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阿坝地区大骨节病的生物地球化学影响机理研究
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摘要
大骨节病Kashin-Bech disease(简称KBD)是一种以侵害人体关节软骨、骺板软骨为主,导致软骨坏死,最终骨端膨大、变形的骨关节病,主要发生生于儿童和少年。在我国,大骨节病主要分布在东北至西藏(阿坝州)的一个狭长高寒地带。地域分布虽广,但受生态及环境特点控制,即主要分布在我国东南部季风湿润带和西北内陆干旱带之间的过渡带,大骨节病的病因至今尚未阐明,生物环境地球化学学说认为本病是由于环境中某些元素缺少、过多或比例失调所致,近年来倾向于认为环境低硒是大骨节病的病因,另外还有有机物中毒学说、食物性真菌毒素中毒学说、环境因子及相关病毒学说等。
     阿坝州位于四川省西北部,是全国罕见的大骨节病重病区。大骨节病的病因在很大程度上和当地的水文环境有着密切的关系,大骨节病区的环境地质条件,特别是地表水体和患病率之间存在紧密联系。论文依托四川省政府与国土资源部合作项目《四川省大骨节病区地下水调查与安全供水示范工程》子课题《四川阿坝州生态地球化学调查》(1212010913022),查明病区的水化学特征和元素组成,联系大骨节病人人发的元素分析,结合相关致病因子的毒理学检测,能初步分析大骨节病的生物地球化学影响机理,探讨体外遗传毒性试验在地球化学领域中的应用范围,为毒理学方法在地球化学研究中的应用积累理论资料,为病区移民安置和打井工程提供科学依据。主要取得如下成果:
     1、研究区水体pH呈现中性-弱碱性,以低矿化度的软水为主。井水矿化度在所有水源中最高,杜柯河矿化度在所有河流中最高,则曲河矿化度最低。水体中阴离子中HCO_3~-占优势,阳离子中Ca~(2+)占主要地位,主要离子含量表现为阴离子HCO_3~->SO_4~(2-)>Cl-,阳离子Ca~(2+)>Mg~(2+)>K~+~+Na~+。水化学类型较为单一,绝大多数样品以HCO_3~-Ca和HCO_3~-CaMg型为主。
     2、水样微量元素中Fe、Co、Ni、Cd、Hg、Sr、Ba、Cu、Zn含量较高,As明显富集,Cs、Se含量较低。则曲河的Ni、Cd、Sr、Ba含量高,Cs、Se含量低最为明显。各流域除了Cl~-含量没有差异,其余均有显著性差异;微量元素中,As、Ba、Cr、Ni等有显著性差异,Pb、Cu、Mn、Be等无统计学差异。
     3、阿坝州各县中,壤塘县的患病率最高;壤塘县中又以南木达、茸木达、尕多、中壤塘、上壤塘五个乡的患病率为高,其中南木达、茸木达、中壤塘、上壤塘等四个乡又均处于则曲河流域,用多元线性回归分析、聚类分析来判断影响因子的强弱以及证明将数据按照流域分类的合理性,其结果如下:
     对患病率影响因素最大的因子是As、TDS、Cd、K、Cs、Ni等6个影响因子,分别以X_1、X_2、X_3、X_4、X_5、X_6来代替,从而可以写出的多元线性回归方程为Y=0.142+0.132X_1-0.001X_2+1.700X_3―0.075X_4―0.773X_5+0.042X_6。通过多元回归系数的正负,可以判断As、Cd、Ni与患病率是正相关关系;TDS、K、Cs与患病率是负相关关系。也就是说在阿坝州的这四个流域地区水中As、Cd、Ni含量越高,大骨节病的患病率越高;TDS、K、Cs含量越高,大骨节病的患病率越低。患病率最高的则曲河流域As、Cd、Ni的含量均高于其他三个流域;而TDS、K、Cs含量均低于其他三个流域。用这6个影响因子的标准化回归系数的绝对值来判断它们对患病率影响的强弱,绝对值越大的,对患病率的影响性越强;反之则越小。由此可以得出结果:影响因子对大骨节病患病率影响强弱大小的顺序是As>TDS>K>Ni>Cs>Cd。聚类分析表明,通过冰柱图和树状图很清地晰显示水样品按照以上6个影响因子聚类分组后,将水样分为四大类,按照五条河四个流域的分组方法是一种合理的分类方法。
     4、通过ICP-AES法测定人发样品100例中的10中元素含量,从结果显示,阿坝州壤塘地区大骨节病患者的人发样品中As、Hg的含量明显比健康人群偏高,对大骨节病的发生有显著的正向影响作用;而Se的含量明显比健康人群偏低,对大骨节病的发生有显著的负向影响作用。而其他七种元素(Ca、Cr、F、I、Mn、Pb、Sr)的含量健康人群与大骨节病患者之间没有显著性差异,说明这些元素含量虽然不同,但对大骨节病的产生无影响。
     5、用彗星试验检测氯化亚汞(Hg~+)、亚硒酸钠(Se4~+)、矿化度(TDS)的致突变性和抗诱变性结果:
     (1)氯化亚汞(Hg~+)在1g/ml以上浓度时能够诱导TK6细胞DNA的单链断裂,具有DNA损伤作用,氯化亚汞(Hg~+)有一定的致突变性。
     (2)亚硒酸钠(Se4~+)在1g/ml至10g/ml的剂量时能够抑制K2Cr2O7诱导TK6细胞DNA的单链断裂,具有减轻DNA损伤的作用,亚硒酸钠(Se4~+)在一定浓度范围内有抗诱变性。
     (3)水源矿化度在160mg/L以下时能够诱导TK6细胞DNA的单链断裂,具有DNA损伤作用,低矿化度水有一定的致突变性。
     6、用体外微核试验检测氯化亚汞(Hg~+)、亚硒酸钠(Se~(4+))、矿化度(TDS)的致突变性和抗诱变性结果:
     (1)氯化亚汞(Hg~+)在在10g/ml左右剂量时有诱导TK6细胞微核率增加的作用,提示Hg~+对染色体有明显损伤作用,氯化亚汞(Hg~+)有一定的致突变性。
     (2)亚硒酸钠(Se~(4+))在1g/ml至10g/ml的剂量时有拮抗MMC诱导TK6细胞微核率增加的作用,提示Se~(4+)在一定浓度范围内对染色体有明显保护防止损伤的作用;但浓度过大可能产生细胞毒性导致细胞死亡。
     (3)水源矿化度在160mg/L以下时有诱导TK6细胞微核率增加的作用,对染色体有明显损伤作用。
     结合两种毒理学试验方法,高浓度Hg和低矿化度水对人的细胞有损伤作用,而Se在一定浓度范围内有保护细胞防止损伤的作用;这些致病因素很可能参与大骨节病的病理损伤的分子机制,对导致软骨细胞发生一系列的病理变化并发生软骨细胞变性坏死有直接或间接的作用。本次研究为进一步探讨大骨节病的发病机理提供了一定的试验依据。
Kashin-Beck disease (KBD) is a violation of human articular cartilage, growthplate cartilage, leading to necrosis of the cartilage, bone, eventually end expansiondeformation of bone and joint disease, occurs mainly in children and adolescents. Inour country, Kashin-Beck disease mainly in the northeast to Tibet (ABa AutonomousRegion)a tall narrow cold zone. The geographical distribution is wide, but theecological and environmental characteristics of control, which are mainly distributedin Southeast China monsoon humid and arid zone of transition between the belt, theetiology of KBD has not been elucidated, biological environmental geochemistry thatthe disease is due to the environment of some elements missing, excess or imbalanceresult, in recent years tend to believe that the environment is low selenium KBDetiology, in addition to the poisoning of the organic compounds, food poisoning of themycotoxin, environmental factors and related virus theory etc.
     Aba Autonomous Region is located in Sichuan Province in the northwest, is theinfrequent high KBD ward. The etiology of KBD in the very great degree and localhydrological environment are closely related, KBD area environment geologicalconditions, especially the surface water and the prevalence rate of close ties existbetween. The thesis based on the Sichuan provincial government and the Ministry ofLand Resources which the sub-name is―the survey of the ecological geochemistry inAba Sichuan province(1212010913022)‖, identified in the water chemicalcharacteristics and elemental composition, contact the KBD in human hair elementanalysis, combined with the related pathogenic factor toxicology testing, can be apreliminary analysis of KBD biogeochemical effect mechanism, in vitro genotoxicitytests in the field of Geochemistry in the scope of application, for the toxicologicalmethods in geochemical research accumulation theory in resettlement for information, and offer a scientific proof for setting down the immigrant and digging well.The main achievements as below:
     1, the water in study place was mostly middle alkalinity and light mineralization.The Duke river had the highest mineralization among the all rives in search place, TheZequ river was the lowest. Water anion HCO_3~-dominant, cation Ca~(2+)occupies themain status, major ion content of anionic HCO_3~->SO_4~(2-)>Cl~-, the cations Ca~(2+)>>Mg~(2+)>K~++Na~+,the water chemistyr’s type was HCO_3-Ca and HCO_3~-Ca Mg.
     2, water microelements of Fe, Co, Ni, Cd, Hg, Sr, Ba, Cu, Zn were little high, Aswas obvious enrichment, Cs and Se were lower. Zequ river Ni, Cd, Sr, Ba higher, Cs,Se lower was most obvious than other rivers. The element Cl was not different, theremaining were significant differences; microelements, As, Ba, Cr, Ni had significantdifference, Pb, Cu, Mn, Be had no statistical difference.
     3, in Aba Autonomous Region, Rangtang county had the highest prevalence rate;Nanmuda, Rongmuda, Gaduo, Zhongrangtang, Shangrangtang. The five townships ofprevalence rate was highest, four of them were in The Zequ river Valley, usingmultiple linear regression analysis, clustering analysis to judge the impact factor ofthe strength as well as proof that the data according to the basin of the reasonability ofthe classification, the results are as follows:
     The prevalence of factors affecting the maximal factor was As, TDS, Cd, K, Cs,Ni influencing factors, respectively, to X_1, X_2, X_3, X_4, X_5, X_6instead, thus can writemultiple linear regression equation was Y=0.14~(2+)0.132X_1-0.001X~(2+)1.700X_3-0.075X_4-0.773X_5~+0.042X_6. Through multivariate regression coefficient of positiveand negative, can determine As, Cd, Ni had positive correlation with prevalence; TDS,K, Cs had negative correlation with prevalence. That is to say in the ABA in the fourriver region water As, Cd, Ni in higher level, KBD prevalence rate is higher; TDS, K,Cs in higher level, KBD prevalence is lower. The highest prevalence of The Zequriver Valley As, Cd, Ni levels were higher than those of the other three watersheds;while TDS, K, Cs levels were lower than those of the other three watersheds. The siximpact factors of the standardized regression coefficient absolute value to judge themon the prevalence rate of impact strength, the larger absolute value, the effect onmorbidity of more intense; otherwise the small. The factors of influence on KBDprevalence effect strength size order was As>TDS>K>Ni>Cs>Cd. Cluster analysisshowed that is very clear to classify water samples according to the above six factorsclustering, water was classified into four categories. The grouping method was areasonable classification method.
     4, through the ICP-AES method for the determination of human hair samples of100patients in the10elements, the results showed that, the Aba Autonomous Region ofKBD in patients with human hair samples of As, Hg were significantly higher than inthe healthy population, on KBD had significant positive effect; while Se was lowerthan in the healthy population of KBD, had significant negative effects. While theother seven elements (Ca, Cr, F, I, Mn, Pb, Sr) in healthy individuals and patients withKBD and there was no significant difference between these elements, althoughdifferent, but to KBD produced no effect.
     5, using the comet assay for the detection of mercuric chloride (Hg~+), sodiumselenite (Se~(4+)), mineralization (TDS) on the mutagenicity and antimutagenicity ofresults as below:
     (1) Mercury chloride (Hg~+) in1g/ml above concentration to induce TK6cell DNAsingle-strand breaks, DNA damage, mercurous chloride (Hg~+) have certainmutagenicity.
     (2) Sodium selenite (Se~(4+)) in1g/ml to10g/ml doses can inhibit K2Cr2O7inducedTK6cell DNA single-strand breaks, can reduce DNA damage, sodium selenite (Se~(4+))concentration in a certain range antimutagenicity.
     (3) The degree of water mineralization in160mg/L following can induce TK6cellDNA damage, low mineralized water has certain mutagenicity.
     6, the in vitro micronuclei test for the detection of mercuric chloride (Hg~+),sodium selenite(Se~(4+)), mineralization (TDS) on the mutagenicity and antimutagenicityof results as below:
     (1) mercury chloride (Hg~+) in about10g/ml dose induced TK6cell micronucleus rateincreased role, prompting Hg~+on chromosome has obvious damage, mercurouschloride (Hg~+) have certain mutagenicity.
     (2) sodium selenite (Se~(4+)) in1g/ml to10g/ml dose antagonist MMC inducedTK6cell micronucleus rate increased role, suggesting that Se4~+concentration in acertain range of chromosome has obvious protection to prevent damage; but theconcentration of too much may produce cytotoxic leads cell death.
     (3) The degree of water mineralization in160mg/L following have induced TK6cellmicronucleus rate of increase the role of chromosome, has obvious damage effect.
     Combination of two methods of toxicological test, high concentrations of Hg andlow mineralized water on human cell damage, and Se in a certain concentration rangeto protect cells prevent damage; these virulence factors are probably involved in KBDpathological damage of molecular mechanisms of cartilage cell, leading to a series of pathological changes and the occurrence of cartilage cell degeneration necrosis havedirect or indirect effect. The research for the further study of KBD pathogenesis willprovide experimental basis.
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