燃煤型氟中毒患者血化学元素含量的变化

Changes in concentration of blood chemical elements of patients with coal-burning fluorosis

摘要:

目的：探讨血锌（Zinc，Zn）、钙（Calcium，Ca）、铜（Copper，Cu）、镁（Magnesium，Mg）、铁（Ferrum，Fe）含量与燃煤污染型地方性氟中毒（燃煤型氟中毒）发病的关联，寻找行之有效的抗氟元素。方法：采取分层整群随机抽样方法，在病区和非病区共选取250例儿童及90例成人进行1∶2配对病例-对照研究，对研究对象进行空腹静脉抽血及收集即时尿液，原子吸收光谱仪测研究对象血Zn、Ca、Cu、Mg、Fe含量及氟离子选择电极法测尿氟含量。结果：巫山儿童血Zn含量为外对照组（78.82±11.40） μmol/L＞内对照组（73.39±8.99） μmol/L＞病例组（69.01±6.98） μmol/L；奉节儿童血Zn含量也为外对照组（78.82±11.40） μmol/L＞内对照组（77.66±12.03） μmol/L＞病例组（72.76±10.87） μmol/L；巫山成人血Zn含量也为外对照组（101.21±11.91） μmol/L＞内对照组（97.92±11.51） μmol/L＞病例组（91.13±10.29） μmol/L（P均小于0.05）。巫山、奉节儿童血Cu、Fe含量均为外对照组大于病例组及内对照组（P均小于0.01）。巫山、奉节儿童及巫山成人尿氟含量为病例组大于内、外对照组（P均小于0.01）。奉节病例组血Zn（72.76±10.87） μmol/L、Ca（1.82±0.19） mmol/L及尿氟（0.83±0.37） mg/L含量大于巫山病例组血Zn（69.01±6.98） μmol/L、Ca（1.41±0.12） mmol/L及尿氟（0.65±0.33） mg/L含量；奉节内对照组血Zn（77.66±12.03） μmol/L、Ca（1.85±0.23） mmol/L及尿氟（0.53±0.23） mg/L含量也大于巫山内对照组血Zn（73.39±8.99） μmol/L、Ca（1.45±0.21） mmol/L及尿氟（0.43±0.18） mg/L含量；血Zn、尿氟P均小于0.05；血Ca P值均小于0.01。结论：除主要致病元素氟外，两县燃煤型氟中毒发病与机体Zn、Ca、Cu、Fe含量关系密切，患者血Zn含量降低，两县儿童体内Cu、Fe含量水平较低；随着病区严重程度增加，病区人群血Zn、Ca含量减少。

Abstract:

Objective：To explore the relationship between blood Zinc（Zn），Calcium（Ca），Copper（Cu），Magnesium（Mg） and Ferrum（Fe） levels and the incidence of coal-burning endemic fluorosis and to find effective anti-fluorine elements for the prevention and control of the disease. Methods：Stratified cluster random sampling method was used and 250 children and 90 adults were investi－gated in fluorosis area and non-fluorosis area for 1∶2 matched case-control study. Fasting venous blood samples were collected by venipuncture in vacuum tubes from all subjects and the concentrations of blood Zn，Ca，Cu，Mg and Fe levels were examined with atomic absorption spectrometer. Spot urine samples were collect－ed from all subjects and the fluoride levels were detected by fluoride ion selective electrode. Results：Blood Zn levels of Wushan children were （78.82±11.40） μmol/L in external con－trols，higher than （73.39±8.99） μmol/L in internal controls and （69.01±6.98） μmol/L in case group. Similarly，blood Zn levels of Fengjie children were （78.82±11.40） μmol/L in external controls，higher than （77.66±12.03） μmol/L in internal controls and （72.76±10.87） μmol/L in case group. Blood Zn levels of Wushan adults were （101.21±11.91） μmol/L in external controls，higher than （97.92±11.51） μmol/L in internal controls and （91.13±10.29） μmol/L in case group，all P<0.05. Blood Cu and Fe levels of children in Wushan and Fengjie were higher in external controls than in internal controls and case group，P<0.01. Urine fluorine were higher in case group than in internal and external controls in Wushan children and adults and Fengjie children，P<0.01. Concentrations of blood Zn，Ca and urine fluorine were （72.76±10.87） μmol/L，（1.82±0.19） mmol/L and （0.83±0.37） mg/L in Fengjie case group，higher than those of （69.01±6.98） μmol/L，（1.41±0.12） mmol/L and （0.65±0.33） mg/L in Wushan case group. Similarly，concentrations of blood Zn，Ca and urine fluorine were （77.66±12.03） μmol/L，（1.85±0.23） mmol/L and （0.53±0.23） mg/L in Fengjie internal controls，higher than those of （73.39±8.99） μmol/L，（1.45±0.21） mmol/L and （0.43±0.18） mg/L in Wushan internal controls，P<0.05 of blood Zn and urine fluoride，P<0.01 of blood Ca. Con－clusions：Blood concentration of Zn，Ca，Cu，Fe are closely related with the process of coal-burning endemic fluorosis in the two coun－ties except the main pathogenic element of fluorine. Patients with fluorosis have lower blood Zn levels and children have lower blood Cu and blood Fe in two counties. Concentrations of blood Zn and blood Ca are decreased with the increase of severity of endemic fluorosis.