燃煤型砷中毒患者临床特征、多系统损害及其意义

Clinical signs and poly-organic and system damages of arsenism caused by burning coal pollution and it's significance

目的 探讨燃煤型砷中毒的临床特征、多系统损害及其意义。方法 采用整群抽样与典型调查结合的方法进行现场调查 ,结合临床检查、生化分析和毒理学方法进行实验室检测。结果 砷进入人体的途径包括摄入富含砷食物和蔬菜以及吸入砷污染的空气 ;患者砷负荷、氧化损伤指标与正常人群比较差异均有统计学意义 ;砷中毒患者除慢性砷中毒的典型特征 (皮肤角化过度、色素异常 )外 ,肝脏、肾脏、神经系统、肺脏、心脏和球结膜微循环等损害亦很明显 ;多项特殊检查显示了砷的非临床早期损害。结论 生活区煤砷含量高及敞灶燃煤致食物和空气砷污染是贵州省地砷病发生的主要原因 ;临床上以多系统损害为特点 ,肝硬化和皮肤癌是其主要死因 ;实验室特殊检查明确显示了病区非患者及中毒患者的临床前期损害 ,如肝、肾功能损害、氨基酸代谢异常、氧化损伤等 ;多指标、多检测方法的联合应用对于砷中毒的监测、诊断和防治具有重要实际意义。

Objective To study the clinical signs and poly organic and system damages of arsenism caused by burning coal pollution and it's significance.Methods Using cluster sampling and typical investigation, a spot research was taken while experimental indexes were determined by clinical, biochemical and toxicologic methods.Results The route of entry included not only the ingestion of arsenic accumulated on food and vegetables but also the inhalation of arsenic polluted air. Arsenic amounts, lipid peroxidation of patients were abnormal changed and over the normal group's. Besides of the typical features of chronic arsenism (dermal hyperpigmentation, depigmentation and hyperkeratosis), liver, kidney and nerve damages, heart, irritation of respiratory tract and conjunctiva microcirculation were also noticed. Many special examinations showed the early non clinical damages of arsenism.Conclusions It is suggested that coal containing high arsenic, which was burned in uncovered stove, resulted in food and air pollution in endemic area of Guizhou province. Poly organic and system damages were its clinical features. Dermal cancer and liver cirrhosis were major sequels causing death. Special experimental examinations clearly showed clinical early damages of local non patients and poisoned patients, such as liver and kidney function, amino acid metabolism and oxidation damage. Combined multi biomarkers and multi methods have important and practical significance for monitoring, diagnosis, prevention and cure of arsenism.