水砷暴露致人群心电图改变的研究

Human electrocardiogram changes caused by exposure to arsenic through drinking water

目的 研究不同水砷含量暴露与人群心电图改变的关系,探讨砷对心血管系统的影响.方法 2008-2013年,根据饮水型地方性砷中毒的历史监测资料,在山西省和内蒙古自治区选择15个村作为调查点,选择年龄≥20岁、饮水≥10年的当地常住居民作为调查对象,按照饮水砷含量分为对照组（＜0.01 mg/L）、低水砷组（0.01～＜0.05 mg/L）、中水砷组（0.05～＜0.10 mg/L）以及高水砷组（≥0.10 mg/L）.采集调查对象家中的饮用水,应用氢化物原子荧光法检测水砷,并描记12导联心电图,比较不同水砷暴露人群的心电图改变.结果 共对1 341人进行心电图检查,异常率为11.56％（155/1 341）,其中,对照组、低、中、高水砷组分别为5.7％（9/158）、12.85％（59/459）、12.02％（28/233）、12.02％（59/491）.对照组的心电图异常率均低于低、中、高水砷组（X^2值分别为6.141、4.391、5.090,P均＜0.05）.心电图改变以心律失常和ST-T改变为主.对照组的各种心律失常异常率[0（0/158）]均低于低、中、高水砷组[4.58％（21/459）、3.86％（9/233）、3.46％（17/491）;X^2值分别为7.483、6.247、5.618,P均＜0.05].4组人群右心室扩大、心肌缺血心电图异常率组间比较差异均有统计学意义（x2值分别为9.525、9.848,P均＜0.05）.结论 饮水型砷中毒病区居民心电图异常改变以心律失常和ST-T改变为主.水砷含量≥0.01 mg/L即可明显引起心电图异常率的增加,饮水砷对心脏组织有一定的影响.

Objective Through studying the relationship between different concentrations of arsenic in drinking water and ECG changes,to investigate the effects of arsenic on human cardiovascular system.Methods During 2008-2013,people that over 20 years old and over 10 years of drinking arsenic water were investigated in 15 villages of Shanxi Province and Inner Mongolia according to the historical data of endemic arsenic poisoning through drinking water,who were divided into control group （〈 0.01 mg/L）,low arsenic group （0.01-〈 0.05 mg/L）,medium arsenic group （0.05-〈 0.10 mg/L） and high arsenic group （≥0.10 mg/L） according to the concentration of water arsenic.Arsenic concentrations in drinking water samples were detected by the method of hydride generation atomic fluorescence spectrometry.ECG-site inspections were finished to record 12-lead ECG.The effect of different concentrations of arsenic in drinking water on ECG was studied.Results ECG of 1341 people were surveyed,and abnormal rate was 11.56% （155/1 341）,including abnormal rate of control group,low arsenic group,medium arsenic group and high arsenic group which was 5.7% （9/158）,12.85% （59/459）,12.02% （28/233）,and 12.02% （59/491）,respectively.The abnormal rate of control group was lower than that of low arsenic group,medium arsenic group and high arsenic group （X^2 =6.141,4.391,5.090,all P 〈 0.05）.ECG changes were characterized by cardiac arrhythmias and ST-T changes.A variety of arrhythmias abnormal rate of control group [0（0/158）] was lower than that of low arsenic group,medium arsenic group and high arsenic group [4.58% （21/459）,3.86% （9/233）,3.46% （17/491）; X^2 =7.483,6.247,5.618,all P 〈 0.05].In addition,there were significant differences among the four groups in the rates of right ventricular enlargement and myocardial ischemia （x2 =9.525,9.848,all P 〈 0.05）.Conclusions ECG changes of the residents in the areas of water-borne-endemic arsenic poisoning are characterized by cardiac arrhythmias and ST-T changes.Water arsenic concentration exceeding 0.01 mg/L could significantly increase the ECG abnormal rate,indicating that arsenic in drinking water has a certain effect on heart tissue.