饮水型砷暴露人群皮肤损伤转归与尿砷甲基化代谢产物水平关系的研究  

Relationship between skin injury outcome and urinary arsenic methylation metabolites levels in people exposed to arsenic through drinking water

作　　者：李昕晔 邓丹宇 赵凡 刘聪 李梦昕 狄震 崔娜 刘一君 孔畅 韦炳干[5] 李艳红 夏雅娟 郭志伟 Li Xinye;Deng Danyu;Zhao Fan;Liu Cong;Li Mengxin;Di Zhen;Cui Na;Liu Yijun;Kong Chang;Wei Binggan;Li Yanhong;Xia Yajuan;Guo Zhiwei(School of Public Health,Inner Mongolia Medical University,Hohhot 010110,China;Department of Research and Education,Inner Mongolia Autonomous Regional Center for Disease Control and Prevention(Inner Mongolia Autonomous Regional Academy of Preventive Medicine),Hohhot 010080,China;Department of Endemic Diseases Prevention and Control,Hangjinhou Banner Center for Disease Control and Prevention,Bayannur 015400,China;Institute of Endemic Disease,Inner Mongolia Autonomous Regional Center for Disease Control and Prevention(Inner Mongolia Autonomous Regional Academy of Preventive Medicine),Hohhot 010080,China;Key Laboratory of Land Surface Pattern and Simulation,Institute of Geographic Sciences and Natural Resources Research,Chinese Academy of Sciences,Beijing 100101,China)

机构地区：[1]内蒙古医科大学公共卫生学院,呼和浩特010110 [2]内蒙古自治区疾病预防控制中心(内蒙古自治区预防医学科学院)科研与宣教处,呼和浩特010080 [3]杭锦后旗疾病预防控制中心地方病防治科,巴彦淖尔015400 [4]内蒙古自治区疾病预防控制中心(内蒙古自治区预防医学科学院)地方病预防控制所,呼和浩特010080 [5]中国科学院地理科学与资源研究所陆地表层格局与模拟院重点实验室,北京100101

出　　处：《中华地方病学杂志》2024年第6期446-451,共6页Chinese Journal of Endemiology

基　　金：中央引导地方科技发展资金项目(2021ZY0047);"西部青年学者"项目(人字[2022]4号);内蒙古自治区科技计划项目(2021GG0383);内蒙古自治区卫生健康科技计划项目(202201161)

摘　　要：目的探讨饮水型砷暴露人群皮肤损伤转归与尿砷甲基化代谢产物水平的关系。方法采用整群抽样法,2004年(改水前)选取内蒙古自治区巴彦淖尔市饮水型地方性砷中毒病区的常住居民作为调查对象,并于2017年(改水后)对74名2004年调查对象进行跟踪随访。采集尿样,采用高效液相色谱电感耦合等离子体质谱仪检测尿砷甲基化代谢产物水平。根据《地方性砷中毒诊断》(WS/T 211-2015)评定调查对象皮肤损伤临床分度(正常、可疑、轻度、中重度)和2017年转归情况(好转、不变、加重),建立数据库并采用SPSS 25.0软件进行统计学分析。结果2004、2017年74例调查对象皮肤损伤临床分度构成(正常、可疑、轻度、中重度:2004年分别为38、18、4、14例,2017年分别为27、31、3、13例)比较,差异有统计学意义(χ^(2)=53.02,P<0.001)。与2004年比较,2017年调查对象尿中总砷(tAs)、无机砷(iAs)、一甲基胂(MMA)、二甲基胂(DMA)、无机砷百分比(iAs%)、一甲基胂与二甲基胂比值(MMA/DMA)水平均较低,差异均有统计学意义(Z=-8.24、-9.07、-7.81、-8.04、-8.24、-3.56,均P<0.001);二甲基胂百分比(DMA%)、一甲基化率(PMI)、二甲基化率(SMI)水平均较高,差异均有统计学意义(Z=-6.39、-8.24、-3.52,均P<0.001)。2004年不同皮肤损伤临床分度者2017年转归情况比较,差异有统计学意义(χ^(2)=30.80,P<0.001)。不同皮肤损伤转归者尿中tAs、iAs、MMA、DMA的变化量比较,差异均有统计学意义(H=10.62、9.35、8.80、9.13,均P<0.05)。结论改水可以显著降低砷暴露人群尿中tAs、iAs、MMA、DMA水平,饮水型砷暴露人群皮肤损伤转归可能与尿砷甲基化代谢产物tAs、iAs、MMA、DMA的变化量有关。Objective To investigate the relationship between the outcome of skin injury and urinary arsenic methylation metabolism levels in people exposed to arsenic through drinking water.Methods Using cluster sampling method,permanent residents from drinking-water-borne endemic arsenic poisoning areas in Bayannur City,Inner Mongolia Autonomous Region were selected as survey subjects in 2004(before water improvement).In 2017(after water improvement),74 survey subjects from 2004 were tracked and followed up.Urine samples were collected from survey subjects and high-performance liquid chromatography inductively coupled plasma mass spectrometry was used to detect the levels of arsenic methylation metabolites in urine.According to the"Diagnosis of Endemic Arsenic Poisoning"(WS/T 211-2015),the clinical grading(normal,suspicious,mild,moderate and severe)of skin injury of the survey subjects and the outcome of 2017(improved,unchanged,aggravated)were assessed.A database was established and SPSS 25.0 software was used for statistical analysis.Results The clinical grading ratios of skin injuries among survey subjects in 2004 and 2017 were compared,the differences were statistically significant(normal,suspicious,mild,moderate and severe:38,18,4,14 cases in 2004 and 27,31,3,13 cases in 2017,χ^(2)=53.02,P<0.001).Compared with 2004,in 2017,the levels of total arsenic(tAs),inorganic arsenic(iAs),monomethylarsenic(MMA),dimethylarsenic(DMA),percentage of inorganic arsenic(iAs%),and ratio of monomethylarsenic to dimethylarsenic(MMA/DMA)in the urine of survey subjects were low,and the differences were statistically significant(Z=-8.24,-9.07,-7.81,-8.04,-8.24,-3.56,P<0.001).The levels of dimethylarsenic percentage(DMA%),monomethylation rate(PMI)and dimethylation rate(SMI)were higher,and the differences were statistically significant(Z=-6.39,-8.24,-3.52,P<0.001).In 2004,patients with different clinical grading of skin injuries had different outcomes in 2017(χ^(2)=30.80,P<0.001).There were statistically significant differences in tAs,iAs,MMA

关 键 词：砷中毒 甲基化 皮肤损伤 转归 

分 类 号：R599.1[医药卫生—内科学]