2006～2008年陕西省汉中市饮水性砷中毒流行病学调查

Epidemiological research on drinking-water arsenic poisoning in Hanzhong City during 2006～2008

目的了解2006～2008年汉中市沿汉江流域地区及分布有高砷石煤的镇巴县高砷水源分布和地方性砷中毒(简称地砷病)现状。方法根据国家和陕西省项目技术方案确定的选点原则,在汉中市沿汉江流域选择宁强、略阳、勉县、洋县、西乡5县及分布有高砷石煤的镇巴县共15个乡(镇)的25个自然村进行居民饮用水源水砷筛查检测,对水砷含量≥0.05 mg/L的村进行地砷病线索调查,对水砷含量≥0.15 mg/L的村进行地砷病病情普查,普查率不低于90%。地砷病诊断按照《地方性砷中毒诊断标准》(WS/T211-2001)进行。结果共检测水样616份,水砷超过国家标准(0.05 mg/L)水样7份,超标率1.14%。超标水样均分布于勉县温泉镇郭家湾村,属于温泉分布区所在地,水砷最高含量0.11 mg/L。超标水源暴露人口970人,暴露率9.84%。地砷病总检出率3.16%(25/791)。其中轻度9例(占36%),中度14例(占56%),重度2例(占8%);年龄52～88岁之间,平均65.56岁;暴露时间52～88年之间,平均65.16年;男性检出率为6.25%(24/384),女性为0.25%(1/407),男性明显高于女性。临床以单纯皮肤色素脱失居多,占76%(19/25),色素脱失与色素沉着并存次之,占24%(6/25),合并有肢端麻木达40%(10/25),未检出皮肤角化、鲍文氏病及皮肤癌病例。在镇巴县燃煤型砷中毒病区未检出水砷含量超标水样。结论汉中市沿汉江流域的勉县温泉地区水砷含量超标,属于地砷病病区,并与地方性氟中毒病区并存,建议开展氟砷联合中毒研究。

Objective To investigate the distribution of high arsenic water and endemic arsenic poisoning （arsenic disease） in Hanzhong City along the Han River valley region and Zhenba County. Methods Five counties along the Han River in Hanzhong City was chosen for investigation according to the national and Shaanxi technical proposal in principle, including Ningqiang, Lueyang, Mianxian, Yangxian, Xixiang. Besides, Zhenba County, where high arsenic coal was mined, was also included. Screening tests of arsenic drinking water were conducted in 15 towns, including 25 villages. And then, endemic arsenic disease investigation was conducted in villages where water arsenic concentrationS0. 05 rag/L, the census rate no less than 90%. The diagnostic standard accorded with Endemic Arsenic Poisoning Diagnostic Criteria （WS/T211-2001）. Results Of the 616 water samples detected, 7 samples（1.14 %） had arsenic content higher than the national standard （0.05 rag/L）, the highest being 0.11 mg/L. These samples were distributed in the spa town of Guojiawan Village in Mianxian County, with 970 people exposed to such water, exposure rate being 9.84%. The overall detection rate of arsenic disease was 3.16% （25/791）, with 9 minor cases（36%）, 14 moderate cases（56%）, and 2 severe cases （8%）. The patients＇age ranged from 52-88, average 65.56 years. The exposure time was 52-88 years, average 65.16. The detection rate of male was 6.25% （24/384）, which was significantly higher than that of female, 0.25% （1/407）. The major clinical manifestation included depigmentation of skin （76%）, pigmentation （24%）, and numbness of extremities （40%）. No case of skin keratinocytes, Baowenshi Disease, or skin cancer was detected. Excessive arsenic water samples were not detected in Zhenba County. Conclusion Along the Han River, the hot water in Mianxian County had the highest arsenic content and was one of the arsenic disease areas, where endemic fluorosis coexisted with arsenic disease. It＇s suggested that research on both fluorosis and arsenic disease should be conducted in this area.