2008年黑龙江省饮水型地方性氟中毒病区成人颈动脉粥样硬化病情调查

目的 调查黑龙江省饮水型地方性氟中毒(简称地氟病)病区成人颈动脉粥样硬化病情,探讨饮水型氟中毒与颈动脉粥样硬化发生的关系.方法 2008年,在黑龙江省肇州县选取4个饮水含氟量≥1.0 mg/L的自然村作为病区组,在泰来县选取4个饮水含氟量＜1.0 mg/L的自然村作为对照组.用B超对40岁以上居民进行了颈动脉粥样硬化检查,保留超声图片并做记分、诊断、评分.结果病区组4个村(新丰村、太平山村、宝产村和后郑村)共检查266人,颈动脉粥样硬化检出率分别为47.3%(35/74)、63.5%(40/63)、73.3%(33/45)、60.7%(51/84);对照组4个村(哈拉村、乾兴村、三家村、爱林村)共检查283人,颈动脉粥样硬化检出率分别为32.7%(17/52)、32.9%(24/73)、39.2%(31/79)、30.4%(24/79),两组间检出率比较,差异有统计学意义(T=26,P＜0.05);病区村与对照村按年龄标准化后的颈动脉动脉粥样硬化检出率分别为47.3%、63.5%、73.3%、60.7%,34.7%、36.3%、43.0%、41.3%,两组间预期阳性率[57.5%(153/266)、37.8%(107/283)]比较,差异有统计学意义(x2=21.36,P＜0.01);按年龄标准化的颈动脉粥样硬化病例病变严重程度两组间比较,差异有统计学意义(x2=36.15,P＜0.01).结论饮水型地氟病病区成人颈动脉粥样硬化的检出率高于对照,病变程度重于对照,高氟与动脉粥样硬化的发生存在一定的关系.     

2009年黑龙江省大骨节病历史病区成人颈动脉粥样硬化调查

目的 调察黑龙江省大骨节病历史病区成人大骨节病病例颈动脉粥样硬化的流行强度,探讨成人大骨节病与动脉粥样硬化发生的关系.方法 2009年,在黑龙江省大骨节病病区山河农场、尚志市和非病区双城县兰棱镇(简称双城对照区),各调查5个村,以40岁以上病区大骨节病患者和双城对照区居民为观察对象,用便携式彩超进行了颈动脉粥样硬化检查,保留超声图片并按病变程度诊断记分.结果山河病区5个村大骨节病病例颈动脉粥样硬化检出率分别为50.0%(26/52)、37.3%(19/51)、42.5%(30/71)、58.2%(39/67)、44.0%(22/50);尚志病区5个村分别为63.0%(34/54)、45.3%(24/53)、47.2%(25/53)、60.0%(30/50)、51.9%(28/54);双城对照区5个村分别为63.9%(46/72)、43.1%(31/72)、57.1%(40/70)、46.9%(30/64)、53.0%(35/66).以村为单位,山河、尚志病区与双城对照区颈动脉粥样硬化标准化检出率比较,差异均无统计学意义(T值分别为25.0、24.5,P均＞0.05);3个地区间颈动脉粥样硬化标准化检出率比较,差异无统计学意义(x2=0.36,P＞0.05);3个地区间颈动脉粥样硬化标准化严重程度比较,差异有统计学意义(x2=15.28,P＜0.05),其中尚志病区与双城对照区比较,差异有统计学意义(x2=8.92,P＜0.05).大骨节病患者病情严重程度与颈动脉粥样硬化的标准化检出率和严重程度间均未见明显关联(x2值分别为1.88、5.07,P均＞0.05).结论黑龙江省大骨节病历史病区成人颈动脉粥样硬化检出率不高于非病区.     

2009年山西省饮水高砷区成人颈动脉粥样硬化调查

Objective To investigate the relationship between drinking-water type of endemic arsenicosis and adult carotid artery atherosclerosis. Methods In 2009, 285 participants aged over 40 from drinking-water type of endemic arsenism areas and 293 residents aged over 40 from control areas were investigated in Yingxian county,Shanxi province. Portable-type B mode color ultrasound was used to examine the carotid artery of all participants.The carotid atherosclerosis were diagnosed and graded through the ultrasonograms. Content of water arsenic and hair arsenic of 10 people randomly selected in every villages were detected. Results A total of 5 villages with drinkingwater type of endemic arsenicosis as observation group and 5 villages without drinking-water type of endemic arsenicosis as control group were investigated. The prevalence rates of adult carotid atherosclerosis within observation group were 35.09%(20/57), 55.74%(34/61), 38.46%(20/52), 36.51%(23/63) and 46.15%(24/52), respectively,and standardized prevalence rates were 32.5%, 33.8%, 34.9%, 46.2% and 47.3%, respectively and the prevalence rates of adult carotid atherosclerosis within control group were 18.18%(10/55), 30.77%(16/52), 20.00%(10/50),18.67% (14/75) and 21.31% ( 13/61 ), respectively; the standardize prevalence rates were 22.4%, 17.7%, 10.7%,24.6%, 18.9%, respectively. The standardize prevalence rates were higher in observation group [39.50%(113/285) ]than that in control group[39.50%(113/285), T = 26, P ＜ 0.01 ]. The severity of adult carotid atherosclerosis (composition of 4 - 7 scores ) was compared between observation group [ 17.70%(20/113 )] and control group [ 14.06% (9/64) ], and the difference was insignificant(x2 = 0.26, P ＞ 0.05). Conclusions The prevalence rate of carotid atherosclerosis in drinking-water type of endemic arsenicosis areas is higher than that of the control areas.The study provides evidence that arsenic poisoning can cause atherosclerosis.     

2008年黑龙江省饮水型地方性氟中毒病区成人颈动脉粥样硬化病情调查

Objective To investigate the disease situation of adult carotid atherosclerosis in water-related endemic fluorosis areas in Heilongjiang province in 2008 so as to explore the relationship between water-related endemic fluorosis and incidence of carotid atherosclerosis disease. Methods A total of 266 participants over the age of 40 from four villages in Zhaozhou county with water fluoride ≥ 1.0 mg/L in a fluorosis area and 283 residents over the age of 40 from four villages in Tailai county with water fluoride ＜ 1.0 mg/L in a nonfluorosis area were investigated. A portable-type B mode color ultrasound was used to examine the left carotid artery of all participants.The carotid atherosclerosis was diagnosed and graded through the ultrasonograms. Results The prevalence rates of carotid atherosclerosis in the 4 fluorosis villages(Xinfeng, Taipingshan, Baochan and Houzheng villages) were 47.3% (35/74), 63.5%(40/63), 73.3%(33/45) and 60.7%(51/84), respectively, and in the 4 nonfluorosis villages(Hala,Qianxing, Sanjia and Ailin villages) were 32.7% (17/52), 32.9% (24/73), 39.2% (31/79) and 30.4% (24/79),respectively. The prevalence rates of carotid atherosclerosis in every villages standardized by age were 47.3% ,63.5%,73.3% ,60.7% and 34.7% ,36.3% ,43.0% ,41.3%, respectively. Statistic method used was Wilcoxon two sample test and the differences were significant(T = 26, P ＜ 0.05 ). Total carotid atherosclerosis positive rate standardized by age in the 4 fluorosis villages was significantly higher than that in the 4 nonfluorosis villages[57.5%(153/266) ,37.8% (107/283), x2 = 21.36, P ＜ 0.01 ]. After standardized by age, the severity of carotid atherosclerosis was significantly different between fluorosis villages and nonfluorosis villages (x2 = 36.15, P ＜ 0.01 ). Conclusion The prevalence rate of carotid atherosclerosis in endemic fluorosis area is higher than that in nonfluorosis area.     

利用577nm阈值下微脉冲激光治疗糖尿病性黄斑水肿

目的：探讨利用577nm阈值下微脉冲激光治疗糖尿病性黄斑水肿(DME)的临床效果。

方法：回顾性分析48例64眼DME患者临床资料,行577nm阈值下微脉冲激光术者26例35眼,行传统格栅样激光术者22例29眼。比较术前及术后1、3、6mo时BCVA(LogMAR)、黄斑中心凹视网膜厚度(CFT)、平均光敏感度(MS)及平均视野缺损(MD)变化,分析两组患者眼底硬性渗出持续时间及并发症。

结果：术后1、3、6mo时,两组视力(0.30±0.09 vs 0.35±0.10、0.19±0.07 vs 0.26±0.09、0.13±0.04 vs 0.18±0.05)及CFT(349.26±21.80μm vs 364.37±23.91μm、314.46±20.49μm vs 335.07±22.68μm、328.35±21.74μm vs 352.43±23.60μm)均较术前下降,且观察组明显低于同一时间对照组(均P<0.05); 观察组MS、MD水平均较术前提升,且明显高于同一时间对照组5.83±1.16dB vs 4.22±1.04dB、6.38±1.29dB vs 4.49±1.17dB、6.75±1.22dB vs 4.68±1.20dB,-5.53±1.41dB vs -7.66±1.52dB、-5.09±1.30dB vs -7.26±1.39dB、-4.68±1.14dB vs-7.05±1.26dB)(均P<0.05)。观察组眼底硬性渗出持续时间明显少于对照组(3.39±0.80mo vs 4.25±1.14mo)(P<0.05)。术后6mo内,观察组眼球疼痛发生率明显低于对照组[3%(1/35)vs 24%(7/29)](P<0.05),而前房炎性反应、视野缺损、高眼压及角膜水肿发生率比较均无差异(P>0.05)。

结论：577nm阈值下微脉冲激光术治疗DME安全有效。     

水砷暴露致人群心电图改变的研究

目的 研究不同水砷含量暴露与人群心电图改变的关系,探讨砷对心血管系统的影响.方法 2008-2013年,根据饮水型地方性砷中毒的历史监测资料,在山西省和内蒙古自治区选择15个村作为调查点,选择年龄≥20岁、饮水≥10年的当地常住居民作为调查对象,按照饮水砷含量分为对照组(＜0.01 mg/L)、低水砷组(0.01～＜0.05 mg/L)、中水砷组(0.05～＜0.10 mg/L)以及高水砷组(≥0.10 mg/L).采集调查对象家中的饮用水,应用氢化物原子荧光法检测水砷,并描记12导联心电图,比较不同水砷暴露人群的心电图改变.结果 共对1 341人进行心电图检查,异常率为11.56％(155/1 341),其中,对照组、低、中、高水砷组分别为5.7％(9/158)、12.85％(59/459)、12.02％(28/233)、12.02％(59/491).对照组的心电图异常率均低于低、中、高水砷组(x2值分别为6.141、4.391、5.090,P均＜0.05).心电图改变以心律失常和ST-T改变为主.对照组的各种心律失常异常率[0(0/158)]均低于低、中、高水砷组[4.58％(21/459)、3.86％(9/233)、3.46％(17/491);x2值分别为7.483、6.247、5.618,P均＜0.05].4组人群右心室扩大、心肌缺血心电图异常率组间比较差异均有统计学意义(x2值分别为9.525、9.848,P均＜0.05).结论 饮水型砷中毒病区居民心电图异常改变以心律失常和ST-T改变为主.水砷含量≥0.01 mg/L即可明显引起心电图异常率的增加,饮水砷对心脏组织有一定的影响.     

2009年山西省饮水高砷区成人颈动脉粥样硬化调查

目的 探讨饮水型砷中毒与成人颈动脉粥样硬化发生的关系.方法 2009年,在山西省应县,根据<地方性砷中毒病区判定和划分标准>(WS 277-2007),选择东辛寨村、北湛村、大西头村、赤堡村和杏寨村为病区组,选择龙泉村、接马峪村、城下庄村、罗庄村和南丰町村作为对照组,利用彩超对40岁以上的饮水型高砷地区居民285人和对照地区居民293人进行颈动脉粥样硬化检查,并进行诊断、记分.在对年龄构成标准化后,计算动脉粥样硬化的标准化检出率.每个调查村各抽取10人,采用原子荧光法检测水砷和发砷.结果在病区组中,东辛寨村、北湛村、大西头村、赤堡村和杏寨村成人颈动脉粥样硬化检出率分别为35.09%(20/57)、55.74%(34/61)、38.46%(20/52)、36.51%(23/63)、46.15%(24/52);标准化检出率分别为32.5%、33.8%、34.9%、46.2%、47.3%;在对照组,龙泉村、接马峪村、城下庄村、罗庄村和南丰町村成人颈动脉粥样硬化检出率分别为18.18%(10/55)、30.77%(16/52)、20.00%(10/50)、18.67%(14/75)和21.31%(13/61);标准化检出率为22.4%、17.7%、10.7%、24.6%、18.9%.病区组的标准化检出率[39.50%(113/285)]高于对照组[21.70%(64/293),T=26,P＜0.01],病区组成人颈部动脉粥样硬化4～7分的构成[17.70%(20/113)]与对照组[14.06%(9/64)]比较,差异无统计学意义(x2=0.26,P＞0.05).结论山西省饮水型砷中毒病区成人的动脉粥样硬化检出率高于对照区.为进一步证实砷中毒可致动脉粥样硬化症提供了证据.