Guha Mazumder D N, Haque R, Ghosh N, De B K, Santra A, Chakraborty D, Smith A H
Institute of Post Graduate Medical Education and Research, Calcutta, India.
Int J Epidemiol. 1998 Oct;27(5):871-7. doi: 10.1093/ije/27.5.871.
A cross-sectional survey was conducted between April 1995 and March 1996 to investigate arsenic-associated skin lesions of keratosis and hyperpigmentation in West Bengal, India, and to determine their relationship to arsenic water levels.
In all, 7683 participants were examined and interviewed, and the arsenic levels in their drinking water measured.
Although water concentrations ranged up to 3400 microg/l of arsenic, over 80% of participants were consuming water containing <500 microg/l. The age-adjusted prevalence of keratosis was strongly related to water arsenic levels, rising from zero in the lowest exposure level (<50 microg/l) to 8.3 per 100 for females drinking water containing >800 microg/l, and increasing from 0.2 per 100 in the lowest exposure category to 10.7 per 100 for males in the highest exposure level (> or =800 microg/l). However, 12 cases with keratosis (2 females and 10 males) were drinking water containing <100 microg/l of arsenic. Findings were similar for hyperpigmentation, with strong dose-response relationships. Among those with hyperpigmentation, 29 cases were exposed to drinking water containing <100 microg/l. Calculation by dose per body weight showed that men had roughly two to three times the prevalence of both keratosis and hyperpigmentation compared to women apparently ingesting the same dose of arsenic from drinking water. Subjects who were below 80% of the standard body weight for their age and sex had a 1.6 fold increase in the prevalence of keratoses, suggesting that malnutrition may play a small role in increasing susceptibility.
The surprising finding of cases who had arsenic-associated skin lesions with apparently low exposure to arsenic in drinking water needs to be confirmed in studies with more detailed exposure assessment. Further research is also needed concerning susceptibility factors which might be present in the exposed population.
1995年4月至1996年3月期间进行了一项横断面调查，以调查印度西孟加拉邦与砷相关的角化病和色素沉着皮肤病变，并确定它们与砷水含量的关系。
总共对7683名参与者进行了检查和访谈，并测量了他们饮用水中的砷含量。
尽管水中砷浓度高达3400微克/升，但超过80%的参与者饮用的水砷含量<500微克/升。年龄调整后的角化病患病率与水砷含量密切相关，在最低暴露水平（<50微克/升）时为零，对于饮用砷含量>800微克/升水的女性，患病率升至每100人中有8.3例，在最低暴露类别中每100人中有0.2例，在最高暴露水平（>或=800微克/升）的男性中增至每100人中有10.7例。然而，有12例角化病患者（2名女性和10名男性）饮用的水砷含量<100微克/升。色素沉着的情况类似，存在强烈的剂量反应关系。在有色素沉着的人中，29例暴露于砷含量<100微克/升的饮用水中。按体重计算剂量表明，与显然从饮用水中摄入相同剂量砷的女性相比，男性的角化病和色素沉着患病率大约是女性的两到三倍。年龄和性别低于标准体重80%的受试者，角化病患病率增加了1.6倍，这表明营养不良可能在增加易感性方面起了小作用。
在饮用水中砷暴露明显较低却出现砷相关皮肤病变的病例这一惊人发现，需要在进行更详细暴露评估的研究中得到证实。还需要对暴露人群中可能存在的易感性因素进行进一步研究。
