【作者】 郭志伟；

【导师】 夏雅娟；

【作者基本信息】 内蒙古医学院 ， 流行病与卫生统计学， 2011， 硕士

【摘要】 目的研究不同剂量砷暴露人群的健康效应及剂量-效应关系,分析慢性砷暴露人群健康效应影响因素之间的关系,对砷暴露人群健康效应的危险度进行评估。方法本研究通过历史性队列研究的方法,整群抽取巴彦淖尔市的砷病区,以自然村为单位,根据居民水砷暴露的情况分层选择乡村,对居住在当地8年及以上的居民进行调查。依据水砷浓度分为<10μg/L(对照组)、10-100μg/L(低剂量组)、101-200μg/L(中剂量组)和>200μg/L(高剂量组)四个剂量组。结果1.皮肤损害患病率随着砷暴露浓度的升高呈上升趋势,对照组、低、中和高剂量砷暴露组居民皮肤角化与色素异常的患病率分别为18.4%、21.1%、25.9%、38.6%和1.5%、2.2%、5.6%和17.8%。不同剂量砷暴露人群砷中毒临床分度构成不同,差异有统计学意义(P<0.01),且随着砷暴露剂量的升高,砷中毒病人增多,病情程度加重,呈剂量-效应关系。2.多因素Logistic回归分析结果显示年龄、使用农药和水砷浓度为皮肤角化的危险因素(OR值分别为1.387、1.583和1.321,P<0.05),职业和维生素为其保护因素(OR值为0.307和0.260,P<0.05);年龄、农药使用、指甲砷含量、氟中毒和水砷浓度为色素异常的危险因素(OR值分别为1.724、2.636、2.741、3.699和1.863,P<0.05),而性别是其保护因素(OR值为0.255,P<0.01)。3.水砷与指甲砷含量呈正相关(r = 0.896,P <0.01),水砷与指甲硒含量呈负相关(r =-0.322,P<0.01),指甲砷与指甲硒含量也呈负相关(r =-0.355,P<0.01),指甲砷与砷暴露人群临床分度呈正相关(r =0.225,P<0.01)。4.与对照组相比,高剂量砷暴露组居民糖化血红蛋白(HbA1c)含量升高(P<0.05)。5.随着砷暴露浓度的升高,冠心病、高血压和神经系统症状的患病率升高,呈剂量-效应关系。结论慢性砷暴露可以造成人体多系统的健康毒害效应,其危害程度除砷暴露外,还与多种因素相关,应采取综合措施进行防治地方性砷中毒及其远期效应。更多还原

【Abstract】 Objective To study the health effects of residents exposed to arsenic in drinking water and their dose-effects relationship, to analyse the relationship of influence factors of health effects, to assess the health risk of arsenic exposure. Methods To analyse by retrospective cohort study. A cluster and stratified sampling method were used to select area and subjects according to arsenic concentration in drinking water. The subjects were asked to resident more than 8 years. They were divided into four groups according to arsenic level: control(<10μg/L), low(10-100μg/L), medium(101-200μg/L) and high(>200μg/L). Results 1.The level of skin lesion aggravated with increasing of the arsenic concentration in drinking water. The prevalence of keratosis and abnormal skin pigmentation in control, low, medium and high group were 18.4%, 21.1%, 25.9%, 38.6% and 1.5%, 2.2%, 5.6%, 17.8%. There were significant differences for clinical type among four groups of As exposed subjects(P<0.01). The number of patients increased and their conditions became more serious with the arsenic level increasing. The results showed a dose-effect relationship. 2.The multivariate factor analysis showed that the risk factors of keratosis were age, pesticide and the arsenic content in drinking water(OR=1.387, 1.583, 1.321, P<0.05), while occupation and vitamin were it’s protective factors(OR=0.307,0.260, P<0.05). The risk factors of abnormal skin pigmentation were age, pesticide, the content of nail arsenic, fluorosis and the arsenic content in drinking water(OR=1.724, 2.636, 2.741, 3.699, 1.863, P<0.05), while sex was it’s protective factor(OR=0.255, P<0.01). 3. The water As content was positively associated with nail As content (r=0.896, P<0.01), but was inversely associated with nail Se content (r=-0.322, P<0.01). The nail As content was also negatively associated with nail Se content (r =-0.355, P<0.01). The nail As was positively associated with clinical type of subjects exposed to arsenic (r =0.225, P<0.01). 4. To contrast with control group, the HbA1c level of high group increased(P<0.05). 5. With the increasing of arsenic concentration in drinking water, the prevalence of Coronary Heart Disease, hypertension and nervous system increased. The results indicated a dose-effect relationship too. Conclusion Many system of person could be damaged when exposed to chronic arsenic. The damage degree was associated with lots of factors except arsenic. A integrated measures should be implemented to prevent arsenism and long-term effects.更多还原