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目的 分析低浓度饮水型砷暴露对人群外周血血细胞的影响,为筛选低浓度砷暴露的早期损伤标志提供依据.方法 在山西省大同市,选择相邻且经济发展均衡的地方性砷中毒(简称地砷病)病区(水砷含量为14.41 ～ 90.34 μg/L)和非地砷病病区(水砷含量为0.00～ 0.87 μg/L),在病区与非病区各选择1个自然村,抽取饮当地水15年以上本地居民,无传染性、遗传性等疾病,无放射线和理化致病因素接触史者为调查对象.其中地砷病病区85名,为砷暴露组;非地砷病病区71名,为对照组.采集静脉血,全自动血细胞分析仪测定血细胞参数的变化.结果 白细胞各项指标:砷暴露组淋巴细胞绝对值[LYM,(2.00±0.90)×109/L]和淋巴细胞百分比[LYM％,(33.92±9.70)％]均高于对照组[(1.58±0.57)×109/L,(29.72±8.32)％,t值分别为-3.348、-2.873,P均＜0.05],单核细胞绝对值[MON,(0.15±0.07)×109/L]、单核细胞百分比[MON％,(2.53±0.77)％]均低于对照组[(0.47±0.15)×109/L,(8.64±1.97)％,t值分别为16.309、24.599,P均＜0.05].红细胞各项指标:砷暴露组红细胞[RBC,(4.44±0.46)×109/L]、血红蛋白[HGB,(136.59±13.84)g/L]、平均红细胞血红蛋白含量[MCH,(30.85±1.87)pg]、平均红细胞血红蛋白浓度[MCHC,(360.67±8.54)g/L]和红细胞体积分布宽度[RDW,(13.19±0.75)％]均高于对照组[(4.10±0.58)×109/L,(111.11±16.49)g/L,(27.68±2.99)pg,(295.20±36.82)g/L,(11.06±1.08)％,t值分别为-4.063、-10.491、-7.747、-14.651、-14.450,P均＜0.05],平均红细胞体积[MCV,(85.49±4.43)fl]则低于对照组[(92.69±7.50)fl,t=7.114,P＜ 0.05].血小板各项指标:砷暴露组血小板[PLT,(217.11±49.36)×109/L]、平均血小板体积[MPV,(7.01±1.16)fl]和血小板压积[PCT,(0.15±0.04)L/L]均低于对照组[(259.30±74.97)×109/L,(11.27±1.31)fl,(0.28±0.08) L/L,t值分别为4.073、21.486、13.428,P均＜0.05],血小板分布宽度[PDW,(18.21±0.55)％]高于对照组[(9.23±2.29)％,t=-32.228,P＜ 0.05].结论 长期低浓度饮水型砷暴露能引起人群外周血血细胞参数的改变.RBC增加,HGB含量升高,PLT数目明显减少,PLT和RBC体积异质性增加.“,”Objective To analyze the impact of low concentrations of arsenic exposure on peripheral blood cells in human being,and to provide a basis for screening early damage indicators of arsenic exposure.Methods In Datong City Shanxi Province,two neighboring districts with and without endemic arsenism were selected,in which economic development was balanced.The arsenic contents in drinking water of the two districts were 14.41-90.34 and 0.00-0.87 μg/L,respectively.One natural village in each district was selected.Aborigines (drinking local water for 15 or more years consecutively) were selected as research subjects (85 people as exposed group and 71 people as control group).All of the candidates had neither infectious nor genetic diseases nor contacted radiation and physicochemical factors which may cause the disease.Venous blood was collected and automatic blood cell analyzer was used to analyze the changes of blood parameters.Results Compared with the control group [lymphocyte (LYM):(1.58 ± 0.57) × 109/L,lymphocyte percentage (LYM％):(29.72 ± 8.32)％,mononuclear cell (MON):(0.47 ± 0.15) × 109/L,mononuclear cell percentage (MON％):(8.64 ± 1.97)％; red blood cell(RBC):(4.10 ± 0.58) × 109/L,hemoglobin (HGB):(111.11 ± 16.49)g/L,mean corpuscular hemoglobin (MCH):(27.68 ± 2.99)pg,mean corpuscular hemoglobin concentration (MCHC):(295.20 ± 36.82)g/L,red distribution width (RDW):(11.06 ± 1.08)％,mean cell volume (MCV):(92.69 ± 7.50)fl; platelet(PLT):(259.30 ± 74.97) × 109/L,mean platelet volume (MPV):(11.27 ± 1.31)fl,platelet deposited (PCT):(0.28 ± 0.08)L/L,platelet volume width (PDW):(9.23 ± 2.29)％],some blood parameters had been changed in arsenic poisoning group:① LYM [(2.00 ± 0.90) × 109/L] and LYM％ [(33.92 ± 9.70)％] were increased (t =-3.348,-2.873,all P ＜ 0.05); MON[(0.15 ± 0.07) × 109/L],MON％[(2.53 ± 0.77)％] were decreased (t =16.309,24.599,all P ＜ 0.05); ②RBC [(4.44 ± 0.46) × 109/L],HGB [136.59 ± 13.84)g/L],MCH [(30.85 ± 1.87)pg],MCHC [(360.67 ± 8.54)g/L] and RDW [(13.19 ± 0.75)％] were increased (t =-4.063,-10.491,-7.747,-14.651,-14.450,all P ＜ 0.05),and MCV [(85.49 ± 4.43)fl] was reduced significantly (t =7.114,P＜ 0.05); ③ Every index of PLT [(217.11 ± 49.36) × 109/L],MPV [(7.01 ± 1.16)] and PCT [(0.15 ± 0.64)L/L] showed an obvious declining trend,and the differences were statistically significant (t =4.073,21.486,13.428,all P ＜ 0.05); PDW[(18.21 ± 0.55)％] showed a rising trend,and the difference was statistically significant (t =-3 2.228,P ＜ 0.05).Conclusions Long-term exposure to low concentrations of arsenic can cause changes in peripheral blood cells.The number of RBC has increased,HGB levels increased,and the number of PLT has decreased significantly.At the same time,the volume heterogeneity of PLT and RBC hasincreased.