【摘要】：目的：了解目前新疆奎屯高砷地區(qū)水砷含量及當地居民的健康狀況,探討砷對人體肝臟的損害作用,為進一步研究砷的肝毒性作用提供基礎。方法：采用meta分析法探討飲水型砷暴露與肝損傷的相關性,以此為理論依據為開展現場調查�；仡櫩透呱榈貐^(qū)往年水砷監(jiān)測結果,分析該地水砷含量變化及分布狀況,根據水砷檢測結果選擇高砷水源的129團部分居民為暴露組,低砷的129團部分居民為內對照組,相鄰非砷暴露的125團為外對照組。進行問卷調查(基本情況、尿砷檢查、皮膚科檢查、B超檢查等),收集問卷,進行樣品采集、保存等。測定生物樣品,并將收集到的數據錄入Epidata建立數據庫,用SPSS19.0進行統(tǒng)計分析。結果：1.關于砷暴露與肝損傷的研究經meta分析,異質性檢驗結果為P=0.16,宜采用固定效應模型,結果表明砷暴露與肝損傷存在中度相關(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)的一個危險因素。鑒于砷暴露組的肝損傷發(fā)生可能性高于對照人群,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.流行病學調查研究：在分析近年來監(jiān)測結果的基礎上,本次研究檢測各組水砷含量,結果顯示暴露區(qū)水砷含量超標,且砷暴露組與內、外對照組水砷差異有統(tǒng)計學意義(P0.05)。人群流行病學資料選擇暴露組200例及內外對照組各100例進行的比較,暴露組與內、外對照組的尿砷含量差異有統(tǒng)計學意義(P0.05),而內外對照組之間差異無統(tǒng)計學意義。肝臟B超檢測顯示暴露組與內、外對照組之間肝損傷分別差異有統(tǒng)計學意義。肝功能標志物檢測顯示,暴露組的血清透明質酸、層粘連蛋白及Ⅳ型膠原含量與內對照組、外對照組的差異有統(tǒng)計學意義；暴露組Ⅲ型前膠原肽與內對照組無統(tǒng)計學差異,而與外對照組有差異；內對照組與外對照組的比較顯示在層粘連蛋白和Ⅳ型膠原上有統(tǒng)計學差異。結論：病區(qū)暴露居民易發(fā)生皮膚、神經系統(tǒng)疾病及肝損傷,且暴露組血清肝纖維化指標高于對照組,提示砷暴露與病區(qū)肝硬化高發(fā)有聯系,砷暴露可能是導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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