新疆奎屯地区砷暴露致肝损伤现况调查

The survey of liver injury induced by arsenic exposure in Kuitun of Xinjiang

目的调查新疆奎屯高砷地区水砷含量及当地居民健康状况,分析砷对人体肝脏的损害作用,为进一步探讨砷的肝毒性作用机制提供基础资料。方法采用现场流行病学的调查方法在新疆奎屯水砷监测点进行调查,调查对象377例,其中砷暴露组137例,内对照组126例,外对照组114例;分别进行问卷调查、临床检查及样品采集,比较3组肝B超检查结果、尿砷含量及肝损伤血清标志物的差异。结果砷暴露组居民尿砷含量为(121.25±18.70)μg/L,高于内对照组的(22.47±19.21)μg/L和外对照组的(18.52±15.98)μg/L,3组差异有统计学意义(F=65.491,P<0.001)。B超检查结果显示肝功能正常者325例,异常者52例。砷暴露组和内对照组、外对照组发生肝脏异常分布比较差异有统计学意义(χ2=6.440,P=0.040)。血清肝纤维化指标检测显示砷暴露组的血清透明质酸、层粘连蛋白及Ⅳ型胶原含量与内对照组、外对照组比较差异有统计学意义;暴露组Ⅲ型前胶原肽与内对照组比较差异无统计学意义,而与外对照组比较差异有统计学意义;内对照组与外对照组的层粘连蛋白和Ⅳ型胶原差异有统计学意义。结论新疆奎屯高砷地区居民饮用高砷水与当地居民肝病高发有一定的联系,砷暴露可能是导致肝功能损害尤其是肝纤维化的主要原因之一,应进一步采取针对性措施降低肝损伤发生率,以促进高砷地区各族居民的身体健康。

Objective The survey is to investigate the relationship between local people′s exposure to arsenic in water in Kuitun of Xinjiang and their health status,and to analyze the damaging effect on human hepatic function,which provides the basis for further study of the mechanism of arsenic toxicity.Methods 377 subjects in Kuitun were collected and were surveyed with a questionnaire,clinic examination and sample collection by using the method of field epidemiological investigation,among whom 137 cases are in arsenic exposure group,126 cases in internal control group and 114 cases in external control group.Results The content of urine arsenic in arsenic exposure group is （121.25±18.70）μg/L,which is higher than that in the internal control group （22.47±19.21）μg/L and the external control group （18.52±15.98）μg/L.The difference between 3 groups was statistically significant （F =65.491,P 〈 0.001）.B ultrasound examina-tion showed 325 cases of liver function were normal,52 cases of abnormal liver function.The difference of liver injury rate between arsenic exposed group and the control group was significant （χ^2= 6.440,P =0.040）.Detection of serum liver fibrosis indexes showed significant differences in serum hyaluronic acid, laminin and type Ⅳ collagen content between exposure group and the control group.It showed no signifi-cant difference in type Ⅲ precollagen between the exposure group and internal control group.There was significant difference in laminin and type Ⅳ collagen between internal control group and external control group.Conclusion There is a link between drinking water with high arsenic and local residents liver diseases in Kuitun of Xinjiang.Arsenic exposure may cause liver damage,particularly liver fibrosis.Therefore, we should take further measures to reduce the incidence of liver injury,and to promote the health of all residents in high arsenic area.