摘要
应用同一检查及诊断标准，分别在病情程度相似的饮水型和燃煤污染型地方性砷中毒重病区检查并诊断了两组病例。两组病人在掌跖角化、躯干色素改变、肢端麻木以及非特异性中枢神经系统中毒症状等基本临床表现上大致相同。但不同型之间也存在一定差异，躯于皮肤色素异常检出率燃煤污染型组低于饮水型组，且病变程度亦较轻。一组可能和皮肤粘膜刺激有关的临床表现──结膜充血、流泪、视力模糊、面部非凹陷性浮肿及甲褶缘粗糙游离致后甲沟形成，在燃煤污染型病例中发生率较高，而饮水型组则很少发生。此外，肝疼、肝肿大、躯干皮肤角化斑等在燃煤污染组检出率也高于饮水型组。另一方面，心悸、关节疼、脱发等则饮水型组（同时水氟亦高）明显高于燃煤污染型组。病情程度相似的两型病人临床表现差异提示除摄入砷因素外，可能还涉及到另一些因素，诸如砷化物的理化性质、摄入途径影响、其他共存致病因子作用。通过比较，进一步确认了掌跖角化、躯干灰黑色色素沉着及勇于脱色斑点为具有诊断意义的特异性表现，以末稍神经炎为主要表现的周围神经炎和以失眠为多见的非特异性中枢神经系统中毒症状在临床诊断上有一定意义。米氏纹的存在与否不是地方性砷中毒必有体征。
This paper reports the results of comparative study on clinical manifestation of arsenism pa-tients in endemic areas of two types of arsenism. The cases were diagnosed by one of the authors with samecriteria in a village with higharsenic drinking water(water group)and another village with burning high-ar-senic coal(coal group),respectively. Some basic clinical mauifestations of the cases of the water group,shchas keratosis on palms & metatarsus,pigmentation and depigmentation spots on trunk,anesthesia of extremi-ties and nonspecific toxic symptoms of the central nervous system,were usually seen in coal group . On theother hand,a lot of differences of some clinical manifestations were observed in both group.The rate of pig-mentation or depigmentation spots on trunk in coal group was lower than that in water group, A group ofmanifestations included conjunctival congestion,lacrin1ation, dimness of vision and fulliness in face,whichmight be caused by the stimulation of the polluted air by burning coal,were usually seen in tbe coal group,butnot seen in water group. The rates of hepatalgia,hepatomegaly,symptoms in digestive tract and keratosisplaques on trunk in the cases of coal group were higher than those in water group.But in water group(alsowith more fluoride in drinking water),the rates of palpitation,arthrodynia and alopecia were higher thanthose in coal group.The report suggests that some factors ,such as the physicochemical character of arsenide,the pathway of arsenic intake and other co-exist factors be the reason for causing these differences. Accordingto the result,the authors confirm that the basic skin signs(keratosis on hands & feet,pigmentation and depig-mentaxion sports on trunk)are specific manifestations for diagnosing the disease,and that the peripheral neu-ritis characterized by anesthesia of the extrenuties and nonspecific toxic symptoms of the central nervous sys-tem are also useful as reference indication for diagnosis .
出处
《地方病通报》
1996年第2期91-95,共5页
Endemic Diseases Bulletin
基金
国家自然科学基金
关键词
地方性砷中毒
临床表现
饮水型
燃煤污染型
Endemic arsenism,Drinking water type
Endemic arsenism,coalsmoke-borne type
Clinicalmanifestation
