饮用水中的砷与皮肤病变：来自印度西孟加拉邦的剂量反应数据。
Arsenic in drinking water and skin lesions: dose-response data from West Bengal, India.
作者信息
Haque Reina, Mazumder D N Guha, Samanta Sambit, Ghosh Nilima, Kalman David, Smith Meera M, Mitra Soma, Santra Amal, Lahiri Sarbari, Das Subhankar, De Binay K, Smith Allan H
机构信息
School of Public Health, University of California, Berkeley, Berkeley, CA 94720-7360, USA.
出版信息
Epidemiology. 2003 Mar;14(2):174-82. doi: 10.1097/01.EDE.0000040361.55051.54.
BACKGROUND
Over 6 million people live in areas of West Bengal, India, where groundwater sources are contaminated with naturally occurring arsenic. The key objective of this nested case-control study was to characterize the dose-response relation between low arsenic concentrations in drinking water and arsenic-induced skin keratoses and hyperpigmentation.
METHODS
We selected cases (persons with arsenic-induced skin lesions) and age- and sex-matched controls from participants in a 1995-1996 cross-sectional survey in West Bengal. We used a detailed assessment of arsenic exposure that covered at least 20 years. Participants were reexamined between 1998 and 2000. Consensus agreement by four physicians reviewing the skin lesion photographs confirmed the diagnosis in 87% of cases clinically diagnosed in the field.
RESULTS
The average peak arsenic concentration in drinking water was 325 microg/liter for cases and 180 microg/liter for controls. The average latency for skin lesions was 23 years from first exposure. We found strong dose-response gradients with both peak and average arsenic water concentrations.
CONCLUSIONS
The lowest peak arsenic ingested by a confirmed case was 115 microg/liter. Confirmation of case diagnosis and intensive longitudinal exposure assessment provide the basis for a detailed dose-response evaluation of arsenic-caused skin lesions.
背景
印度西孟加拉邦有超过600万人生活在地下水源被天然砷污染的地区。这项嵌套病例对照研究的主要目的是描述饮用水中低砷浓度与砷诱发的皮肤角化病和色素沉着之间的剂量反应关系。
方法
我们从1995 - 1996年西孟加拉邦横断面调查的参与者中选取病例（有砷诱发皮肤病变的人）以及年龄和性别匹配的对照。我们对砷暴露进行了详细评估，涵盖至少20年。参与者在1998年至2000年期间接受了复查。由四位医生对皮肤病变照片进行的一致性诊断确认了现场临床诊断病例中87%的诊断结果。
结果
病例组饮用水中砷的平均峰值浓度为325微克/升，对照组为180微克/升。皮肤病变的平均潜伏期为首次接触后23年。我们发现砷水峰值浓度和平均浓度均呈现出强烈的剂量反应梯度。
结论
确诊病例摄入的最低砷峰值为115微克/升。病例诊断的确认和密集的纵向暴露评估为详细评估砷导致的皮肤病变的剂量反应提供了依据。
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