水砷暴露水平与皮肤病变关系的病例对照研究

A case-control study of the realationship between arsenic in drinking water and skin lesions

目的分析山西省饮水型砷中毒病区水砷暴露水平与皮肤病变间的关系。方法按照《地方性砷中毒诊断标准》(WS/T211-2001)在山西省山阴县抽取192例地砷病患者和117例健康成人作为调查对象。入户采集饮用水,用电感耦合等离子体质谱联用仪(ICP-MS)定量检测水砷浓度。结果 126份砷中毒患者的饮用水样品中,水砷浓度范围为4.04～720μg/L,中位数为87.75μg/L,超过国家标准(50μg/L)的有80份,超标率为63.49%。按照不同的水砷暴露水平(≤10,～50,>50μg/L),以≤10μg/L组作为参考值进行分级分析,掌跖角化、色素沉着、色素脱失、总病情各组间比值比(OR)值分别为1.36、3.99,1.61、2.96,1.74、6.92,3.21、27.04,OR值呈递增趋势。进一步对水砷暴露水平与皮肤病变严重程度进行Spearman等级相关检验发现,水砷暴露水平与掌跖角化、色素沉着、色素脱失和总病情的严重程度之间存在正相关关系,r值分别为0.272、0.205、0.401、0.482(P<0.05)。结论山西省山阴县饮用水砷含量偏高,饮用高砷井水是慢性砷中毒的危险因素。随着水砷暴露水平的增加,皮肤病变严重程度增加。

Objective To investigate The relationship between arsenic in drinking water andskin lesions in endemic arsenicosis area of Shanxi Province.Methods Acording to The National Diagnosis Standard for Endemic Arsenism WS/T211-2001,192 endemic arsenism and 117 controls were selected in Shanyin County of Shanxi provience.The concentration of arsenic in dinking water which was collected indoors was analyzed for total arsenic,using inductivity coupled plasma-mass spectrometry（ICP-MS）.Results As concentration in drinking water was 4.04~720μg/L,The medium value of As in drinking water samples was 87.75μg/L,and there were 63.49% samples above the As level（50μg/L） of standards for drinking water quality in China.The water As concentrations was divided into three groups,≤10μg/L,~50μg/L and 〉50 μg/L,as compared with arsenic level（≤10μg/L） in drinking water,the OR values for hyperkeratosis,hyerpigmentation,hypopigmention,total skin lesions was 1.36,3.99;1.61,2.96;1.74,6.92;3.21,27.04;respectively.Further,Spearman correlation test showed that the severity of skin lesions was associated with the increasing of As concentration in water.Conclusion As levels in drinking water was high in water-born endemic arsenism area of Shanxi province.Arsenic in drinking water has been considered as a risk factor of arsenic poisoning.The degree of skin lessions increased,as the arsenic in drinking water increased.