山西省山阴县地方性砷中毒病区饮水砷与皮肤病变问关系调查

The relationship between arsenic in drinking water and skin lesions in endemic arsenism area in Shanyin County of Shanxi Province

目的分析山西省山阴县地方性砷中毒（简称地砷病）病区居民饮水砷暴露与皮肤病变间的关系，为地砷病防治研究提供流行病学依据。方法在山西审山阴县地砷病病区抽取17个村的189例地砷病患者和59例非患者（对照）作为调查对象。人户采集所有调查对象饮用水，用水砷快速检测试剂盒半定量检测水砷，并用高效液相色谱一等离子体质谱联用仪（HPLC—ICP—MS）定量检测水砷。地砷病皮肤病变按《地方性砷中毒诊断标准》（WS／T211-2001）进行诊断。结果在抽取的134份水样中，砷超标率达64．9％（87／134），水砷中位数为91.43μg／L。饮水砷暴露水平（〉50μg／L为高砷暴露，≤50μg／L为低砷暴露）与掌跖角化、色素沉着和脱失间的关联强度OR（95％CI）值分别为2．46（1．22—4．94）、3．34（1．50～7．44）和2．86（1．50～5．46）。随着水砷暴露水平（按≤10、≤50、≤200、〉200μg／L分组）升高，患掌跖角化、色素沉着和色素脱失组问OR值呈增加趋势，尤其是水砷〉200μg／L组以≤10μg／L组作为参考，OR值分别为6．15、13．96、11．41，组间差异均有统计学意义（P〈0．05）。皮肤色素Ⅲ度脱失患者水砷暴露水平（318．300μg／L）明显高于0、I、Ⅱ度脱失患者（86．670、131．800、110．590μg／L，P〈0．05）。结论山阴县属于中度砷暴露地区，水砷暴露是皮肤病变的危险因素，随着水砷暴露量增加，病变程度加重。

Objective To investigate the relationship between arsenic in drinking water and skin lesions in endemic arsenism area in Shanyin County of Shanxi Province, in order to provide epidemiologie data for further arsenism research. Methods One hundred and eighty-nine endemic arsenism patients and 59 controls were randomly selected in 17 endemic arsenism countries in Shanyin County of Shanxi Province. The content of arsenic in drinking water which was collected indoors was half-quantitatively screened by a kit made by Chinese Center for Disease Control and Prevention, then quantitatively determined by HPLC-ICP-MS. Patients of endemic arsenism were diagnosed by ＂The Standard of Diagnosis for Endemic Arsenism＂ （WS/T 211-2001 ）. Results There were 64.9% （87/134） samples above the arsenic level （50 μg/L） of drinking water and the median value of arsenic in drinking water was 91.43 μg/L in 134 water samples. The OR （95%CI） value between arsenic in drinking water and hyperkeratosis, hyperpigmentation, depigmentation was 2.46 （ 1.22 - 4.94）, 3.34 （ 1.50 - 7.44 ） and 2.86 （ 1.50 - 5.46 ）, respectively. The prevalence of hyperkeratosis, hyperpigmentafion and depigmentation increased, as the arsenic in drinking water increased（≤ 10, ≤50, ≤200, 〉 200 μg/L）, especially in 〉 200 μg/L group（OR = 6.15,13.96, 11.41, P 〈 0.05）. The arsenic level in drinking water of Ⅲ degree of depigmentation patients （318.300 μg/L） was higher（P 〈 0.05） than that of 0, Ⅰ and Ⅱ degree groups（86.670,131.800,110.590 μg/L,P 〈 0.05）. Conclusions Shanyin County is a medial arsenic pollution area. Arsenic in drinking water is considered as a risk factor of skin lesion. The degree of skin lesions increased, as the arsenic in drinking water increased.