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[背景]慢性砷暴露与皮肤损害相关。然而,尚不知道减少砷暴露是否会改善皮肤损害。[目的]评估随时间的推移,砷暴露减少与皮肤损害恢复之间的关联。[方法]在2001—2003年间孟加拉国登记的基线皮肤损害病例(n=900)的基础上,于2009—2011年随访研究550名患者。确定基线及随访时饮用水和脚趾甲中的砷与皮肤损伤的状态及严重程度。采用logistic回归及广义估计方程(GEE)模型评估砷暴露lg浓度转换值与皮肤损害的持久性及严重性之间的关联。[结果]在研究期间,这一人群中饮用水的砷浓度总体下降41%,65名基线时有皮肤损害的个体在随访中没有可辨认的损伤。在校正模型中,水中砷及脚趾甲中砷以lg浓度下降时,皮损恢复分别相对增加22%[比值比(OR)=1.22,95%CI:0.85~1.78]和4.5倍(OR=4.49,95%CI:1.94~11.1)。[结论]减少砷暴露可增加皮损恢复的可能性,皮肤受损的个体将在10年内恢复或皮肤病变的严重程度减轻。在孟加拉国和其他用水受到砷污染的地区,必须继续将减少砷暴露作为一项公共卫生重点。
[Background] Chronic arsenic exposure is associated with skin damage. However, it is unknown whether reducing arsenic exposure will improve skin damage. [Purpose] To assess the association between reduced arsenic exposure and recovery from skin lesions over time. [Method] Based on a baseline case of skin lesions registered in Bangladesh during 2001-2003 (n = 900), 550 patients were followed up during 2009-2011. Determine the status and severity of arsenic and skin lesions in drinking water and toenails at baseline and at follow-up. Logistic regression and generalized estimating equation (GEE) models were used to assess the association between the lg concentration change in arsenic exposure and the duration and severity of skin lesions. [Results] The overall arsenic concentration in drinking water decreased by 41% during the study period, and 65 individuals with skin lesions at baseline had no identifiable damage at follow-up. In the calibration model, arsenic and toenail arsenic showed a relative increase of 22% in the recovery of arsenic at lg concentrations (odds ratio = 1.22, 95% CI: 0.85-1.78) and 4.5 times (OR = 4.49 , 95% CI: 1.94 ~ 11.1). [Conclusion] Decreasing arsenic exposure may increase the possibility of recovery of skin lesions. Individuals with damaged skin will recover within 10 years or reduce the severity of skin lesions. In Bangladesh and other areas where water is contaminated with arsenic, it is important to continue reducing arsenic exposure as a public health priority.