Neuropathy in arsenic toxicity from groundwater arsenic contamination in West Bengal, India
Neuropathy in arsenic toxicity from groundwater arsenic contamination in West Bengal, India
复制标题
DOI：
10.1081/ese-120016887
复制
发表时间：
2003-01-01
影响因子：
2.1
通讯作者：
Chakraborti, D
中科院分区：
文献类型：
--
作者：
Mukherjee, SC;Rahman, MM;Chakraborti, D
印度西孟加拉邦18个地区中有9个地区的许多人由于饮用含砷量超过世界卫生组织最高允许限度50杯/升的管井水而地方性地暴露于砷污染的地下水中。从我们正在进行的对西孟加拉邦不同地区砷中毒患者神经系统受累的研究中，我们报告了来自三个地区（穆尔西达巴德、纳迪亚和布尔德万）的451名患者的研究结果，包括267名男性和184名女性，年龄从11岁到79岁不等。他们都有砷性皮肤病变，阳性生物标志物和确定的砷污染饮用水来源。第1组413例患者中有154例（37.3%）发生周围神经病变，第2组38例患者中有33例（86.8%）发生周围神经病变。排除了神经病变的其他可能原因和其他解释。第1组154例患者的颞叶表现为慢性病变，第2组33例患者同时表现为神经病变和皮肤病变。亚急性组2患者神经病变发生率高。2组患者下肢远端疼痛发生率分别为73.7%和23.7%，明显高于1组（18.4%和11.1%）。第1组和第2组分别有7.3%和10.5%的患者出现远端肢体无力或萎缩。总的来说，神经病变患者的感觉特征比运动特征更常见，在第一组和第二组中，诊断为感觉神经病变的分别为30%和76.3%，诊断为感觉运动的分别为7.3%和10.5%。88例临床中度和轻度神经病患者的神经传导和肌电图检查显示，感觉神经功能障碍占45%和27%，运动神经功能障碍占20%和16.7%。20例患者的诱发电位研究除视觉诱发电位异常和脑干听觉诱发电位异常两例外，基本正常。轻度和早期诊断的神经病变预后良好，而大多数其他较严重和晚期诊断的病例则表现为缓慢和部分恢复甚至恶化。神经病变性砷中毒患者的预后和长期毒性神经系统效应尚未探索和未知，仍是未来关注的问题，需要密切监测。
Large number of people from 9 out of 18 districts of West Bengal, India are endemically exposed to arsenic contaminated groundwater due to drinking of tubewell water containing arsenic level above World Health Organization's maximum permissible limit of 50 mug/L. From our ongoing studies on neurological involvement in patients of arsenicosis from different districts of West Bengal, we report our findings in a total of 451 patients of three districts (Murshidabad, Nadia, and Burdwan), comprising 267 males and 184 females with age ranging from 11 to 79 years. They all had arsenical skin lesions, positive biomarkers and identified source of arsenic contaminated water drinking. Peripheral neuropathy was the predominant neurological complication in these patients affecting 154 (37.3%) of 413 patients of Group 1 and 33 (86.8%) of 38 patients of Group 2. Other possible causes and alternative explanations of neuropathy were excluded. The temporal profile in most of the cases (154 of Group 1) were of chronic affection while the 33 patients of Group 2 developed both neuropathy and dermopathy subacutely. Subacutely affected Group 2 patients had much higher incidence of neuropathy. Paresthesias and pains in the distal parts of extremities were much higher in incidence in Group 2 (73.7% and 23.7% respectively) than in Group 1 (18.4% and 11.1%). Distal limb weakness or atrophy was evident in 7.3% in Group 1 and 10.5% in Group 2. Overall, sensory features were more common than motor features in patients of neuropathy and sensory neuropathy was diagnosed in 30% and 76.3% and sensorimotor in 7.3% and 10.5% respectively in Group I and Group 2 subjects. Nerve conduction and electromyographic studies performed in 88 cases revealed dysfunction of sensory nerve in 45% and 27% and of motor nerve in 20% and 16.7% of patients with moderate degree and mild degree of clinical neuropathies respectively. Evoked potential studies performed in 20 patients were largely normal except for two instances each of abnormal visual evoked potential and brainstem auditory evoked potential findings. Prognosis was favorable in mild and early diagnosed cases of neuropathy whereas most of the other more severe and late diagnosed cases showed slow and partial recovery or even deterioration. Outcome in neuropathic patients of arsenicosis and long term toxic neurologic effects yet unexplored and unknown remain as matters of future concern requiring close monitoring.