發(fā)布時(shí)間：2018-08-03 09:58

【摘要】：目的：了解目前新疆奎屯高砷地區(qū)水砷含量及當(dāng)?shù)鼐用竦慕】禒顩r,探討砷對(duì)人體肝臟的損害作用,為進(jìn)一步研究砷的肝毒性作用提供基礎(chǔ)。方法：采用meta分析法探討飲水型砷暴露與肝損傷的相關(guān)性,以此為理論依據(jù)為開(kāi)展現(xiàn)場(chǎng)調(diào)查�；仡櫩透呱榈貐^(qū)往年水砷監(jiān)測(cè)結(jié)果,分析該地水砷含量變化及分布狀況,根據(jù)水砷檢測(cè)結(jié)果選擇高砷水源的129團(tuán)部分居民為暴露組,低砷的129團(tuán)部分居民為內(nèi)對(duì)照組,相鄰非砷暴露的125團(tuán)為外對(duì)照組。進(jìn)行問(wèn)卷調(diào)查(基本情況、尿砷檢查、皮膚科檢查、B超檢查等),收集問(wèn)卷,進(jìn)行樣品采集、保存等。測(cè)定生物樣品,并將收集到的數(shù)據(jù)錄入Epidata建立數(shù)據(jù)庫(kù),用SPSS19.0進(jìn)行統(tǒng)計(jì)分析。結(jié)果：1.關(guān)于砷暴露與肝損傷的研究經(jīng)meta分析,異質(zhì)性檢驗(yàn)結(jié)果為P=0.16,宜采用固定效應(yīng)模型,結(jié)果表明砷暴露與肝損傷存在中度相關(guān)(OR=3.72),提示砷暴露可能是砷中毒地區(qū)暴露人群肝病高發(fā)的一個(gè)危險(xiǎn)因素。鑒于砷暴露組的肝損傷發(fā)生可能性高于對(duì)照人群,因此砷暴露可能是病區(qū)人群肝病高發(fā)的主要原因之一。2.流行病學(xué)調(diào)查研究：在分析近年來(lái)監(jiān)測(cè)結(jié)果的基礎(chǔ)上,本次研究檢測(cè)各組水砷含量,結(jié)果顯示暴露區(qū)水砷含量超標(biāo),且砷暴露組與內(nèi)、外對(duì)照組水砷差異有統(tǒng)計(jì)學(xué)意義(P0.05)。人群流行病學(xué)資料選擇暴露組200例及內(nèi)外對(duì)照組各100例進(jìn)行的比較,暴露組與內(nèi)、外對(duì)照組的尿砷含量差異有統(tǒng)計(jì)學(xué)意義(P0.05),而內(nèi)外對(duì)照組之間差異無(wú)統(tǒng)計(jì)學(xué)意義。肝臟B超檢測(cè)顯示暴露組與內(nèi)、外對(duì)照組之間肝損傷分別差異有統(tǒng)計(jì)學(xué)意義。肝功能標(biāo)志物檢測(cè)顯示,暴露組的血清透明質(zhì)酸、層粘連蛋白及Ⅳ型膠原含量與內(nèi)對(duì)照組、外對(duì)照組的差異有統(tǒng)計(jì)學(xué)意義；暴露組Ⅲ型前膠原肽與內(nèi)對(duì)照組無(wú)統(tǒng)計(jì)學(xué)差異,而與外對(duì)照組有差異；內(nèi)對(duì)照組與外對(duì)照組的比較顯示在層粘連蛋白和Ⅳ型膠原上有統(tǒng)計(jì)學(xué)差異。結(jié)論：病區(qū)暴露居民易發(fā)生皮膚、神經(jīng)系統(tǒng)疾病及肝損傷,且暴露組血清肝纖維化指標(biāo)高于對(duì)照組,提示砷暴露與病區(qū)肝硬化高發(fā)有聯(lián)系,砷暴露可能是導(dǎo)致肝功能損害尤其是肝纖維化的原因之一。
[Abstract]:Objective: to investigate the arsenic content in water and the health status of local residents in Kuitun, Xinjiang, and to explore the damage effect of arsenic on human liver, and to provide a basis for further study on the hepatotoxicity of arsenic. Methods: meta analysis was used to investigate the correlation between arsenic exposure and liver injury in drinking water. Reviewing the results of water arsenic monitoring in Kuitun high arsenic area in previous years, and analyzing the variation and distribution of arsenic in water in this area, according to the results of water arsenic detection, 129 regiment residents of high arsenic water source were selected as exposure group and some residents of 129 regiment with low arsenic as internal control group, 125 groups of adjacent non-arsenic exposed groups were used as external control group. Carry on the questionnaire (basic condition, urine arsenic examination, dermatology examination, B ultrasonic examination etc.), collect the questionnaire, collect the sample, save and so on. The biological samples were measured and the collected data were input into Epidata to establish the database. SPSS19.0 was used for statistical analysis. The result is 1: 1. The study on arsenic exposure and liver injury was analyzed by meta. The result of heterogeneity test was P0. 16, and the fixed effect model should be used. The results showed that there was a moderate correlation between arsenic exposure and liver injury (OR=3.72), which suggested that arsenic exposure might be a risk factor for high incidence of liver disease in population exposed to arsenic poisoning. As the possibility of liver injury in arsenic exposure group is higher than that in control group, arsenic exposure may be one of the main reasons for the high incidence of liver disease. Epidemiological investigation and study: on the basis of analyzing the monitoring results in recent years, this study detected the arsenic content in water in each group. The results showed that the arsenic content in water in the exposed area exceeded the standard, and the difference between the arsenic exposure group and the internal and external control groups was statistically significant (P0.05). The comparison of 200 cases of exposure group and 100 cases of internal and external control group showed that there was significant difference in urinary arsenic content among exposure group, internal and external control group (P0.05), but there was no significant difference between internal and external control group. Liver B-ultrasound examination showed that there were significant differences in liver injury between the exposed group and the internal and external control groups. The levels of serum hyaluronic acid, laminin and type 鈪，

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