电离辐射对心脏影响的研究进展

长期以来,广泛认为心脏长期暴露于高剂量电离辐射可导致心脏损伤。近年来流行病学、实验和临床研究均证实,低剂量电离辐射暴露可通过不同机制造成心血管系统损伤。本综述分析了电离辐射暴露导致的心脏损伤以及潜在心血管疾病风险、综述了目前用于心脏电离辐射损伤检测的非侵入性方法、并提出了预防和减轻放射性心脏损伤的有关措施,从而为心脏电离辐射损伤早期发现和早期干预提供参考依据。     

地方性氟中毒致机体损伤的研究进展

地方性氟中毒是指生活在由自然或人为污染所致高氟环境中的居民, 因体内摄入过量氟化物而引起的一种地方性疾病。氟斑牙、氟骨症是地方性氟中毒较常见的症状;此外, 长期氟暴露还可引起神经系统、心血管系统、泌尿系统等多个系统的损伤, 最终导致全身多器官的慢性病变和功能障碍。目前, 地方性氟中毒仍是我国乃至世界的严重公共卫生问题之一。故本文从骨相和非骨相系统两方面就地方性氟中毒对人群机体损伤的研究进展进行综述, 以期为今后地方性氟中毒的持续防控提供参考依据。     

氟暴露对机体骨外系统损伤的研究─兼与现行《工业性氟病诊断标准及处理原则》的商榷

通过实验研究和对氟暴露工人健康监护２０年动态观在结果表明，氟可引起机体多系统、多功能的损伤，骨外系统损伤主要表现为上呼吸道炎（鼻炎、咽炎）、上消化道炎、牙周炎、血清ＩｇＧ和免疫功能及血清酶（ＡＬＰ、ＳＯＤ）与微量元素（Ｚｎ）等改变。这在评价氟暴露对骨外系统损伤方面具有明显的特异性和敏感性，不仅对及时发现氟损伤，而且对工业性氟病的早期诊断具有重要的参考价值。     

电离辐射心血管系统损伤途径的研究进展

不同剂量电离辐射对心血管系统的损伤途径存在一定差异,高剂量电离辐射可直接破坏微血管内皮细胞功能屏障,影响细胞黏附分子(cell adhesion molecules,CAMs)等生物大分子的表达,诱导炎性细胞渗出、组织纤维化及坏死等慢性微血管内皮细胞损伤。进而影响循环系统内环境稳态,诱发早期心血管疾病。小剂量电离辐射对心血管系统的损伤途径主要表现为电离辐射的异常DNA甲基化效应和氧化应激效应,由此产生的代谢产物如活性氧自由基(reactive oxygen species, ROS)和同型半胱氨酸(homocysteine, Hcy)均可对心血管系统造成慢性损伤,电离辐射持续暴露导致次级效应代谢产物的蓄积将加剧心血管系统损伤倾向。     

高氟暴露对机体免疫损害的研究进展

高氟暴露可导致机体多系统、多脏器损伤,近年来,高氟暴露对机体免疫功能影响的研究取得较大进展,其研究主要集中在细胞免疫,体液免疫、细胞因子等三方面。本就此作一综述。     

职业噪声对人体听觉外系统损伤的影响

长期暴露于噪声环境中 ,会对人体造成一系列的损伤。噪声的特征性损伤可引起听力损伤以至噪声性耳聋。此外 ,噪声还可以引起听觉外系统的损伤 ,心血管系统、神经系统、消化系统、呼吸系统、内分泌系统、女性生殖系统等。现根据已经进行过的大量调查研究 ,职业噪声对人体的听觉外系统的损伤影响主要有以下几个方面。1　噪声对心血管系统的影响许多研究显示 ,噪声可对心血管系统造成损害 ,引起血压升高、心电图改变等。噪声工作人员的血压升高检出率明显高于对照组 ,心电图主要表现为窦性心动过缓 ,其次为T波改变 ,其心电图总异常率明显高于…     

氟暴露对机体骨外系统损伤的研究：兼与现行《工业性氟病诊…

通过实验研究和对氟工人健康监护２０年动态观察结果表明，氟可引起机体多系统、多功能的损伤，骨处系统损伤主要表现为上呼吸道炎（鼻炎、咽炎）、上消化道炎、牙周炎、血清ＩｇＧ和免疫功能及血清酶（ＡＬＰ、ＳＯＤ）与微量元素（Ｚｎ）等改变。这在评价氟暴露对骨外系统损伤方面具有明显的特异性和敏感性，不仅对及时发现氟损伤，而且对工业性氟病的早期诊断具有重要的参考价值。     

砷暴露对心血管系统的影响

砷是一种类金属元素,广泛分布于土壤、空气和水中,长期慢性砷暴露可以引起全身多系统的病变,严重危害人类的健康。近年来,慢性砷暴露导致心血管系统的损伤引起了社会广泛的关注,该文从流行病学及机制研究方面出发,对砷造成的心血管系统的危害做一综述,并为今后砷中毒的防治和研究工作提出了建议。     

大气细颗粒物对心血管系统的影响及营养干预研究进展

目的 总结大气细颗粒物对心血管系统的影响及营养物质保护作用的研究进展。方法 通过用“大气细颗粒物”、“心血管”、“维生素”、“脂肪酸”、“矿物质”、“植物化学物”等关键词对CNKI、PUBMED数据库进行文献检索,了解大气细颗粒物对心血管系统的影响及营养物质对心血管系统保护作用的实验研究结果。结果 大气细颗粒物通过氧化应激、炎症反应诱发心血管系统损伤。维生素、矿物质、脂肪酸和植物化学物等营养素发挥着重要的保护作用。 结论 大气细颗粒物在造成心血管损伤的过程中,某些营养物质可以起到一定的保护作用。     

铅神经毒性的分子生物学研究回顾与展望

铅是环境中广泛存在的重金属元素。它能对多个器官造成损伤,如中枢神经系统和外周神经系统、血液系统、肾脏、心血管系统和生殖系统等。铅具有很强的神经发育毒性,儿童在发育期对铅暴露产生的毒性尤为敏感。因此,铅对儿童的生长发育有很大的影响。流行病学调查已证实了持续铅暴露与儿童认知能力损伤之间的关系。据统计我国城市儿童中约半数以上处于无症状的亚临床铅中毒状态。目前,铅对智力发育影响的研究成为国内外研究的重点。     

氟对软骨的损伤作用研究

氟是人体必需的微量元素,但长期过量摄入可引起以氟骨症和氟斑牙为主要特征的慢性全身性疾病,严重影响人们的身体健康与生活质量。高氟对软骨造成损伤,如软骨细胞坏死、软骨基质合成异常、酶活性降低等。本文从信号通路、氧自由基、细胞凋亡等方面,阐述氟对软骨损伤的作用机制,为氟中毒的发病机制提供依据。     

Health effects of indoor fluoride pollution from coal burning in China.

The combustion of high fluoride-content coal as an energy resource for heating, cooking, and food drying is a major exhaust emission source of suspended particulate matter and fluoride. High concentrations of these pollutants have been observed in indoor air of coal-burning families in some rural areas in China. Because airborne fluoride has serious toxicological properties, fluoride pollution in indoor air and the prevalence of fluorosis have been analyzed in a fluorosis area and a healthy nonfluorosis area in China and in a rural area in Japan. For human health, fluoride in indoor air has not only been directly inhaled by residents but also has been absorbed in stored food such as corn, chilies, and potatoes. In the fluorosis area in China, concentrations of urinary fluoride in the residents have been much higher than in the nonfluorosis area in China and in the rural area in Japan. In the fluorosis area, almost all elementary and junior high school students 10-15 years of age had dental fluorosis. Osteosclerosis in the skeletal fluorosis patients was very serious. Urinary deoxypyridinoline in rural residents in China was much higher than in rural residents in Japan. Data suggest that bone resorption was extremely stimulated in the residents in China and that fluoride may stimulate both bone resorption and bone formation. Because indoor fluoride from combustion of coal is easily absorbed in stored food and because food consumption is a main source of fluoride exposure, it is necessary to reduce airborne fluoride and food contamination to prevent serious fluorosis in China.     

贵州省小儿氟骨症骨转换机制的动态研究

本文报告了在环境流行病学调查的基础上，用病区粮食及燃煤进行大鼠氟中毒模型的复制，进一步探讨不同类型氟骨症的影响因素及发病机制，为制订有针对性的防治措施提供科学依据。实验用Wistar大鼠180只，随机分为6组，即高氟组、高氟加营养组、低氟组、低氟加营养组、煤烟污染组及对照组。结果表明，除对照组外，其余各组均出现氟斑牙．骨蛎X光片及病理组织学检查，高氟组出现骨疏松，并伴有骨转换征象，加营养可减轻骨病变程度，呼吸道吸入氟也可引起氟骨症，但病变较轻。引起不同类型氟骨症的主要因素是总摄氟量高、营养低下（蛋白质及钙摄入不足）和铝元素增多等。     

Epidemiologic health study of workers in an aluminum smelter in Kitimat, B.C. II. Effects on musculoskeletal and other systems

A health study was carried out on 2066 workers in an aluminum smelter in Kitimat, British Columbia to study the effects of exposure to fluoride and other air contaminants encountered on the potlines on the musculoskeletal system, hemopoietic tissue, liver, and renal function. Three hundred seventy-two railway repair workers from Squamish, British Columbia served as an "external" control group. Examination of the spine and sacroiliac joints and pelvic X-ray were conducted on long-term potline workers and a number of "internal" control workers in the smelter not exposed to any air contaminants. Urinary fluoride measurements and personal sampling for airborne fluoride were also carried out. Blood samples were collected for routine blood count and liver and renal function test. Definite cases of skeletal fluorosis were not found in any potroom workers. Some of the changes of early skeletal fluorosis described on pelvic X-rays, e.g., increased density, calcification of ligaments, and periosteal changes, were found in a few workers who were employed on the potlines for more than 10 yr. There was, however, poor agreement in the findings of the two radiologists who read the films. The entity "musculoskeletal fluorosis" does not exist in this smelter where the potroom workers were exposed to total fluoride levels below the currently accepted threshold limit value of 2.5 mg/m3. No ill effects on the hematopoietic tissue or liver and renal function were found.     

氟暴露对工人牙齿影响的研究

目的 研究氟暴露对工人牙齿的影响。方法 对651名作业工人和268名对照工人进行了专科检查;其中对工龄5年以上的104名工人进行了微量牙表层组织氟浓度的检测,结果 氟暴露工人牙齿疾患的患百闻不如一见 率为39.3%、疾患率为71.6%,工人牙表层组织氟浓度增高,均明显高于对照组。结论 工人牙疾患的增高与氟暴露有一定的关系,随着氟暴露工龄的增加而明显,这对防治措施提供了依据。     

山东省黄河下游冲积平原地区地方性氟中毒流行病学调查

目的 了解山东省黄河下游冲积平原地区地方性氟中毒流行现状.方法 按照国家<2008年地方病防治项目技术实施方案>要求,选择16个县,每个县选择3个村,测定饮用水含氟量,检查8～12岁儿童氟斑牙和＞16岁人群氟骨症,并抽查尿氟含量.水、尿氟含量测定采用氟离子选择电极法,8～12岁儿童氟斑牙诊断采用Dean's法,氟骨症诊断执行<地方性氟骨症诊断>标准(WS 192-2008).结果 调查26个改水村,其中水氟均值≤1.00mg/L的村19个(73.08%),＞1.00 mg/L的村7个(26.92%);水氟最大值为3.73 mg/L.调查22个未改水村,其中水氟均值≤1.00 mg/L的村5个(22.73%),＞1.00 mg/L的村17个(77.27%);水氟最大值为3.38 mg/L.8～12岁儿童氟斑牙总患病率为52.18%(1042/1997),氟斑牙指数为1.17,缺损率为8.01%(160/1997);儿童尿氟均值＞1.40mg/L的人数占65.00%(845/1300),最高值为18.53mg/L;＞16岁人群氟骨症临床和X线检出率分别为4.35%(1121/25 781)和11.36%(5/44).成年人尿氟均值＞1.60mg/L的人数占63.92%(606/948),最高值为21.35 mg/L.结论 山东省黄河下游冲积平原地区地方性氟中毒尚未得到有效控制.     

总摄氟量卫生标准的研究

在全国选轻、中、重和极重４个燃煤型氟病区和１个对照区及高（饮水型氟病区）、适宜和低饮水氟地区各２个，共１１个调查点，代表了中国不同地区人群的不同摄入氟水平。调查研究的内容包括空气、饮水和食物氟含量，８～１５岁和＞１５岁２个人群组的日总摄氟量、氟斑牙和氟骨症患病率以及尿氟水平。研究结果表明：在燃煤型氟病区８～１５岁和＞１５岁人群的日总摄氟量分别小于或等于２．２８ｍｇ与３．１０ｍｇ，在饮水型氟病区８～１５岁和＞１５岁人群的日总摄氟量分别小于或等于２．３４ｍｇ和３．５４ｍｇ时，无重度氟斑牙和氟骨症发生，尿氟属正常范围。根据这些结果，并参考国内外有关人群总摄氟量的资料，提出了人群总摄氟量卫生标准的建议值，８～１５岁在燃煤型氟病区为每日２ｍｇ，饮水型氟病区为每日２．４ｍｇ；＞１５岁在燃煤型氟病区为每日３ｍｇ，饮水型氟病区为每日３．５ｍｇ，为预防地方性氟中毒提供了综合评价指标     

Dose-effect relationship between drinking water fluoride levels and damage to liver and kidney functions in children

Although a dose-effect relationship between water fluoride levels and damage to liver and kidney functions in animals has been reported, it was not demonstrated in humans. To evaluate the effects of drinking water fluoride levels on the liver and kidney functions in children with and without dental fluorosis, we identified 210 children who were divided into seven groups with 30 each based on different drinking water fluoride levels in the same residential area. We found that the fluoride levels in serum and urine of these children increased as the levels of drinking water fluoride increased. There were no significant differences in the levels of total protein (TP), albumin (ALB), aspartate transamine (AST), and alanine transamine (ALT) in serum among these groups. However, the activities of serum lactic dehydrogenase (LDH), urine N-acetyl-beta-glucosaminidase (NAG), and urine gamma-glutamyl transpeptidase (gamma-GT) in children with dental fluorosis and having water fluoride of 2.15-2.96 mg/L and in children having water fluoride of 3.15-5.69 mg/L regardless of dental fluorosis were significantly higher than children exposed to water fluoride of 0.61-0.87 mg/L in a dose-response manner. In contrast to children with dental fluorosis and having water fluoride of 2.15-2.96 and 3.10-5.69 mg/L, serum LDH activity of children without dental fluorosis but exposed to the same levels of water fluoride as those with dental fluorosis were also markedly lower, but the activities of NAG and gamma-GT in their urine were not. Therefore, our results suggest that drinking water fluoride levels over 2.0mg/L can cause damage to liver and kidney functions in children and that the dental fluorosis was independent of damage to the liver but not the kidney. Further studies on the mechanisms and significance underlying damage to the liver without dental fluorosis in the exposed children are warranted.     

Prevalence of Brick Tea-Type Fluorosis in the Tibet Autonomous Region

Background

The prevalence of brick tea-type fluorosis is high in Tibet because of the habit of drinking brick tea in this region. Brick tea-type fluorosis has become an urgent public health problem in China.

Methods

A cross-sectional survey was conducted to investigate prevalence of brick tea-type fluorosis in all districts of Tibet using a stratified cluster sampling method. Dental fluorosis in children aged 8–12 years and clinical skeletal fluorosis in adults were diagnosed according to the national criteria. A total of 423 children and 1320 adults participated in the study. Samples of drinking water, brick tea, brick tea infusion (or buttered tea), and urine were collected and measured for fluoride concentrations by the fluoride ion selective electrode method.

Results

The fluoride level in all but one of the brick tea samples was above the national standard. The average daily fluoride intake from drinking brick tea in all seven districts in Tibet was much higher than the national standard. The prevalence of dental fluorosis was 33.57%, and the prevalence of clinical skeletal fluorosis was 46.06%. The average daily fluoride intake from drinking brick tea (r = 0.292, P < 0.05), urine fluoride concentrations in children (r = 0.134, P < 0.05), urine fluoride concentrations in adults (r = 0.162, P < 0.05), and altitude (r = 0.276, P < 0.05) were positively correlated with the prevalence of brick tea-type fluorosis. Herdsmen had the highest fluoride exposure and the most severe skeletal fluorosis.

Conclusions

Brick tea-type fluorosis in Tibet is more serious than in other parts of China. The altitude and occupational factors are important risk factors for brick tea-type fluorosis.Key words: brick tea-type fluorosis, skeletal fluorosis, dental fluorosis, altitude, Tibet