Tseng Chin-Hsiao, Huang Yung-Kai, Huang Ya-Li, Chung Chi-Jung, Yang Mo-Hsiung, Chen Chien-Jen, Hsueh Yu-Mei
Department of Internal Medicine, Division of Endocrinology and Metabolism, National Taiwan University Hospital, Taipei, Taiwan.
Toxicol Appl Pharmacol. 2005 Aug 15;206(3):299-308. doi: 10.1016/j.taap.2004.11.022.
Long-term exposure to ingested inorganic arsenic is associated with peripheral vascular disease (PVD) in the blackfoot disease (BFD)-hyperendemic area in Taiwan. This study further examined the interaction between arsenic exposure and urinary arsenic speciation on the risk of PVD. A total of 479 (220 men and 259 women) adults residing in the BFD-hyperendemic area were studied. Doppler ultrasound was used to diagnose PVD. Arsenic exposure was estimated by an index of cumulative arsenic exposure (CAE). Urinary levels of total arsenic, inorganic arsenite (As(III)) and arsenate (As(V)), monomethylarsonic acid (MMA(V)), and dimethylarsinic acid (DMA(V)) were determined. Primary methylation index [PMI = MMA(V)/(As(III) + As(V))] and secondary methylation index (SMI = DMA(V)/MMA(V)) were calculated. The association between PVD and urinary arsenic parameters was evaluated with consideration of the interaction with CAE and the confounding effects of age, sex, body mass index, total cholesterol, triglycerides, cigarette smoking, and alcohol consumption. Results showed that aging was associated with a diminishing capacity to methylate inorganic arsenic and women possessed a more efficient arsenic methylation capacity than men did. PVD risk increased with a higher CAE and a lower capacity to methylate arsenic to DMA(V). The multivariate-adjusted odds ratios for CAE of 0, 0.1-15.4, and >15.4 mg/L x year were 1.00, 3.41 (0.74-15.78), and 4.62 (0.96-22.21), respectively (P < 0.05, trend test); and for PMI < or = 1.77 and SMI > 6.93, PMI > 1.77 and SMI > 6.93, PMI > 1.77 and SMI < or = 6.93, and PMI < or = 1.77 and SMI < or = 6.93 were 1.00, 2.93 (0.90-9.52), 2.85 (1.05-7.73), and 3.60 (1.12-11.56), respectively (P < 0.05, trend test). It was concluded that individuals with a higher arsenic exposure and a lower capacity to methylate inorganic arsenic to DMA(V) have a higher risk of developing PVD in the BFD-hyperendemic area in Taiwan.
长期摄入无机砷与台湾黑脚病（BFD）高流行地区的外周血管疾病（PVD）有关。本研究进一步探讨了砷暴露与尿砷形态对PVD风险的相互作用。对居住在BFD高流行地区的479名成年人（220名男性和259名女性）进行了研究。采用多普勒超声诊断PVD。通过累积砷暴露指数（CAE）评估砷暴露情况。测定了尿中总砷、无机亚砷酸盐（As(III)）和砷酸盐（As(V)）、一甲基胂酸（MMA(V)）和二甲基胂酸（DMA(V)）的水平。计算了一级甲基化指数[PMI = MMA(V)/(As(III) + As(V))]和二级甲基化指数（SMI = DMA(V)/MMA(V)）。在考虑与CAE的相互作用以及年龄、性别、体重指数、总胆固醇、甘油三酯、吸烟和饮酒的混杂效应的情况下，评估了PVD与尿砷参数之间的关联。结果显示，随着年龄增长，无机砷甲基化能力下降，且女性的砷甲基化能力比男性更强。PVD风险随着CAE升高和将砷甲基化为DMA(V)的能力降低而增加。CAE为0、0.1 - 15.4和>15.4 mg/L·年时，多因素调整后的优势比分别为1.00、3.41（0.74 - 15.78）和4.62（0.96 - 22.21）（P < 0.05，趋势检验）；PMI≤1.77且SMI>6.93、PMI>1.77且SMI>6.93、PMI>1.77且SMI≤6.93以及PMI≤1.77且SMI≤6.93时，优势比分别为1.00、2.93（0.90 - 9.52）、2.85（1.05 - 7.73）和3.60（1.12 - 11.56）（P < 0.05，趋势检验）。研究得出结论，在台湾BFD高流行地区，砷暴露较高且将无机砷甲基化为DMA(V)能力较低的个体发生PVD的风险更高。
