燃煤型砷中毒患者肺功能损伤现况调查
A cross-sectional study on lung function damage in patients with coal-burning type arsenism
-
摘要:
背景 非职业性砷暴露主要是通过使用高砷煤、饮水或食物接触砷。肺是砷作用的主要靶器官之一。肺功能指标可反映早期肺部损伤, 对评价人群肺的损伤程度和劳动能力鉴定意义重大。
目的 探讨贵州省燃煤型砷中毒病区患者肺功能损伤情况。
方法 以贵州省雨樟燃煤型砷中毒病区为调查点, 根据WS/T 211-2015《地方性砷中毒诊断标准》确定砷中毒病例216名, 其中轻度砷中毒56名、中度砷中毒81名和重度砷中毒79名。选取非病区生活习惯相似且无燃用高砷煤史, 无遗传和肿瘤家族史, 且体检合格的79名健康人为对照组。采用肺功能检测仪检测调查对象肺功能, 测定指标包括用力肺活量(FVC)、第一秒用力呼气量(FEV1)等, 以FEV1/FVC低于预测值的92%作为反映阻塞性通气功能障碍的敏感指标。
结果 各组调查对象年龄、性别差异无统计学意义。轻、中、重度组燃煤型砷中毒病人肺通气功能异常率分别为30.4%、43.2%、45.6%, 均高于对照组的肺功能异常率(7.6%)(P < 0.05);轻、中、重度组的阻塞性肺通气功能障碍发生率分别为26.8%、30.9%和31.6%, 均高于对照组(6.3%), 且随着燃煤型砷中毒的程度的增高而增高(χ趋势2=14.51, P < 0.05);轻、中、重度组的限制性和混合性肺通气功能障碍发生率分别为3.6%、12.3%、13.9%, 均高于对照组(1.3%), 且随着燃煤型砷中毒的程度的增高而增高(χ趋势2=11.08, P < 0.05)。与对照组相比, 各砷中毒组肺通气功能指标FVC、FEV1、FVC%、FEV1/FVC、MEF75%、MEF50%、MEF25%均降低(P < 0.05);重度中毒组FEV1/FVC、MEF75%均低于轻度组(P < 0.05)。
结论 燃煤型砷中毒病人大、小气道均受损, 主要表现为阻塞性肺通气功能障碍, 其肺功能下降可能与砷暴露有关。
Abstract:Background Non-occupational arsenism is largely ascribed to arsenic exposure through arsenic contaminated coal, drinking water, and food. Lung is one of the target organs of arsenic. Lung function indicators can reflect early lung injury, and have great significance in evaluating the grade of lung injury and labor capacity of arsenism patients.
Objective Our aim is to investigate the lung function in patients from a coal-burning type arsenism area in Guizhou Province.
Methods In a coal-burning arsenism area named Yuzhang Village, a total of 216 cases of coalburning type arsenism were diagnosed according to the Standard of Diagnosis for Endemic Arsenism (WS/T 211-2015), including 56 mild, 81 moderate, and 79 severe cases. In a non-coalburning arsenism area, 79 healthy residents indicated by physical exams were selected as control group who had similar living habits, but no high-arsenic coal-burning history nor inheritance and family history of cancer. Lung function was evaluated using spirometer, and the indicators included forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1). FEV1/FVC lower than 92% of the predicted value was used as a sensitive indicator of obstructive ventilatory disorder.
Results There was no significant difference in age and sex between designed groups. The rates of pulmonary ventilation disorder in the mild, moderate, and severe coal-burning type arsenism groups were 30.4%, 43.2%, and 45.6%, respectively, which were higher than 7.6% in the control group (P < 0.05). The rates of obstructive ventilatory disorder in the mild, moderate, and severe groups were 26.8%, 30.9%, and 31.6%, respectively, which were all higher than 6.3% in the control group, and increased with the aggravation of coal-burning type arsenism (χtrend2=14.51, P < 0.05). The rates of restrictive and mixed ventilatory disorder in the mild, moderate, and severe groups were 3.6%, 12.3%, and 13.9%, respectively, which were all higher than 1.3% in the control group, and also increased with the aggravation of coal-burning type arsenism (χtrend2=11.08, P < 0.05). Compared with the control group, the levels of FVC, FEV1, FVC%, FEV1/FVC, MEF75%, MEF50%, and MEF25% in the three arsenism groups were all reduced (P < 0.05). The FEV1/FVC and MEF75% in the severe group were lower than those in the mild group (P < 0.05).
Conclusion Both large and small airways of the patients with coal-burning type arsenism are impaired, manifested as obstructive ventilatory disorder, and the decline of lung function may be associated with arsenic exposure.
下载:
