| Objective (1) To investigate the prevalence of water type of endemic fluorosis in Shanxi province; (2) To understand the relationship between endemic fluorosis and Serum chemical elements, as well as Serum enzyme. (3) To explore the PvuII site polymorphism in the COL1A2 gene, relationship between influencing factors and skeletal fluorosis.Method (1) The subjects were selected from the high, medium endemic area and control area of drinking water type of endemic fluorosis in Shanxi province, investigated the prevalence of dental fluorosis, and skeletal fluorosis, measured the levels of peripheral serum Ca, Cu, Fe, Mg, P, Zn and serum enzymes ALP,γ-GT, LDH, ALT, CHE, compared the differences of the index between different groups. (2) The case-control study was conducted in this subject, patients with skeletal fluorosis were selected as case group and healthy people in same area were selected as control group. COL1A2 PvuII site genotype were detected by polymerase chain reaction - restriction fragment length polymorphisma (PCR-RFLP). All the data were analyzed by SPSS13.0 statistical software, the influencing factors were analyzed by non-conditional logistic regression andχ2-test.Results (1) 829 subjects from endemic and control areas of drinking water type of endemic fluorosis were detected dental fluorosis and 449 adults more than 30 years old were detected skeletal fluorosis. There was evident different of dental fluorosis(χ2=447.108, P<0.001), dental fluorosis of children of 8-12 years old(χ2=55.871,P<0.001) and skeletal fluorosis(χ2=54.612, P<0.001) among the medium and the high endemic fluorosis and control areas, the prevalence of dental fluorosis in the high endemic area and the medium one were 95.7% and 94.4%, children's prevalence were 93.0% and 77.8%, respectively. The prevalence of the skeletal fluorosis (59.7%) in the high endemic area was higher than those (24.4%.) in the medium area.(2) 835 subjects of chemical element in serum were detected, there were differents among three district groups of chemical elements in serum Ca, Cu, Fe, Mg, P, Zn content (P<0.05); also there were significant differences of Ca, Cu, Fe, Mg, P, Zn among sketetal patients of the endemic fluorosis areas, non-patients and the control area people (P<0.05); as well as, contents of serum Ca, P, Zn in different levels of skeletal fluorosis patients were significant differences (P<0.05). In this way, Ca, P content both showed U-curve relationship. In addition, serum Mg content has significant difference among three area groups (P<0.001), Medium and high areas were significantly lower than the control area, and there was significant difference serum Ca, Mg levels among dental fluorosis of the endemic fluorosis areas, non-patients and the control area children of 8-12 years old (P<0.05) .(3) 854 subjects of serum enzymes were detected, there were differences among three district groups of chemical elements in serum ALP,γ-GT, LDH, ALT, CHE content (P<0.05); as well as among sketetal patients of the endemic fluorosis areas, non-patients and the control area people (P<0.05).(4) There were significant differences among three district groups of COL1A2 PvuII site genotype (χ2=13.756, P=0.008), however, no differences were found between sketetal patients of the endemic fluorosis areas and non-patients as well as the control area people (P>0.05).(5) Case control study on the influencing factors about skeletal fluorosis by non-conditional logistic regression showed accommodation area, age and sex,seemed to be the major risk factors of skeletal fluorosis, accommodation area (OR=9.115,OR95%CI 4.219～19.690), sex(OR=2.751,OR95%CI 1.454～5.204), age(OR=1.214,OR95%CI 1.156～1.274). The risk suffering from the skeletal fluorosis of people in the high endemic area was 9.115 times than which in medium area; men's risk was 2.751 times than women; as the ages increased 10 years, the risk increased 1.214 times.(6) Interaction between sex and PvuII site polymorphism in the COL1A2 gene were found, the interaction index S = 0.31, for the antagonism.Conclusion (1) The condition of dental and skeletal fluorosis prevalence in Linyi, Shanxi Province were serious; (2) There was antagonistic effect between calcium, phosphorus and the fluorosis; People from endemic fluorosis areas showed obvious hypomagnesemia, it was high time that the locals should complemented calcium, magnesium, phosphorus, zinc,et al; (3)The serum ALP from endemic fluorosis group reflected the compensatory function of bone metabolism, it was a great significance to early skeletal fluorosis damage; long-term intake of fluoride might have a certain degree of liver injury, but serum ALT still can not be used as early liver damage indicators, needs to be further evidence; further evidences should also be studied to explore the impact of serumγ-GT,LDH,CHE and liver and kidney damage, energy metabolism disorders, nerve conduction.(4) Area, male and age were risk factors of skeletal fluorosis; (5) There was interaction between COL1A2 PvuII site pp genotype and sex, the Synergy Index S=0.31, which was antagonism.
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