Some standard content:
.ICS 13.100
National Occupational Health Standard of the People's Republic of China GBZ5—2002
Diagnostic Criteria of Industrial Fluorosis2002-04-08 Issued
Ministry of Health of the People's Republic of China
Implementation on 2002-06-01
Article 5.1 of this standard is recommended, and the rest are mandatory. This standard is formulated in accordance with the "Law of the People's Republic of China on the Prevention and Control of Occupational Diseases". From the date of implementation of this standard, if there is any inconsistency between the original standard GB3234-1982 and this standard, this standard shall prevail. Long-term exposure to excessive amounts of inorganic fluorine compounds in occupational activities can damage the health of exposed workers and cause systemic diseases mainly involving the skeletal system. This standard is formulated to protect the health of workers. The formulation of this standard takes the degree of bone changes and the scope of involvement as the basis for diagnostic classification. Appendix A of this standard is an informative appendix, and Appendix B and C are normative appendices. This standard is proposed and managed by the Ministry of Health of the People's Republic of China. This standard was drafted by Hunan Institute of Labor Health, Hunan Metallurgical Protection Institute, and Occupational Disease Hospital of West China Medical Center, Sichuan University.
This standard is interpreted by the Ministry of Health of the People's Republic of China. ..com disease.
Diagnostic criteria for industrial fluorosis
GBZ5-2002
Industrial fluorosis is a systemic disease characterized by bone changes caused by long-term exposure to excessive amounts of inorganic fluoride at work. Bone changes can be found by X-ray examination. They first appear in the trunk bones, especially the pelvis and lumbar spine, and then the radius, ulna, tibia, and fibula may also be affected. Bone density increases, trabeculae become thicker and thicker, and cross into a network, showing "gauze-like" or "sack-like" patterns. In severe cases, they are like "marble-like". Periosteum, interosseous membrane, tendon and ligament in the burn bone, ulna, cavity bone, rib, pelvis and lumbar spine show calcification or ossification of different sizes and shapes (bud-like, rose thorn-like or candle-like, etc.) and other periosseous changes.
Clinically, eye, upper respiratory tract and skin irritation symptoms and chronic inflammation appear earlier, and urine fluoride content often exceeds the local normal value. Back and limb pain, neurasthenia syndrome and digestive tract symptoms (loss of appetite, nausea, vomiting and upper abdominal pain, etc.) are more common. In severe cases, there may be limited joint movement, bone deformity and nerve compression symptoms. 1 Scope
This standard specifies the diagnostic criteria and treatment principles for industrial fluorosis. This standard applies to the diagnosis and treatment of industrial fluorosis. 2 Diagnostic principles
Based on the close occupational exposure history and bone X-ray changes, with reference to clinical symptoms and laboratory tests, comprehensive analysis should be conducted to exclude other diseases before diagnosis can be made. 3 Observation objects
Bone density is within the normal range, trabeculae are slightly thickened, and there are slight changes around the bones. 4 Stages of bone X-ray changes
Bone density increases, trabeculae are thickened and thickened, and cross-shaped in a "gauze-like" appearance; there is clear calcification or ossification of the periosteum and interosseous membrane of the radius, ulna or tibia and fibula. Among the bone or bone changes, if one is significant and the other changes are mild, it can also be diagnosed.
4.2 Stage II
In addition to the trunk bones, other parts can also be affected, with significantly increased bone density, significantly thickened trabeculae, and a "sack pattern" appearance; the changes around the bones are more obvious and extensive. 4.3 Stage IIII
Most of the bones in the body are affected. Bone density increases significantly, trabeculae are blurred and "marble-like"; long bone cortex thickens, chest cavity narrows. Peribone changes are more obvious and extensive, bone bridges may form between vertebrae. 5 Treatment principles
5.1 Treatment principles
..com Nutrition can be appropriately strengthened, vitamins can be supplemented, and symptomatic treatment can be given. Other treatments
Observation subjects
Regular review, no special treatment is required.
Stage 1 patients
Generally, there is no need to remove fluorine from work.
Stage II and IIIII patients
Remove fluorine from work, and arrange appropriate work or rest according to the body's functional status. Instructions for the correct use of this standard
See Appendix A (Informative Appendix), Appendix B and C (Normative Appendix). A.1 Scope of application of this standard
Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
This standard is only applicable to diseases caused by fluorine and its inorganic compounds, and is not applicable to diseases caused by organic fluorides. A.2 This disease is caused by long-term exposure to excessive inorganic fluorides, so there must be a history of working in a high-concentration environment for many years. The onset period is generally more than 10 years. In special cases where the working conditions are particularly bad, those who have been exposed for 3 years may also develop the disease. A.3 Bone X-ray changes are the main basis for the diagnosis and staging of this disease. Since bone X-ray changes are only relatively specific, other diseases with similar bone ray changes must be excluded, such as endemic fluorosis, rheumatoid arthritis, osteopetrosis, bone metastases and renal osteodystrophy. A.4 The clinical manifestations of this disease are relatively complex, involving almost every organ. Although these symptoms are not specific, they may precede or coexist with bone changes, and are important clues for discovering diseases. They can provide strong evidence in comprehensive analysis. Clinical symptoms should be referred to during diagnosis. However, since they are often not parallel to bone X-ray changes and it is difficult to clearly divide them into stages, diagnosis and staging are mainly based on bone X-ray changes.
A.5 The results of urine fluoride examination are irregular and highly volatile. In addition to being affected by drinking water and food, the main reason is the inconsistent urine retention time. The urine fluoride of fluoride-exposed workers rises and falls with the exposure after work, and basically returns to the original level after resting for 24 hours. Therefore, the urine retained before work 24 hours after being out of contact can better reflect the actual level in the workers' bodies. Taking into account the natural fluctuation of urine fluoride, urine should be retained once a week for more than three consecutive times, and the average value should be taken as the basis for measuring the level of urine fluoride..comB.1 Principle
Appendix B
(Normative Appendix)
Selective electrode determination of fluoride in urineThe fluoride electrode method is to use the potentiometric method to determine the activity of fluoride ions in the solution. The fluoride single crystal membrane is the sensitive element of the electrode. It is selective for fluoride ions. Due to the different fluoride ion concentrations inside and outside the membrane, a potential difference is generated on both sides of the membrane, which is called membrane potential (Em). The size of the membrane potential is related to the fluoride ion activity inside and outside the membrane, and the relationship can be expressed by the Nernst equation. When the fluoride ion activity of the solution inside the membrane remains unchanged, the relationship between the potential and the fluoride ion activity of the measured solution outside the membrane can be expressed by the following formula: Em=2.303×(RT/nF)×logaF
Wherein: R is a gas constant, equal to 8.3148 joules/gram molecule; T is an absolute temperature, equal to 273+solution temperature ℃; n is an ion charge number, for F, n=-1; F is a Faraday constant, equal to 96488 coulombs/gram equivalent; aF is a fluoride ion activity, equal to the product of the fluoride ion concentration (cF) and the activity coefficient (), that is, aF\=cF. During the test, the fluorine electrode and the saturated calomel electrode form a chemical cell, and the electromotive force of the cell is E = E, -Em. In the formula, E, is the potential of the saturated calomel electrode (reference electrode), which is a constant. Therefore, the electromotive force E is linearly related to logaF-, and 2.303RT/nF in the above formula is the slope of the straight line (also known as the gradient or Nernst coefficient). At 25°C, for negative 1-valent fluoride ions, it is equal to -59.16 millivolts: Therefore, by measuring the electromotive force E value, the corresponding fluoride ion concentration can be obtained. 2 Instruments
Fluoride ion selective electrode: It is recommended to use the CSB-F-1 product ion activity meter or precision acidometer produced by Changsha Semiconductor Materials Factory, or the acidometer and high potential potentiometer. b)
Magnetic stirrer.
50ml polyethylene plastic beaker.
B.3 Reagents
5N hydrochloric acid or sodium hydroxide solution.
b) 1% bromocresol green aqueous solution.
c) Fluorine-free total ionic strength buffer (for drawing standard curve): weigh 58g sodium chloride, 10g sodium citrate dihydrate, 57ml glacial acetic acid, dissolve in 500ml distilled water, add 3ml bromocresol green indicator, adjust pH with 20% sodium hydroxide solution until the indicator just turns green-blue, and dilute with water to 1L. d) Fluorine standard solution: accurately weigh 2.2104g analytical pure sodium fluoride dried at 105℃, dissolve in water, transfer to a 11 volumetric flask, dilute to scale, and shake well. This solution contains 1000μg F in 1ml and is stored in a polyethylene plastic bottle. When used, dilute into two standard application solutions: 1ml containing 100μg F and 1ml containing 10μg F. B.4 Collection of urine samples
..comWhen used as a diagnostic reference, it is recommended to collect urine before work 24 hours after the contact is broken, and measure it three times in a row, once a week. B.5 Analysis steps
a) In 7 50ml volumetric flasks, add standard solutions containing 5, 10, 25, 50, 100, 250, and 500μg of F in turn, add 25ml of total ionic strength buffer to each bottle, dilute to the mark with water, shake well, and the concentration of F in each bottle is 0.1, 0.2, 0.5, 1.0, 2.0, 5.0, and 10.0mg/l in turn. Pour about 20-25ml of the solution in each bottle into a 50ml small beaker (the volume does not need to be accurately measured), and put a magnetic stirring bar with an iron core plastic tube in each. Starting from low concentration, place the beakers on the magnetic stirrer in turn, insert the fluorine electrode and calomel electrode, turn on the stirrer and stir for about 2-4 minutes, stop stirring, and read the millivolt value of the potential. d) Stir for another 1-2 minutes, stop, and read the millivolt value again until it stops changing, and record the value. e) Draw a standard curve on semi-logarithmic coordinate paper. Accurately measure an appropriate amount (10 or 15 ml) of urine sample in a 50 ml beaker, add 2-3 drops of bromocresol green indicator, and adjust the pH value with 0.5 N hydrochloric acid or sodium hydroxide if necessary until the indicator just turns blue-green. 9) Add the same volume of total ionic strength buffer and stirring rod as the urine sample, insert the electrode, and measure the millivolt value in the same way. h) Find the fluorine concentration corresponding to the millivolt value on the standard curve and multiply it by 2, which is the fluorine concentration of the urine sample. Appendix C
(Normative Appendix)
Requirements for bone X-ray film
C.1 Use an X-ray diagnostic machine with an A of more than 200 mA, with a focal spot size not exceeding 2.0X2.0 mm, preferably a rotating anode bulb.
C.2 Filming location: The basic requirement is pelvic AP film, radial and ulna AP films on one side, and tibia and rib AP and lateral films on the same side: chest and lumbar spine AP films can be taken if necessary. The requirements are as follows.
Filming location
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talus, peroneal navicular
Target film distance, cm
Note, it is best to use a monitoring film base for practice film.
C.4 Radiography quality requirements
Milliampere-second, mAs
100~150
100~150
Kilovolt, kv
Thickness (cm)×2+(3~40)
Thickness (cm)×2+(30~40)
Thickness (cm)×2+（50~40）
Thickness (cm)x+（30~40)
Origin (cm)×2+(15~25)
Tideline
The radiography position is accurate, the contrast is good, the directly exposed area is black, the soft tissue is gray, the layers are distinct, and the cortex and trabeculae are clearly displayed.
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