贵州燃煤型砷中毒患者患恶性肿瘤死亡观察

Mortality of malignant tumor patient with endemic arsenism caused by coal-burning pollution in Guizhou

目的探讨贵州燃煤型砷中毒病区病人恶性肿瘤死亡情况,了解燃煤型砷中毒与癌症死亡之间的流行病学关系。方法采用前瞻性研究方法,观察了病区砷中毒病人从1991～2001年11年来的癌症死亡情况。结果砷中毒病人癌症年死亡率(204.07/10万)显著高于非砷中毒组(22.36/10万),其相对危险度(RR)为9.13,归因危险度(PAR)为89.04%。男性相对危险度(RR)为10.61,归因危险度(PAR)为90.57%,女性相对危险度(RR)为6.53,归因危险度(PAR)为84.69%。男女之间死亡率(危险度)差别有显著意义。总砷摄入量与癌症死亡率之间呈明显的剂量反应关系。癌症构成中依次为肺癌(39.02%)、肝癌(30.89%)、皮肤癌(25.20%)、胃癌(1.63%)、膀胱癌(1.63%)和直肠癌(0.81%)。女性尿中排泄的形态砷中3价砷(AsⅢ)明显较男性少,而二甲基胂酸(DMA)显著较多。结论长期摄入高砷煤污染的室内空气和粮食(玉米和辣椒)导致砷中毒,对癌症的发生具有直接作用,从而确立了燃煤型砷中毒与癌症的关系。女性砷中毒癌症死亡率显著低于男性,可能与女性无机砷甲基化能力高于男性有关。

Objective To study the mortality of malignant tumors patient with endemic arsenism and explore the relation of high-arsenic intake from indoor air and foodstuff polluted by coal-burning to cancers. Methods A historical prospective method was used to followed-up all cases with endemic arsenism for 11 years from 1991 to 2001. Results The mortality of malignant tumor ptient in the arsenism cases （204.07 per hundred thousand person-year） was significantly higher than that in the subject without endemic arsenism （22.36 per hundred thousand person-year）（P 〈 0.001）.The relative risk （RR） was 9.13. The mortality in female was significantly lower than that in male. A significant dose-response relationship between the total arsenic intake and the mortality of cancers was observed. The constitution order in the mortality of cancers was as follows： lung cancer（39.02%）, liver cancer（30.89%）, skin cancer（25.20%）, stomach cancer（1.63%）, bladder cancer （1.63%） and rectum cancer （0.81%）. Female was found to excrete more As^Ⅲ and DMA. Conclusions Intake of high arsenic from the indoor air and foodstuff polluted by domestic coal-burning is responsible for the mortality of cancers in the cases with endemic arsenism. The mortality of top three in this endemic area are lung, liver and skin cancer. The mortality in female was significantly lower than that in male, which is probably related to higher inorganic arsenic methylation capability in female.