慢性饮水型砷中毒患者皮肤表现和合并疾病及影响因素分析

目的 分析慢性饮水型砷中毒患者的皮肤表现、合并疾病以及可能的影响因素。方法 对内蒙古95例慢性饮水型砷中毒患者的人口学特征、皮肤表现、合并疾病进行流行病学调查和分析。建立logistic回归模型，分析性别、年龄、开始饮用高砷水年龄、水砷浓度及饮用高砷水时间年龄与皮肤表现、合并疾病间的相关性。结果 95例患者中共有77例患者发生色素沉着，75例发生色素减退，93例发生掌跖部皮肤角化，27例患者发生皮肤癌，其中多发性皮肤癌8例。合并结核5例、高血压15例、类风湿性关节炎2例、脑梗死4例、冠心病7例、内脏恶性肿瘤3例、肝硬化6例、贫血2例。回归分析发现色素沉着与水砷浓度相关（OR = 0.32，95% CI = 0.10 ~ 0.98）；校正OR = 0.27，95% CI = 0.08 ~ 0.90）。冠心病的发生与饮用高砷水时间具有相关性（OR = 6.41，95% CI = 1.09 ~ 37.88；校正OR = 8.55，95% CI = 1.212 ~ 60.41）。肝硬化的发生与水砷浓度具有相关性（OR = 24.67，95% CI = 2.69 ~ 226.57；校正OR = 22.51，95% CI = 2.38 ~ 213.11）。结论 慢性砷中毒患者色素代谢异常、掌跖部皮肤角化、皮肤癌发生率高。水砷浓度、饮用高砷水时间不同对人体可能产生不同的影响。

Skin manifestations and comorbidities of chronic arsenicosis due to contaminated drinking water and their risk factors

Han Jianwen, Di Zhen, Zhang Qiaoli, Liu Jia, Wuriga, Zhi Yanping, Wurina Department of Dermatology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China （Han JW, Liu J, WRG, WRN）; Bayannaoer Hanggin Rear Banner Center for Disease Control and Prevention, Bayannaoer 015400, Inner Mongolia, China （Di Z）; Department of Pediatrics, Ordos Central Hospital, Ordos 017000, Inner Mongolia, China （Zhang QL）; Department of Dermatology, Inner Mongolia International Mongolian Hospital, Hohhot 010020, China （Zhi YP） Corresponding author: Wurina, Email: wurinawu506@hotmail.com 【Abstract】 Objective To investigate skin manifestations and comorbidities of chronic arsenicosis due to conta-minated drinking water, and to explore their possible risk factors. Methods Data about demographic characteristics, skin manifestations and comorbidities were collected from 95 patients with chronic arsenicosis due to contaminated drinking water in Inner Mongolia, and retrospectively analyzed. A logistic regression model was established to analyze associations of skin manifestations and comorbidities with patients′ gender, age, age at onset of drinking of arsenic-contaminated water, arsenic concentrations in water and duration of arsenic exposure. Results Among the 95 patients, 77 had hyperpigmentation, 75 hypopigmentation, 93 palmoplantar keratoderma, 27 skin cancer, and 8 multiple skin cancer. Five patients were complicated by tuberculosis, 15 by hypertension, 2 by rheumatoid arthritis, 4 by cerebral infarction, 7 by coronary heart diseases, 3 by internal malignancy, 6 by hepatic cirrhosis and 2 by anemia. Logistic regression analysis revealed a significant correlation between hyperpigmentation and arsenic concentrations in water （OR = 0.32, 95% CI = 0.10 - 0.98; ORadjusted = 0.27, 95% CI = 0.08 - 0.90） , between occurrence of hepatic cirrhosis and arsenic concentrations in water （OR = 24.67, 95% CI = 2.69 - 226.57; ORadjusted = 22.51, 95% CI = 2.38 - 213.11）, and between occurrence of coronary heart diseases and duration of arsenic exposure （OR = 6.41, 95% CI = 1.09 - 37.88; ORadjusted = 8.55, 95% CI = 1.21 - 60.41）. Conclusions There is a high incidence of aberrant pigment metabolism, palmoplantar keratoderma and skin cancer in patients with chronic arsenicosis due to contaminated drinking water. Different arsenic concentrations in water and duration of arsenic exposure seem to have different influences on the human body.