陕南燃煤型砷中毒患者内外环境砷、硒水平及对血清P53、BCL2、NO、MDA的影响

1、陕南燃煤型砷中毒患者内外环境砷、硒水平及对血清P53、BCL2、NO、MDA的影响         11-01-10 15:22:00     编辑：studa20        作者：王宇东，王芝芳，白广禄，雷艳霞，王立新，范中学，耿冬，郭雄【摘要】  目的 探讨陕南燃煤型砷中毒患者内外环境砷、硒水平及对血清P53、B淋巴细胞瘤/白血病2(BCL2)、一氧化氮(NO)、丙二醛(MDA)

2、 的影响。方法 采用石墨炉原子吸收法测定煤、水、土、玉米、辣椒、血清、尿、发中砷、硒含量；采用ELISA法、硝酸还原酶法、TBA法分别测定血清P53、BCL2、NO、MDA水平。结果 病区煤、土、玉米、辣椒中砷、硒含量显著高于非病区；病例组血清、尿和发砷、硒含量显著高于内、外对照组；病例组血清BCL2水平显著高于外对照组，病例组、内对照组的血清MDA水平显著低于外对照组。结论 陕南燃煤型砷中毒患者内、外环境砷含量增高，外环境硒含量偏高而内环境硒负荷适宜， 其血清BCL2水平增高，MDA降低，而P53、NO无显著变化。 【关键词】  燃煤型砷中毒；砷；硒；P53；B淋巴细胞瘤/白血病2

3、；一氧化氮；丙二醛ABSTRACT: Objective  To investigate the levels of arsenic (As) and selenium (Se) in the internal and external environment, and their effects on P53, Bcell lymphoma/leukemia2 (BCL2), nitric oxide (NO) and maleic dialdehyde (MDA) in serum of burningcoaltype arseniasis from south Shaanxi

4、Province. Methods  As and Se contaminations in the external environment (coal, drinking water, soil, corns and pepper) and the internal one (serum, urine and hair) were analyzed using a graphite furnace atomic absorption spectrophotometer. The contents of P53, BCL2, NO and MDA in serum were det

5、ected by ELISA, nitrifying ferment and TBA, respectively. Results  The contents As and Se in coal, soil, corns and pepper from the arseniasisaffected area were significantly higher than those in the nonarseniasisaffected area. Concentrations of As in serum, urine and hair and Se in hair from pa

6、tient group with arsenism were statistically higher than those from the other two groups. BCL2 content in serum from patient group with arsenism was statistically higher than that from the controls in nondiseased areas, while MDA contents in serum from both patients and the control groups in the dis

7、eased areas were significantly lower than those from the controls in nonarsenism areas. Conclusion  As levels in internal and external environment of patients with arsenism were statistically higher than those in the controls both arsenismaffected and nonarsenismaffected area, and Se levels in

8、the external environment were increased while those in the internal were moderate. BCL2 content was raised in the patients with arsenism, but MDA decreased, and P53 and NO had  little changes.KEY WORDS: burningcoaltype arsenism; arsenic; selenium; P53; Bcell lymphoma/leukemia2 (BCL2); nitric ox

9、ide (NO); maleic dialdehyde (MDA)近年来，继贵州省之后发现的陕南燃煤污染型砷中毒是地方性砷中毒的一种特殊类型，以皮肤与全身多系统多器官损害为特点。尽管有研究表明陕南燃煤型砷中毒外环境砷(arsenic, As)、硒(selenium, Se)含量高于非病区1，但对患者体内砷、硒含量及血清P53、B淋巴细胞瘤/白血病2(Bcell lymphoma/leukemia2, BCL2)、一氧化氮(nitric oxide, NO)、丙二醛(maleic dialdehyde, MDA)水平的影响尚不清楚。本文采用流行病学调查方法，检测陕南燃煤型砷中毒患者血清、尿和发砷

10、、硒及对血清P53、BCL2、NO和MDA水平的影响，以探讨陕南燃煤型砷中毒的发病机制，为提高防治水平提供科学依据。1  材料与方法1.1  调查对象与分组  调查陕西省安康市汉滨区燃煤型砷中毒病区198例居民，按照地方性砷中毒诊断标准(WS/T 2112001)诊断砷中毒患者60例，随机抽取30例为病例组，抽取病区29例正常者为内对照组。调查西安市长安区五台乡非砷中毒病区118例居民，随机抽取29例为外对照组。病例组男18例，女12例，平均年龄(65.77±10.26)岁；内对照组男14例，女15例，平均年龄(42.00±17.26)岁；外对

11、照组男13例，女16例，平均年龄(44.03±13.72)岁，三组性别均衡但年龄有差异。1.2  样品采集与处理  采集调查对象家中的煤、玉米、辣椒、发样和其耕田土置信封内密封保存；采集饮用水样及尿样置专用塑料瓶内，采集静脉血离心取血清存于离心管中，保存于-30冰箱。1.3  实验方法  煤、水、土、玉米、辣椒、血清、尿、发中砷、硒含量均采用石墨炉原子吸收法测定，砷标准液由日本和光纯药工业株式会社提供，硒标准液由北京国家标准物质研究中心提供，石墨炉原子吸收分光光度计为日立公司18080型。NO、MDA试剂盒购自南京建成生物工程研究所，采用772

12、光电比色计测定。P53、BCL2检测试剂盒产自美国R&D公司，采用德国FLUOstar OPTIMA高通量多功能微板测试系统测定。1.4  数据处理  所有数据采用SPSS 13.0 软件分析。因数据呈偏态分布，采用中位数(median, M)及四分位数间距(quartile range, QR)表示，取对数值后进行t检验或方差分析，因三组间年龄分布有差异，采用协方差法分析相关性指标，显著性标准为P<0.05。2  结果2.1  病区与非病区煤、水、土、玉米、辣椒中砷、硒含量的比较  病区中的石煤(表1)、土、玉米、辣椒砷、硒含量

13、均显著高于非病区，病区水中硒含量显著高于非病区(表2、3)。表1  病区与非病区燃煤中砷、硒含量的比较（略）Table 1  The comparison of As and Se concentrations in coal between the diseased and nondiseased areas*P<0.01 vs. nondiseased area2.2  病例组与内、外对照组血清、尿、发中砷、硒水平的比较  病例组血清、尿、发砷水平显著高于内、外对照组；与外对照组比较，内对照组尿砷水平无显著性差异，血清砷水平显著降低，但发砷水平

14、显著增高(表4)。病例组尿硒水平显著高于内、外对照组，但三组间血清、发硒水平无显著性差异(表5)。表2  病区与非病区水、土、玉米、辣椒中砷含量的比较（略）Table 2  The comparison of As concentrations in drinking water, dissolved soil, corns and pepper between the diseased and nondiseased areas*P<0.05 vs. nondiseased area表3  病区与非病区水、土、玉米、辣椒中硒含量的比较（略）Table 3&

15、#160; The comparison of Se concentrations in drinking water, dissolved soil, corns and pepper between the diseased and nondiseased areas*P<0.05 vs. nondiseased area表4  病例组及对照组血清、尿、发中砷水平的比较（略）Table 4  The comparison of As concentrations in serum, urine and hair among three groups*P<0.05 vs. IC; P<0.05 vs. EC; As: arsenism; IC: internal control; EC: external control表5  病例组及对照组血清、尿、发中硒含量的比较（略）Table 5  The comparison of Se concentrations in seru