燃煤污染型砷中毒患者血尿常规与肝肾生化指标特征  

Characteristics of blood routine indices, urine routine indices,and biochemical indices of liver and kidney in patients with coal-burning arsenism

作　　者：张涛 王庆陵[2,3] 葛建梅 邹忠兰 王大朋 孙宝飞[2,3] 魏绍峰 李军[2,3] 张爱华 ZHANG Tao;WANG Qing-lin;GE Jian-mei;ZOU Zhong-lan;WANG Da-peng;SUN Bao-fei;WEI Shao-feng;LI Jun;ZHANG Ai-hua(Guiyang Public Health Treatment Center,Guiyang,Guizhou 550001,China;Key Laboratory of Environmental Pollution Monitoring and Disease Control,Ministry of Education,Guiyang,Guizhou 550025,China;Sehool of Public Health,Guizhou Medical University,Guiyang,Guizhou 550025,China)

机构地区：[1]贵阳市公共卫生救治中心,贵州贵阳550001 [2]贵州医科大学环境污染与疾病监控教育部重点实验室,贵州贵阳550025 [3]贵州医科大学公共卫生学院,贵州贵阳550025

出　　处：《环境与职业医学》2018年第12期1089-1093,1099,共6页Journal of Environmental and Occupational Medicine

基　　金：国家自然科学基金项目(编号:81430077;81660525)

摘　　要：[目的]检测燃煤型砷中毒患者尿砷含量、血尿常规与肝肾生化指标,初步了解其健康状况。[方法] 2017年3月以贵州省雨樟镇燃煤型砷中毒病区为调查点,按照WS/T 211—2015《地方性砷中毒诊断标准》纳入200例砷中毒患者,按皮肤损伤程度将其分为轻度砷中毒组(59例)、中度砷中毒组(70例)和重度砷中毒组(71例);选取距病区12 km外有同样生活习惯,但无燃用高砷煤史的40名非砷暴露者居民为对照组;采用电感耦合等离子体质谱(ICP-MS)检测尿砷含量,全自动血液/尿液分析仪检测血尿常规及全自动生化分析仪检测肝肾生化指标。[结果]轻、中和重度患者尿砷含量分别为(27.59±19.72)、(25.58±17.78)、(31.72±22.79)μg/L·Cr,均高于对照组(P<0.05)。轻、中和重度患者血常规指标中白细胞(13.6%、14.3%、15.5%)、中性粒细胞(13.6%、15.7%、16.9%)、红细胞平均体积(44.1%、47.1%、49.3%)、平均血红蛋白浓度(28.8%、27.1%、29.6%)和血小板分布宽度(22.0%、28.6%、31.0%)异常率均高于对照组(P<0.05),上述指标异常率在轻、中和重度砷中毒患者组间差异无统计学意义(P>0.05)。对照组、轻、中和重度患者尿常规各指标异常率均未见统计学差异(P>0.05)。轻、中和重度患者肝生化指标中血清总蛋白[(79.54±5.01)、(77.69±6.04)、(76.08±5.73)g/L]、白蛋白[(47.23±3.35)、(44.10±4.34)、(42.30±3.76)g/L]、白球比(1.48±0.27、1.33±0.19、1.27±0.23)均低于对照组(P<0.05),中、重度患者肝生化指标胆碱酯酶[(9 618±1 942)、(9 600±2 273)U/L)]低于对照组(P<0.05);各砷中毒组组间比较结果显示,重度患者血清总蛋白明显低于轻度组(P<0.05),中、重度患者人血白蛋白、白球比和胆碱酯酶低于轻度组(P<0.05)。肾生化指标中,轻、中和重度患者尿素氮[(5.10±1.29)、(5.24±1.20)、(5.13±1.27)mmol/L)]含量高于对照组(P<0.05),中度及重度患者血肌酐[(67.40±12.32)、(69.03±13.14)mmol/L)]高于�[Objective] To detect urine arsenic content, blood/urine routine indices, and liver and kidney biochemical indices of patients with coal-burning arsenism, and preliminarily understand their health status.[Methods] In March 2017, a coal-burning arsenism area in Yuzhang Town of Guizhou was selected for investigation. According to the Diagnostic Criteria for Endemic Arsenism (WS/T 211-2015), 200 arsenism patients were diagnosed, and they were further divided into a mild arsenism group (n=59), a moderate arsenism group (n=70), and a severe arsenism group (n=71) according to skin damage. Another 40 non-arsenic exposed residents with similar living habits but living 12 km away from the endemic area were selected as the control group. Inductively coupled plasma mass spectrometry was used to detect arsenic content in urine samples, full automatic blood/urine analyzers were used to measure blood/urine routine test indices, and automatic biochemical analyzer was used to detect biochemical indices of liver and kidney.[Results] Urine arsenic levels in the mild, moderate, and severe coal-burning arsenism groups were (27.59±19.72), (25.58±17.78), and (31.72±22.79)μg/L·Cr, respectively, and all were higher than the level in the control group (P < 0.05). The abnormal rates of white blood cells (13.6%, 14.3%, 15.5%), neutrophils (13.6%, 15.7%, 16.9%), mean corpuscular volume (44.1%, 47.1%, 49.3%), mean corpuscular hemoglobin concentration (28.8%, 27.1%, 29.6%), and platelet distribution width (22.0%, 28.6%, 31.0%) in blood routine test of the mild, moderate, and severe arsenism groups were higher than the corresponding rates of the control group (P < 0.05), respectively, and there were no statistical differences in the above indices among the three arsenism groups (P > 0.05). There were no significant differences in the abnormal rates of urine routine indices among the four groups (P > 0.05). The total protein[(79.54±5.01), (77.69±6.04), (76.08±5.73) g/L], albumin[(47.23±3.35), (44.10±4.34), (42.30±3.76) g/L], and albu

关 键 词：砷中毒 煤 血常规 尿常规 血生化指标 

分 类 号：R124[医药卫生—环境卫生学]