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目的探讨燃煤型污染砷中毒与肝损害的关系,为砷致肝损害的“三早预防”提供依据。方法采用临床内科、影像学、病理学及生物化学方法对燃煤型污染砷中毒病区砷暴露人群进行临床症状体征、肝脏B超、病理形态学检查及血清学肝损害指标检测。结果砷暴露者有不同程度的消化系统主观症状;轻、中、重度组砷中毒患者的B超异常率分别为12%,34%和64%(P<0.01);砷中毒患者肝脏病理学改变以肝组织纤维增生改变最为明显。血清学检查发现:谷胱甘肽硫转移酶(GSTs)(20.42±11.10)U/L,羟脯氨酸(Hyp)(29.5±7.3)μg/mL,血清透明质酸(HA)(68.48±51.80)μg/L,轻、中、重度组皆明显高于对照组(P<0.01);总胆汁酸(6.84±4.45)μmol/L、γ-谷氨酰转肽酶(49.71±28.50)U/L,Ⅲ型前胶原(92.01±43.77)μg/L和Ⅳ型胶原(89.33±14.41)μg/L,在中、重度组明显高于对照组(P<0.01)。结论GSTs、Hyp、HA的联合检测对早期发现和诊断砷所致肝细胞损害及肝纤维化有重要参考价值;肝脏B超检查及选择性监测上述指标,对判断肝损害的发生发展及针对性治疗有实际意义。
Objective To explore the relationship between arsenic poisoning and liver damage caused by coal-burning pollution and provide the basis for prevention of arsenic-induced liver damage. Methods Clinical signs, liver ultrasonography, histopathological examination and serological liver damage indexes of arsenic exposed patients with coal-burning arsenic poisoning were detected by clinical, imaging, pathology and biochemical methods. Results The arsenic exposed persons had subjective symptoms of digestive system in varying degrees. The abnormalities of B-ultrasonography were 12%, 34% and 64% respectively in the arsenic poisoning group (P <0.01) Liver fibrosis to change the most obvious. Serum levels of glutathione S-transferase (GSTs) (20.42 ± 11.10) U / L, hydroxyproline (29.5 ± 7.3) μg / mL and serum hyaluronic acid (P <0.01). The total bile acid (6.84 ± 4.45) μmol / L, γ-glutamyl transpeptidase (49.71 ± 28.50) U / L, type Ⅲ procollagen (92.01 ± 43.77) μg / L and type Ⅳ collagen (89.33 ± 14.41) μg / L in the moderate and severe groups were significantly higher than those in the control group (P <0.01). Conclusion The combined detection of GSTs, Hyp and HA has important reference value for the early detection and diagnosis of arsenic-induced hepatocyte damage and hepatic fibrosis. Liver B-ultrasound and selective monitoring of the above indicators are helpful for judging the occurrence and development of liver damage Treatment has practical significance.