贵州水城氟铝联合中毒病区流行病学调查

本文对贵州水城铝氟联合中毒病区进行了流行病学调查。证实地方性氟中毒、骨软化病人均分布在食用原煤加拌煤泥烘玉米的家庭中,患病率3.95％;<20岁的病人占76％,患病率6.13％。病人全血、尿铝、氟均显著高于非病区对照,患儿全血、尿铝明显或显著(P<0.02或0.05)高于病区正常儿童,尿氟显著低于病区正常儿童。上述现象初步考虑是食用含氟很高的玉米,氟、铝在体内蓄积并相互影响代谢所致,与膳食营养关系不大。     

贵州省水城氟铝联合中毒病区儿童甲状腺功能的变化

为探讨氟铝联合中毒对甲状腺功能的影响，本文对氟铝联合小毒病区儿童血清Ｔ３，Ｔ４和ＴＳＨ水平进行了研究，结果表明，氟铝联合中毒病区儿童患者血清Ｔ４含量明显低于病区正常儿童及非病区正常儿童Ｔ３和ＴＳＨ水平明则未见明显异常改变。     

贵州水城氟铝联合中毒病区患者骨骼X线分析

对水城氟铝联合中毒病区患者进行骨骼X线检查。成人组47人,氟骨症检出率为63.9％。未成年组103人,异常X线征象者检出率为65.0％。其中氟骨症、骨软化、佝偻病共存者5例;氟骨症、骨软化共存者22例;氟骨症22例;骨软化11例;佝偻病7例。氟病区严重软化畸形病人的出现,考虑为氟铝联合中毒协同作用的结果。     

高氟区人群内外环境微量元素水平及其意义

对高氟区的氟中毒病人(病区村)和非病区村人群内外环境中F,Se,Zn,Cu,Mo等元素的含量进行了检测。结果表明,病区村小麦中Z n含量高于非病区村,两者比较差异有显著性(P<0.001),外环境Se等其它元素水平两村大体一致(P>0.05);随饮水F增加,病人体内F,Se和血Zn,Mo,Zn/Cu升高,血Cu,Cu/Mo降低,与对照组比较差异均有显著性或极显著性(P<0.05或P<0.001)。提示氟中毒病人体内Se等微量元素代谢紊乱。     

铝氟联合中毒实验研究——大白鼠模型复制

本文报告了大白鼠铝氟联合中毒模型的复制。实验用 Wistar 雄性大鼠88只,分为五组。Ⅰ为对照组;Ⅱ为高岭土拌煤烘烧玉米组(玉米占饲料的40%);Ⅲ组与Ⅱ组同样,但烘烤玉米占80%;Ⅳ组饮水加 AlF_3;Ⅴ为饮水加 NaF 组。结果除Ⅰ组外,其余各组均出现氟斑牙,且其严重程度与含 F~-剂量呈正比。骨骼病理组织学检查及 X 光摄片见Ⅴ组为骨硬化,Ⅱ、Ⅲ、Ⅳ组为骨软化。但实验中骨软化有逆转现象,且这种变化与骨骼各元素含量变化情况相吻合。说明铝氟联合中毒与“单纯”氟中毒明显不同。     

贵州燃煤氟病区小学生氟斑牙病情与尿氟含量关系的分析探讨

燃煤污染尤其是煤烘玉米氟病区,是经济社会发展滞后的标志性地方病。氟斑牙是地方性氟中毒病区划分的主要内容,尿氟是氟负荷敏感指标。氟斑牙与尿氟关系专题探讨较少。我们对燃煤氟病区六盘水市21所小学的8-10岁学生,进行了氟斑牙和尿氟检查,探讨氟斑牙与尿氟关系,为较早、较准确判断地方性氟中毒变化趋势提供参考。     

燃煤型地氟病区家猪氟中毒趾骨病理及形态计量学研究

采用病理组织学，骨计量学方法对地氟病区和非病区家猪趾骨进行比较性研究。结果显示：病区血、尿和骨氟的含量明显增高，而血钙显著降低，组织病理学检查和形态定量分析，可见家猪趾骨以骨质疏松占优势。     

铝在氟中毒病因中的地位实验研究

Wistar大鼠212只,经36周慢性实验发现,饲料中加入氟化物后,使大鼠骨氟、铝均显著升高。骨氟与骨铝呈极显著正相关。表明氟能促进食物中自然铝的吸收和蓄积;发现氟斑牙发生率和严重程度及肾功能损害程度与氟铝联合作用有关。提示,氟中毒时很可能伴有铝在体内蓄积和发生作用。因此,首次提出铝是氟中毒的病因之一,在一定条件下氟铝联合作用是发生氟中毒的重要条件。     

河北省阳原县高氟区水氟含量和地方性氟中毒病情调查

目的了解河北省阳原县地方性氟中毒病区水氟含量以及人群氟中毒患病情况。方法选择阳原县地方性氟中毒病区南洼村和非病区东堡村为调查点,测定井水氟含量、儿童尿氟含量,并进行儿童氟斑牙患病率及人群残废型氟骨症情况调查。结果南洼村井水氟含量明显高于东堡村(P<0.01),井水氟含量范围为2.20～2.91mg/L,均超过《生活饮用水卫生规范》(2001),南洼村8～12岁儿童氟斑牙患病率为81.4%,其氟斑牙患病率和尿氟含量均明显高于东堡村(P<0.01);南洼村仍存在成人残废型氟骨症患者。结论阳原县地方性氟中毒病区南洼村井水氟含量超标严重,病区人群仍存在严重的氟中毒流行。     

大鼠小肠原位灌流研究铝、氟混合物的吸收过程

将两种不同比例的铅与氟分别溶解于pH7.0的Tris缓冲液中,原位灌流大鼠小肠40分钟。灌流期检测门静脉血中铝和氟含量。结果显示,高剂量铝比例组(4660μg/ml Al+200μg/ml F)和低剂量铝比例组(860μg/ml Al+200μg/ml F)氟吸收不明显。低剂量铝比例组铝吸收亦不明显,但高剂量铝比例组的铝吸收显著,表明铝拮抗氟毒性的机理主要是铝抑制了肠道对氟的吸收。     

贵州水城氟铝中毒病区儿童血液过氧化脂质及抗氧化物质水平的改变

研究了贵州水城氟铝中毒病区儿童血液脂质过氧化物及抗氧化物质水平的变化。结果显示,氧铝中毒病区儿童血浆GSH—px活性降低,以有中毒表现的儿童尤为明显,即非病区正常组为36.78±3.52U/100μl,病区正常组为33.94±3.72U/100μl,病区中毒组为31.05±4.33U/100μl;血浆SOD活性、Lpo含量及红细胞GSH含量等在病区和非病区儿童之间未见明显改变。表明氟铝中毒病区儿童机体抗氧化能力有减弱的趋向。     

Morphometric study of bone in domestic pigs with fluorosis caused by coal-burning pollution

Forty four domestic pigs were divided into 2 groups: control group: 17 pigs; fluorosis group: 27. They were fed for 14 months in the endemic area or non-endemic area respectively. In some of the pigs, double tetracycline was given for bone dynamic study, and blood and urine were collected for biochemical analyses. Iliac, tibia, fibula, the 2nd metatarsal and the 2nd vertebrae were reserved either for bone density measurement or for bone histomorphometric study. The results showed that fluoride content either in serum and in urine or in bone tissue was significantly elevated. The bone density of tibia was increased. Bone histomorphometry showed that trabecular bone volume of iliac and vertebrae was increased while that of fibula head was decreased. Trabecular resorption surface of fibula head was expanded while that of vertebrae was shrunk. As to bone dynamics, both bone formation rate and bone mineralization rate were inhibited, indicating that the toxic effects of fluoride in tremendous amount on bone remodeling. The authors suggest that the existence of osteosclerosis of axial and osteoporosis of peripheral bone in fluorosis might be related to the redistribution of calcium within the body. Furthermore, fluoride may be an osteomalacic factor for the development of osteomalacia in endemic fluorosis.     

砖茶型氟铝联合中毒的实验研究

目的:复制砖茶型氟铝联合中毒动物模型。方法:通过检测动物骨、肝、肾、脑组织和血清中的氟、铝含量观察氟和铝在体内代谢的情况。结果:至实验期末各实验组动物体重均显著低于对照组(P<0.05),其中砖茶组动物体重降低更加显著(P<0.01);砖茶组动物各组织中氟、铝含量与对照组比较极显著增高(P<0.01)。结论:长期大量饮用砖茶水可导致砖茶型氟铝联合中毒;高氟可促进铝吸收并蓄积在骨组织中。     

肾移植病人围手术期利尿药物的应用

目的 探讨托拉塞米在肾移植病人围手术期中的应用价值。方法 52例肾移植术后病人分为2组。托拉塞米组26例．男性16例，女性10例，年龄（31±10）岁，围手术期应用托拉塞米100mg＋氯化钠注射液500mL，iv，qd；呋塞米组26例，男性15例，女性11例，年龄（29±9）岁，围手术期中应用呋塞米400mg·d-1＋NS500mL，iv，qd。2组均治疗7d为一个疗程。观察手术前和术后每日尿钾、钠及血钾、钠的含量，血压、血肌酐和24h尿量变化情况。监测2组环孢素全血谷值血药浓度。结果 手术后托拉塞米组24h尿钠含量、血钠和血肌酐与呋塞米组比较，差异无显著性（P〉0．05）。托拉塞米组血钾的含量和24h尿量高于呋塞米组，差异非常显著（P〈0．01）。呋塞米组24h尿钾含量高于托拉塞米组，差异非常显著（P〈0．01）。2组血压和环孢素全血谷值血药浓度比较，差异不显著（P〉0．05）。不良反应发生率托拉塞米组为8％（2／26），呋塞米组为69％（18／26），差异非常显著（P〈0．01）。结论 托拉塞米具有排钠又相对保钾的作用，在增加病人尿量的同时不影响环孢素全血谷值血药浓度，减少了肾移植病人不良反应的发生，是一种比呋塞米更加适合肾移植围手术期利尿药物。     

陕南安康地区大竹园镇砷中毒患者血清PICP、PINP与COL1α1序列检测

OBJECTIVE: To investigate type I collagen metabolism in patients with arsenic poisoning in Dazhuyuan town, Ankang area in southern Shaanxi province known for high-level exposure to arsenic (As), fluoride (F) and selenium (Se). METHODS: This case-control study involved 29 patients with arsenic poisoning from Dazhuyuan, a town in Ankang area of Shaanxi province affected by coal-borne endemic arsenicosis. Thirty individuals without arsenic poisoning from Chang'an county of Xi'an city were included as the control group. The serum concentrations of As and Se were determined using a graphite furnace atomic absorption spectrophotometer, and the levels of F detected with a fluoride ion-selective electrode. Enzyme-linked immunosorbent assay (ELISA) was used for assessing serum contents of PICP and PINP, and the sequence of COL1alpha1 gene was analyzed with ABI sequence analyzer. RESULTS: The contents of PICP and PINP were similiar between the two groups, which had also identical COL1alpha1 DNA sequences. After controlling for all the other factors, an inverse correlation was noted between PICP and serum F contents (r=-0.4, P<0.05) and between PINP and hair F content (r=-0.5, P<0.05), but a positive correlation was found between PINP and hair Se content (r=0.5, P<0.05). CONCLUSION: Hair F and Se levels are the major factors affecting PINP synthesis, and increased hair F level is associated with elevated PINP content, whereas hair Se level is inversely correlated to PINP content. But in the patients with arsenic poisoning from Dazhuyuan town, the PICP, PINP contents and COL1alpha1 DNA sequence show no significant alterations, suggesting that hair Se increment abolishes the effect of hair F increment in inducing the decrease in PINP content.     

低剂量阿德福韦酯致Fanconi综合征和低磷骨软化症1例及文献回顾

A young male patient with a clear diagnosis of chronic hepatitis B, had taken long-term adefovir dipivoxil and lamivudine antiviral therapy. Osteomalacia related symptoms, such as bone pain and walking difficulties appeared 10 months ago. Renal damage related symptoms, such as urine volume change and increased urinary foam appeared 7 months ago. The examination showed signs of osteomalacia after admission, such as duck step, osteoarticular tenderness, thoracic and pelvic compression sign positive. Relevant examinations showed that hypophosphatemic osteomalacia related signs, such as hypophosphatemia, normal blood calcium, elevated blood alkaline phosphatase, no significant decline in active vitamin D3 and intact parathyroid hormone (iPTH). In bone mineral density test, bone fracture line could be noted. Bone scan suggested multiple metabolic lesions. At the same time, there were Fanconi syndrome related performances, such as elevated serum creatinine, decreased blood uric acid, urine glucose positive, elevated urinary and uric acid, urinary protein positive with mainly small molecule proteins, increased renal tubular damage indicators, and the clearance test suggested a decrease in renal tubular reabsorption of phosphorus. Kidney stones could be seen in urinary ultrasound. Therefore, combined with the patient’s clinical manifestations, past history and examinations, we definitely considered his diagnosis was adefovir dipivoxil related renal injury. Adefovir has been widely used for the treatment of chronic hepatitis B. Some studies confirmed that the nephrotoxicity of adefovir, including Fanconi syndrome and hypophosphatemic osteomalacia, was dose-dependent. A daily high-dose of 60-120 mg/d adefovir was concluded in the treatment of human immunodeficiency virus (HIV) infection, inducing nearly 1/2 patients of renal injury. A daily moderate-dose of 30 mg/d adefovir was used for patients in chronic hepatitis B, with nearly 1/3 patients of renal injury. Long-term low-dose adefovir (10 mg/d) used for chronic hepatitis B patients was found to be responsible for renal injury, but the incidence was significantly reduced. We studied this patient and related literature to analyze the pathogenesis, clinical characteristics and treatment outcomes in low-dose adefovir-induced Fanconi syndrome and hypophosphatemic osteomalacia.     

低剂量阿德福韦酯致Fanconi综合征和低磷骨软化症1例及文献回顾

A young male patient with a clear diagnosis of chronic hepatitis B, had taken long-term adefovir dipivoxil and lamivudine antiviral therapy. Osteomalacia related symptoms, such as bone pain and walking difficulties appeared 10 months ago. Renal damage related symptoms, such as urine volume change and increased urinary foam appeared 7 months ago. The examination showed signs of osteomalacia after admission, such as duck step, osteoarticular tenderness, thoracic and pelvic compression sign positive. Relevant examinations showed that hypophosphatemic osteomalacia related signs, such as hypophosphatemia, normal blood calcium, elevated blood alkaline phosphatase, no significant decline in active vitamin D3 and intact parathyroid hormone (iPTH). In bone mineral density test, bone fracture line could be noted. Bone scan suggested multiple metabolic lesions. At the same time, there were Fanconi syndrome related performances, such as elevated serum creatinine, decreased blood uric acid, urine glucose positive, elevated urinary and uric acid, urinary protein positive with mainly small molecule proteins, increased renal tubular damage indicators, and the clearance test suggested a decrease in renal tubular reabsorption of phosphorus. Kidney stones could be seen in urinary ultrasound. Therefore, combined with the patient’s clinical manifestations, past history and examinations, we definitely considered his diagnosis was adefovir dipivoxil related renal injury. Adefovir has been widely used for the treatment of chronic hepatitis B. Some studies confirmed that the nephrotoxicity of adefovir, including Fanconi syndrome and hypophosphatemic osteomalacia, was dose-dependent. A daily high-dose of 60-120 mg/d adefovir was concluded in the treatment of human immunodeficiency virus (HIV) infection, inducing nearly 1/2 patients of renal injury. A daily moderate-dose of 30 mg/d adefovir was used for patients in chronic hepatitis B, with nearly 1/3 patients of renal injury. Long-term low-dose adefovir (10 mg/d) used for chronic hepatitis B patients was found to be responsible for renal injury, but the incidence was significantly reduced. We studied this patient and related literature to analyze the pathogenesis, clinical characteristics and treatment outcomes in low-dose adefovir-induced Fanconi syndrome and hypophosphatemic osteomalacia.     

克汀病人血Cu,Zn,Se含量及CuZnSOD,SeGSH—Px活性观察

测定地方性克汀病患者、病区正常成人血液中Ｃｕ、Ｚｎ、Ｓｅ含量及细胞ＣｕＺｎＳＯＤ、ＳｅＧＳＨ－ＰＸ活性，发现克汀病患者及病区正常人血Ｚｎ、Ｓｅ含量低，红细胞ＣｕＺｎＳＯＤ、ＳｅＧＳＨ－Ｐｘ活性显著低于非病区成人，克汀病人ＳＯＤ活性还显著低于病区正常成人。同时测定病区粮食、饮水、土壤中相应元素含量，发现病区居民主食Ｚｎ、Ｓｅ含量低，病区人群Ｚｎ、Ｓｅ代谢紊乱可能正是由于环境中两种元素缺乏的结果。     

不同类型少儿氟骨症病因研究──Ⅱ.贵州省少儿氟骨症流行因素调查研究

通过对贵州省三个地区不同类型少儿氟骨症流行因素的综合调查研究，对环境、生物样品、粮食蔬菜等样品中氟等元素的测定及儿童的体格检查，初步确定煤烟型氟污染导致粮食含氟过高，使得摄氟量高（总摄氟量５６．２２ｍｇ／ｄ）、营养低下（动物蛋白质、脂肪、钙和铁摄入不足，血钙偏低。），降低总摄氟量的综合治理措施是有效的预防手段。