng)。氟(fu)(fu)(fu)(fu)(fu)斑牙(ya)(ya)(ya)主(zhu)要(yao)表(biao)現(xian)為門牙(ya)(ya)(ya)出現(xian)釉(you)斑，牙(ya)(ya)(ya)齒表(biao)面粗糙無光澤，嚴(yan)重時牙(ya)(ya)(ya)面磨損(sun)、碎裂并脫落。氟(fu)(fu)(fu)(fu)(fu)骨(gu)(gu)癥(zheng)主(zhu)要(yao)表(biao)現(xian)為四肢(zhi)、脊柱關節持續疼痛，關節僵硬骨(gu)(gu)骼變形，甚至造成癱瘓(huan)。雖然進入人(ren)體(ti)的(de)(de)(de)氟(fu)(fu)(fu)(fu)(fu)來源(yuan)很多，但由(you)于(yu)水(shui)(shui)(shui)中(zhong)(zhong)的(de)(de)(de)氟(fu)(fu)(fu)(fu)(fu)化物(wu)具有(you)易(yi)溶(rong)性(xing)(xing)(xing)，吸收率往往在90％以(yi)上，因此(ci)是體(ti)內氟(fu)(fu)(fu)(fu)(fu)化物(wu)的(de)(de)(de)主(zhu)要(yao)來源(yuan)。我(wo)國地(di)(di)方性(xing)(xing)(xing)氟(fu)(fu)(fu)(fu)(fu)病(bing)(bing)主(zhu)要(yao)屬(shu)飲(yin)(yin)水(shui)(shui)(shui)型。據(ju)調查，地(di)(di)方性(xing)(xing)(xing)氟(fu)(fu)(fu)(fu)(fu)中(zhong)(zhong)毒(du)(du)遍及我(wo)國28個省、自(zi)治區、直(zhi)轄(xia)市(上海市除(chu)外(wai))，病(bing)(bing)區人(ren)口總數(shu)達(da)8561萬。全(quan)國約有(you)氟(fu)(fu)(fu)(fu)(fu)斑牙(ya)(ya)(ya)患(huan)者(zhe)3753萬人(ren)，氟(fu)(fu)(fu)(fu)(fu)骨(gu)(gu)癥(zheng)患(huan)者(zhe)172萬人(ren)。氟(fu)(fu)(fu)(fu)(fu)骨(gu)(gu)癥(zheng)的(de)(de)(de)患(huan)病(bing)(bing)率與飲(yin)(yin)用(yong)(yong)(yong)水(shui)(shui)(shui)中(zhong)(zhong)氟(fu)(fu)(fu)(fu)(fu)含(han)(han)量(liang)呈正相關。飲(yin)(yin)用(yong)(yong)(yong)水(shui)(shui)(shui)中(zhong)(zhong)氟(fu)(fu)(fu)(fu)(fu)含(han)(han)量(liang)低于(yu)3.0mg/L時，氟(fu)(fu)(fu)(fu)(fu)骨(gu)(gu)癥(zheng)病(bing)(bing)情較輕(qing)；達(da)到4.0mg/L以(yi)上時，氟(fu)(fu)(fu)(fu)(fu)骨(gu)(gu)癥(zheng)患(huan)病(bing)(bing)率增高(gao)；當飲(yin)(yin)用(yong)(yong)(yong)水(shui)(shui)(shui)中(zhong)(zhong)氟(fu)(fu)(fu)(fu)(fu)含(han)(han)量(liang)高(gao)于(yu)10.0mg/L時，氟(fu)(fu)(fu)(fu)(fu)骨(gu)(gu)癥(zheng)患(huan)病(bing)(bing)率明顯增高(gao)，病(bing)(bing)情嚴(yan)重，可致患(huan)者(zhe)殘疾。為防止地(di)(di)方性(xing)(xing)(xing)氟(fu)(fu)(fu)(fu)(fu)中(zhong)(zhong)毒(du)(du)，我(wo)國飲(yin)(yin)用(yong)(yong)(yong)水(shui)(shui)(shui)衛生標準(zhun)中(zhong)(zhong)規定(ding)了飲(yin)(yin)用(yong)(yong)(yong)水(shui)(shui)(shui)中(zhong)(zhong)氟(fu)(fu)(fu)(fu)(fu)的(de)(de)(de)含(han)(han)量(liang)限(xian)值為1.0mg/L。

(2)地方性甲狀腺腫　

地(di)方性(xing)甲(jia)狀(zhuang)(zhuang)(zhuang)(zhuang)腺腫(zhong)(zhong)的(de)(de)(de)發(fa)病(bing)(bing)(bing)(bing)(bing)(bing)原因主要(yao)是由于(yu)水(shui)(shui)和(he)土(tu)壤中缺乏碘(dian)(dian)。該病(bing)(bing)(bing)(bing)(bing)(bing)主要(yao)的(de)(de)(de)臨床特征(zheng)是甲(jia)狀(zhuang)(zhuang)(zhuang)(zhuang)腺腫(zhong)(zhong)大(da)，嚴重流行地(di)區(qu)兒童可(ke)發(fa)生地(di)方性(xing)克(ke)汀病(bing)(bing)(bing)(bing)(bing)(bing)，病(bing)(bing)(bing)(bing)(bing)(bing)人癡(chi)呆、矮(ai)小、聾啞、智力低(di)(di)下。除上(shang)海市無(wu)地(di)方性(xing)甲(jia)狀(zhuang)(zhuang)(zhuang)(zhuang)腺腫(zhong)(zhong)外，其余(yu)省、自治(zhi)區(qu)、直(zhi)轄市均有(you)不同程度(du)的(de)(de)(de)流行。病(bing)(bing)(bing)(bing)(bing)(bing)區(qu)人口總數37864萬人，全國約有(you)地(di)方性(xing)甲(jia)狀(zhuang)(zhuang)(zhuang)(zhuang)腺腫(zhong)(zhong)患者(zhe)約1984萬人。病(bing)(bing)(bing)(bing)(bing)(bing)區(qu)的(de)(de)(de)土(tu)壤、飲(yin)(yin)用水(shui)(shui)、食品(pin)中碘(dian)(dian)的(de)(de)(de)含(han)(han)量普遍偏低(di)(di)。飲(yin)(yin)用水(shui)(shui)中碘(dian)(dian)含(han)(han)量越(yue)低(di)(di)，該病(bing)(bing)(bing)(bing)(bing)(bing)發(fa)病(bing)(bing)(bing)(bing)(bing)(bing)率(lv)(lv)往往越(yue)高(gao)(gao)。一般飲(yin)(yin)用水(shui)(shui)中碘(dian)(dian)含(han)(han)量低(di)(di)于(yu)10ug/L時(shi)，就有(you)可(ke)能(neng)發(fa)生地(di)方性(xing)甲(jia)狀(zhuang)(zhuang)(zhuang)(zhuang)腺腫(zhong)(zhong)；飲(yin)(yin)用水(shui)(shui)中碘(dian)(dian)含(han)(han)量低(di)(di)于(yu)4ug/L時(shi)，地(di)方性(xing)甲(jia)狀(zhuang)(zhuang)(zhuang)(zhuang)腺腫(zhong)(zhong)的(de)(de)(de)患者(zhe)明顯(xian)增(zeng)多；含(han)(han)量低(di)(di)于(yu)2ug/L時(shi)，居(ju)民中甲(jia)狀(zhuang)(zhuang)(zhuang)(zhuang)腺腫(zhong)(zhong)患者(zhe)可(ke)達50％。飲(yin)(yin)用水(shui)(shui)中碘(dian)(dian)含(han)(han)量高(gao)(gao)時(shi)，該病(bing)(bing)(bing)(bing)(bing)(bing)患病(bing)(bing)(bing)(bing)(bing)(bing)率(lv)(lv)較低(di)(di)。值得注(zhu)意的(de)(de)(de)是當飲(yin)(yin)用水(shui)(shui)中碘(dian)(dian)含(han)(han)量過高(gao)(gao)(大(da)于(yu)90ug/L)時(shi)，甲(jia)狀(zhuang)(zhuang)(zhuang)(zhuang)腺腫(zhong)(zhong)患病(bing)(bing)(bing)(bing)(bing)(bing)率(lv)(lv)反(fan)而(er)升高(gao)(gao)，說(shuo)明攝入(ru)過多的(de)(de)(de)碘(dian)(dian)可(ke)能(neng)導致抑制甲(jia)狀(zhuang)(zhuang)(zhuang)(zhuang)腺素的(de)(de)(de)生成和(he)釋放。防(fang)治(zhi)地(di)方性(xing)甲(jia)狀(zhuang)(zhuang)(zhuang)(zhuang)腺腫(zhong)(zhong)的(de)(de)(de)主要(yao)方法是采(cai)(cai)用碘(dian)(dian)制劑和(he)含(han)(han)碘(dian)(dian)多的(de)(de)(de)海產品(pin)，大(da)面積預防(fang)可(ke)采(cai)(cai)用食鹽加碘(dian)(dian)的(de)(de)(de)辦法。

(3)地方性砷中毒

地方性砷(shen)中毒是由于(yu)飲(yin)用(yong)(yong)含砷(shen)量高(gao)的(de)(de)水而引起(qi)的(de)(de)一(yi)種地方病(bing)。主(zhu)要(yao)表(biao)現為末梢神經炎、皮膚(fu)(fu)色素沉著、手掌(zhang)和(he)腳掌(zhang)皮膚(fu)(fu)高(gao)度角化以(yi)及(ji)皮膚(fu)(fu)癌。由于(yu)砷(shen)進入機體(ti)后引起(qi)四肢(特別是下肢)血管神經紊亂，使(shi)肢體(ti)血管痙攣，最后完全阻塞，導(dao)致(zhi)皮膚(fu)(fu)變黑壞死，因此該(gai)(gai)病(bing)又稱為黑腳病(bing)。尋找并使(shi)用(yong)(yong)符合飲(yin)用(yong)(yong)水衛生標(biao)準、含砷(shen)量較低的(de)(de)水源，研究和(he)采用(yong)(yong)有效(xiao)的(de)(de)飲(yin)用(yong)(yong)水除砷(shen)措施是該(gai)(gai)病(bing)的(de)(de)主(zhu)要(yao)預防手段。

我國地方病病區廣闊，暴露人口眾多，某些種類的地方疾病，依然危害著病區人民群眾的健康。影響著社會經濟的發展，我國政府對地方病的防治工作非常重視，2002年11月29日，國務院關于進一步加強農村衛生工作的決定中，強調地方病重區要加強改水、改灶、移民和環境保護等綜合措施。當前地方病防治工作，依然是我國衛生工作的長期任務和工作重點之一。
 

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