邹忠兰,王庆陵,王祺,李成贵,张爱华
ZOU Zhonglan,WANG Qingling,WANG Qi,LI Chenggui,ZHANG Aihua

• 1:贵州医科大学环境污染与疾病监控教育部重点实验室
• 2:贵州医科大学公共卫生学院卫生毒理学教研室

摘要(Abstract)：

目的:追踪调查贵州雨樟燃煤型砷中毒患者肝损害情况,分析综合防控9年后砷中毒患者肝生化指标随病情的改变情况。方法:以贵州雨樟燃煤型砷中毒病区为调查点,按《地方性砷中毒诊断标准》(WS/T211—2001)确定362例砷暴露者,按皮肤损伤程度分为病区非病人组(n=81)和砷中毒组(n=281),砷中毒组再分为轻度砷中毒组(n=97)、中度砷中毒组(n=100)及重度砷中毒组(n=84);以相邻生活习惯和经济条件与病区人群相近的63名非砷暴露者居民为对照组,采用生物化学法检测调查对象清晨空腹血清中血清总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)、胆碱酯酶(CHE)、碱性磷酸酶(ALP)、谷氨酰胺转移酶(γ-GT)、总胆汁酸(TBA)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)水平及A/G值,并计算其超标率。结果:与对照组比较,病区非病人组ALB含量显著降低(P <0. 05),砷中毒组ALB、TP含量和A/G显著降低(P <0. 05),TBA、ALP和γ-GT含量显著升高(P <0. 05);与病区非病人组比较,砷中毒组ALB、TP含量和A/G显著降低(P<0. 05),TBA和ALP含量显著升高(P <0. 05); PA、CHE、AST、ALT活性在各组间比较,差异均无统计学意义(P> 0. 05);与对照组相比,病区非病人组及轻、中、重度砷中毒组ALB含量显著降低(P <0. 05),轻、中、重度砷中毒组TP含量和A/G显著降低、TBA和ALP含量显著升高(P <0. 05),γ-GT在中、重度砷中毒组显著升高(P <0. 05);与病区非病人组比较,各砷中毒组ALB含量和A/G显著降低,TBA含量显著升高(P <0. 05),中、重度砷中毒组TP含量显著降低(P <0. 05),重度砷中毒组ALP含量显著升高(P <0. 05);病区非病人组血清TP、CHE、AST、ALT、ALP和γ-GT超标率高于对照组,砷中毒患者血清TP、ALB、A/G、ALP、TBA、γ-GT、PA和AST超标率高于对照组。结论:综合防控9年后,贵州燃煤型砷中毒病区的非砷中毒病人肝功能有所好转,但砷中毒患者部分指标仍超过临床正常参考范围。
Objective: To investigate the liver damage in patients with Coal-burning arsenic poisoning of Yuzhang in Guizhou and analyze the changes of liver biochemical indexes in patients with arsenic poisoning after 9 years of comprehensive prevention and control. Methods: Coal-burning arsenism area in Yuzhang of Guizhou was selected for investigation. According to the Diagnostic Criteria for Endemic Arsenism(WS/T 211-2001),362 cases of arsenic exposure were selected and divided into the nonpatient group(n = 81) and the arsenism group(n = 281) due to the degree of skin injury. The arsenic poisoning group was subdivided into mild arsenism group(n = 97),moderate arsenism group(n =100) and severe arsenism group(n = 84). The control group of 63 non-arsenic exposed residents whose living habits and economic conditions was similar to those in the endemic area. Serum total protein(TP),albumin(ALB),prealbumin(PA),cholinesterase(CHE),alkaline phosphatase(ALP),glutamine transferase(γ-GT) and total bile acid(TBA),alanine aminotransferase(ALT),the level of aspartate aminotransferase(aAST) and A/G value were detected in subjects fasting serum of the morning by biochemical method,and the exceeding standard rate was calculated. Results: Compared with the control group,the ALB content in the non-patient group was significantly lower than that in the control group(P < 0. 05); the contents of ALB,TP and A/G were decreased significantly in arsenic poisoning group(P < 0. 05); the contents of TBA,ALP and γ-GT were increased significantly(P < 0. 05). Compared with the non-patient group,the content of ALB,TP and A/G were decreased significantly in arsenic poisoning group(P < 0. 05),and the contents of TBA and ALP were increased significantly(P < 0. 05). There was no significant difference in activity of PA,CHE,AST and ALT among different groups(P > 0. 05). Compared with the control group,the ALB content in non-patient,mild,moderate and severe arsenism group was decreased significantly(P < 0. 05). The contents of TP and A/G were significantly decreased,and the contents of TBA and ALP were significantly increased in mild,moderate and severe arsenic poisoning groups(P < 0. 05). γ-GT was increased significantly in moderate and severe arsenic poisoning groups(P < 0. 05). Compared with the non-patient group,the ALB content and A/G in the arsenism group were decreased significantly,and TBA content was increased significantly(P < 0. 05). The content of TP in moderate and severe arsenism group was significantly decreased(P < 0. 05),and the content of ALP in severe arsenism group was significantly increased(P < 0. 05). The exceeding standard rates of serum TP,CHE,AST,ALT,ALP,TBA and γ-GT in non-patient group were higher than those in control group. The rates of TP,ALB,A/G,ALP,TBA,γ-GT,PA and AST in patients with arsenism were higher than those in the control group. Conclusion: After 9 years of comprehensive prevention and control,the liver function of non-arsenism patients in coal-burning arsenism areas in Guizhou is improved,but some indexes of arsenic poisoning patients are still beyond the normal reference range of clinical practice.

关键词(KeyWords)： 燃煤污染;砷中毒;肝损害;生化指标;综合防控;贵州
coal pollution;arsenism;liver lesion;biochemical indexes;comprehensive control;Guizhou

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金重点资助项目(81430077,81730089)

作者(Author): 邹忠兰,王庆陵,王祺,李成贵,张爱华
ZOU Zhonglan,WANG Qingling,WANG Qi,LI Chenggui,ZHANG Aihua

DOI: 10.19367/j.cnki.1000-2707.2018.10.009

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