特刊文章-临床肾病学和治疗学杂志(2021)第0卷，第0期

通过环境成分中有毒金属含量分析探讨病因不明慢性肾病(CKDu)的根本原因水、土壤和食物

慢性肾脏疾病(CKD)由于其迅速传播，已成为国际社会关注的全球性公共卫生问题。然而，病因不明的CKD在世界某些地区也很普遍，并取得了快速进展，特别是在非洲、中美洲和亚洲。在世界不同的地理区域，水、土壤和食物的质量与地下地质之间的密切关系已被反复记录。对于普遍存在的CKDu，假设有许多风险因素，如未知的环境毒素、长期接触农药、水和土壤中肾毒性重金属水平增加、高氟水平、AlFx对土壤和水的潜在影响以及水资源中蓝藻的生长。我们调查的总体目的是通过评估斯里兰卡CKDu流行地区的有毒金属含量，对饮用水、农业土壤、水稻(Oryza sativa)和鱼类(ettroplus suratensis)进行风险评估。此外，将结果与CKDu非流行地区进行比较，以获得更好的澄清。在斯里兰卡卫生部的帮助下，已经确定了CKDu热点地区，以便进行抽样过程。在旱季(2019年8月)收集了足够数量的饮用水、水稻土、水稻和鱼类样本。CKDu热点选择了Eppawala GN (Grama Niladhari)分区、Medirigiriya GN分区、Giradurukotte GN分区，斯里兰卡的Dambethalawa分区作为参考地点。结果表明，选定CKDu疫区饮用水中Mn、Co、as、Cd、Pb、Cu、Zn、Fe等重金属/类金属物质的平均浓度远低于斯里兰卡水质标准。 Besides, all sampling locations dropped below the medium range of the Heavy Metal Pollution Index of water (HPI 15 – 40). Geo accumulation indexes (Igeo) of paddy soil reveal that agricultural soil in selected CKDu endemic areas is moderately polluted with toxic metals/metalloids such as As, Pb, Cu, Ni, and Cr, Zn, and Cd. However, the concentrations of Cr (p=0.44), As (p=0.36), and Cd(p=0.37) of paddy soil in CKDu hotspots were significantly higher than the reference. Among the trace metals analyzed in rice grains in the CKDu endemic areas, mean Cr, Cd, As, and Pb contents were recorded as 0.342 mg/kg, 0.011 mg/kg, 0.035 mg/kg, 0.112 mg/kg, respectively. The mean concentrations of Cd, Pb, As, and Cr in Etroplus suratensis were 84.31, 45.20, 206.85, and 115.62 μg/kg, respectively, in the Ulhitiya reservoir (in CKDu endemic area). But significantly lower Cd levels contents were observed in the CKDu hotspot than the reservoir in the reference area. Application of fertilizers that contained high doses of toxic metals could be the driving force for the agricultural soil pollution with heavy metals and long term exposure to the toxic metals via drinking water and frequently consumed foods may generate a risk for kidney tissue damage.

作者:W. P. R. T. Perera

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