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目的研究砷接触人群肾功能损害情况,探讨镉在砷接触人群肾功能损害方面与砷的联合作用。方法以贵州省地方病办公室1991年3月确诊并经1997年3月和2001年3月临床复查的122例砷中毒患者为本次调查对象,无砷污染区居民123名作为对照。以尿砷、尿镉作为接触标志物,尿β2微球蛋白(Uβ2MG)、尿白蛋白、尿N乙酰βD氨基葡萄糖苷酶(UNAG)作为砷、镉致肾小管和肾小球损害的效应标志物。同时分别计算尿砷、尿镉的基准剂量(BMD)及其下限值(BMDL)。结果接触组的接触指标和效应指标均高于对照组,尿砷、尿镉水平与Uβ2MG、尿白蛋白、UNAG水平间均为正相关,具有明显的剂量效应关系;砷、镉联合毒性比单独砷或镉同等剂量下的毒性更大。尿砷的BMD和BMDL值(以肌酐含量计)分别为12191～17188μg/g和10211～14444μg/g;尿镉的BMD和BMDL值(以肌酐含量计)分别为105～148μg/g和088～124μg/g。结论砷、镉联合毒性剂量明显低于单一毒性剂量,镉可能增强了砷在长期砷接触人群中对肾脏的损伤作用;运用BMD方法计算砷接触人群肾功能损伤尿砷、尿镉的BMD和BMDL值,尿砷、尿镉的BMDL值分别为以肌酐含量计10211μg/g、088μg/g。
Objective To study the renal damage caused by arsenic exposure and to explore the combined effects of cadmium and arsenic on renal damage induced by arsenic exposure. Methods A total of 122 cases of arsenic poisoning diagnosed by the endemic office of Guizhou Province in March 1991 and clinically reviewed in March 1997 and March 2001 were selected as the objects of this survey. 123 residents without arsenic contamination were taken as control. Urinary arsenic and urinary cadmium were used as contact markers, urinary β2-microglobulin (Uβ2MG), urinary albumin and urinary N-acetylglucosaminidase (UNAG) as a marker of renal tubular and glomerular damage induced by arsenic and cadmium Things. The urinary arsenic and urinary cadmium baseline dose (BMD) and its lower limit (BMDL) were also calculated. Results The contact index and effect index of the exposed group were all higher than those of the control group. The urinary arsenic and urinary cadmium levels were positively correlated with Uβ2MG, urinary albumin and UNAG levels, and had obvious dose-response relationship. Arsenic or cadmium at the same dose toxicity. Urinary arsenic BMD and BMDL values (creatinine content) were 12191 ~ 17188μg / g and 10211 ~ 14444μg / g; urinary cadmium BMD and BMDL values (creatinine content) were 105 ~ 148μg / g and 088 ~ 124 μg / g. Conclusions The combined doses of arsenic and cadmium are significantly lower than the single toxic dose. Cadmium may enhance the renal damage caused by arsenic in long-term arsenic exposure. BMD is used to calculate the arsenic and urinary cadmium BMD and BMD BMDL values of urinary arsenic and urinary cadmium were 10211 μg / g and 088 μg / g, respectively.