新疆奎屯地区砷暴露与肝损伤关系的Meta分析及现况研究

发布时间：2018-08-03 09:58

【摘要】：目的：了解目前新疆奎屯高砷地区水砷含量及当地居民的健康状况,探讨砷对人体肝脏的损害作用,为进一步研究砷的肝毒性作用提供基础。方法：采用meta分析法探讨饮水型砷暴露与肝损伤的相关性,以此为理论依据为开展现场调查。回顾奎屯高砷地区往年水砷监测结果,分析该地水砷含量变化及分布状况,根据水砷检测结果选择高砷水源的129团部分居民为暴露组,低砷的129团部分居民为内对照组,相邻非砷暴露的125团为外对照组。进行问卷调查(基本情况、尿砷检查、皮肤科检查、B超检查等),收集问卷,进行样品采集、保存等。测定生物样品,并将收集到的数据录入Epidata建立数据库,用SPSS19.0进行统计分析。结果：1.关于砷暴露与肝损伤的研究经meta分析,异质性检验结果为P=0.16,宜采用固定效应模型,结果表明砷暴露与肝损伤存在中度相关(OR=3.72),提示砷暴露可能是砷中毒地区暴露人群肝病高发的一个危险因素。鉴于砷暴露组的肝损伤发生可能性高于对照人群,因此砷暴露可能是病区人群肝病高发的主要原因之一。2.流行病学调查研究：在分析近年来监测结果的基础上,本次研究检测各组水砷含量,结果显示暴露区水砷含量超标,且砷暴露组与内、外对照组水砷差异有统计学意义(P0.05)。人群流行病学资料选择暴露组200例及内外对照组各100例进行的比较,暴露组与内、外对照组的尿砷含量差异有统计学意义(P0.05),而内外对照组之间差异无统计学意义。肝脏B超检测显示暴露组与内、外对照组之间肝损伤分别差异有统计学意义。肝功能标志物检测显示,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、外对照组的差异有统计学意义；暴露组Ⅲ型前胶原肽与内对照组无统计学差异,而与外对照组有差异；内对照组与外对照组的比较显示在层粘连蛋白和Ⅳ型胶原上有统计学差异。结论：病区暴露居民易发生皮肤、神经系统疾病及肝损伤,且暴露组血清肝纤维化指标高于对照组,提示砷暴露与病区肝硬化高发有联系,砷暴露可能是导致肝功能损害尤其是肝纤维化的原因之一。
[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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