贵州省燃煤污染型砷中毒病区9年前后环境危险因素比较分析

目的 对比分析贵州省兴仁县燃煤污染型砷中毒病区9年前后(1998、2006年)环境危险因素的变化,为了解该病的发生、发展原因和进一步采取针对性十预控制措施提供依据.方法 采用典型抽样方法对1998年确诊的181例燃煤污染型砷中毒患者进行追踪调查,调查的项目包括年龄、性别、家庭经济状况、燃用和停用高砷煤年限、室内通风情况、食物十燥方式、吸烟等;同时选择病区12 km以外非砷污染村65例居民作为对照组.采用二乙基二硫代甲酸银法(Ag-DDC)测定煤、土壤、空气、水、大米、玉米和辣椒中含砷量:单因素和多因素非条件Logistic回归模型分析燃煤污染型砷中毒人群的暴露凶素和环境危险冈索的关系,比较9年前后的差异.结果 病区室内、室外空气和燃煤、辣椒、玉米含砷量均值由1998年的0.0880、0.0220 mg/m3和397.20、45.07、2.64 mg/kg分别下降到2006年的0.0790、0.0070 mg/m3和93.01、3.46、1.50 mg/kg.9年前后的多因素非条件Logistic回归分析,在发生燃煤污染型砷中毒的相关因素中,危险因素为燃用高砷煤年限、年龄、氟中毒和吸烟(x2值分别为50.159、12.195、37.690、6.358,P＜0.01或＜0.05),影响因素为家庭经济状况(x2=4.614,P＜0.05);居室通风情况由1998年的危险因素转变为2006年的影响因素(x2=38.093.P＜0.01);煤火烘烤粮食和文化程度,在2006年不再是危险冈素和影响因素,但粮食保存方式和性别成为影响因素(x2值分别为17.463,11.004,P＜0.01).结论 贵州省兴仁县燃煤污染型砷中毒病区9年后环境砷污染状况明显改善,病区低剂量砷污染的持续存在是该型砷中毒未得以明显控制的主要原因;燃用高砷煤年限、年龄、吸烟、氟中毒、家庭经济状况和居室通风情况与该病的发生发展密切相关;切实禁绝燃用高砷煤、加强和巩固改炉改灶和发展病区经济是进一步控制燃煤污染型砷中毒的有效措施.

Comparative analysis of environmental risk factors in nine years in an area polluted by arsenic coal-burning in Guizhou Province

Objective To comparatively analyze the changes of environmental risk factors in 9 years in an area polluted by arsenic coal-burning in Xingren County of Guizhou Province,in order to provide evidence for reasoning the occurrence and development as well as its effective prevention and control.Methods Epidemiological sampling methods was used to conduct follow-up investigation on 181 arsenism patients who were diagnosed in 1998 in arsenic polluted area.Control group included 65 residents who lived far from polluted area of 12 km.The follow up investigation included age,sexuality,family economic situation,time of use or stop use of arsenic coal, ventilation of the room,desiccation of food etc.Diethyl dithiocarbamate silver(Ag-DDC)method was used to detect arsenic content of coal,soil,air,water and rice,corn,chili;Single factor and multivariate factors non-conditional Logistic regression models were used to analyze exposure factors of patients and related environmental risk factom, and the differences of those in 1998 and 2006 were compared. Results The arsenic content in indoor and outdoor air,coal,chili and corn went down from 0.0880 and 0.0220 mg/m3,397.20,45.07 and 2.64 mg/kg in 1998 to 0.0790 and 0.0070 mg/m3,93.01,3.46 and 1.50 mg/kg in 2006. Arsenic contents of other samples were less than national standard. The analysis of single factor and multivariate factors non-conditional Logistic regression showed that time of using high arsenic coal,age,fluorosis and smoking(x2 = 50.159,12.195,37.69,6.358,P ＜ 0.05 or ＜ 0.01 ) were still the main risk factors for arsenism,while family economic situation was still influential factors (X2 = 4.614,P ＜ 0.05);Ventilation of the room changed from a risk factors at 1998 to an influencing factors at 2006(X2 = 38.093,P ＜ 0.01 ). Single factor non-conditional Logistic regression model analysis showed that food desiccation by arsenic coal-burning and educational level were no longer risk and influencing factors,while food preservation and gender had become influencing factors(x2 = 17.463,11.004,all P ＜ 0.01 ) nine years after. Conclusions Environmental arsenic pollution in arsenism area in Guizhou Province has been obviously improved after nine years. However,the continued existence of low doses of arsenic pollution is still a major cause of failure of controlling arsenism. Time of using high arsenic coal,age,smoking,fluorosis,family economic situation and ventilating room are closely related to the occurrence and the development of arsenism. Prohibition of use of high arsenic coal,furnace improvement,health education and economic development are effective measures