张涛, 王庆陵, 葛建梅, 邹忠兰, 王大朋, 孙宝飞, 魏绍峰, 李军, 张爱华. 燃煤污染型砷中毒患者血尿常规与肝肾生化指标特征[J]. 环境与职业医学, 2018, 35(12): 1089-1093, 1099. DOI: 10.13213/j.cnki.jeom.2018.18347
引用本文: 张涛, 王庆陵, 葛建梅, 邹忠兰, 王大朋, 孙宝飞, 魏绍峰, 李军, 张爱华. 燃煤污染型砷中毒患者血尿常规与肝肾生化指标特征[J]. 环境与职业医学, 2018, 35(12): 1089-1093, 1099. DOI: 10.13213/j.cnki.jeom.2018.18347
ZHANG Tao, WANG Qing-ling, GE Jian-mei, ZOU Zhonglan, WANG Da-peng, SUN Bao-fei, WEI Shao-feng, LI Jun, ZHANG Ai-hua. Characteristics of blood routine indices, urine routine indices, and biochemical indices of liver and kidney in patients with coal-burning arsenism[J]. Journal of Environmental and Occupational Medicine, 2018, 35(12): 1089-1093, 1099. DOI: 10.13213/j.cnki.jeom.2018.18347
Citation: ZHANG Tao, WANG Qing-ling, GE Jian-mei, ZOU Zhonglan, WANG Da-peng, SUN Bao-fei, WEI Shao-feng, LI Jun, ZHANG Ai-hua. Characteristics of blood routine indices, urine routine indices, and biochemical indices of liver and kidney in patients with coal-burning arsenism[J]. Journal of Environmental and Occupational Medicine, 2018, 35(12): 1089-1093, 1099. DOI: 10.13213/j.cnki.jeom.2018.18347

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

  • 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)高于对照组(P < 0.05);各砷中毒组组间比较结果显示,中、重度砷中毒组血肌酐水平明显高于轻度砷中毒组(P < 0.05)。

    结论 该病区部分患者体内尿砷负荷高于当地对照人群,血常规、肝肾生化指标异常,提示低砷污染及除砷典型皮肤损害外的其他脏器的慢性损害不容忽视,持续加强病区砷污染状况的监管及关注砷中毒患者慢性病的发生发展情况,对防止病情进展及早期针对性治疗有重要意义。

     

    Abstract: 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 albumin/globulin (1.48±0.27, 1.33±0.19, 1.27±0.23) in the liver biochemical test of the mild, moderate, and severe groups all were lower than those of the control group (P < 0.05); the cholinesterase levels(9 618±1 942), (9 600±2 273) U/L of the moderate and severe groups were lower than that of the control group (P < 0.05); the total protein of the severe group was lower than that of the mild group (P < 0.05); albumin, albumin/globulin, and cholinesterase of the moderate and severe groups were lower than those of the mild group (P < 0.05). In the renal biochemical test, the urea nitrogen levels of the mild, moderate, and severe groups(5.10±1.29), (5.24±1.20), (5.13±1.27) mmol/L were higher than that in the control group (P < 0.05); the serum creatinine levels in the moderate and severe patients(67.40±12.32), (69.03±13.14) mmol/L were higher than those in the control group (P < 0.05); the serum creatinine levels of the moderate and severe groups were significantly higher than that in the mild group (P < 0.05).

    Conclusion The urinary arsenic levels of some patients in this coal-burning arsenism area is higher than that of local controls, and their blood routine test and liver/kidney biochemical indices are abnormal. It suggests that low arsenic pollution and its chronic damage to other organs other than skin should not be ignored, and continuously strengthening the supervision of arsenic pollution and paying attention to the occurrence and development of chronic diseases in arsenism patients are important to the prevention and early targeted treatment of the disease.

     

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