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地方性肢端壞疽症與麩胺基硫轉移酵素基因多型性關係之探討

Association between Glutathione S-transferase Gene Polymorphism and Endemic Gangrenous Panaritium

摘要


Objectives. Since 1954, an endemic-specific spontaneous gangrene happened in the South-Western Sea Coast of Taiwan. Patients experienced numbness, cold and intermittent limping of the lower extremities, gradually symptoms getting worse, skin color of the affected parts getting darker and spreading upward, tissue necrosis and the affected foot turning into black color, which derived the name of 'Black Foot Disease, BFD'. Actually, BFO does not limited itself to lower extremities only, according to Dr. Ming-yi Wang, hands of the upper extremities are also affected, therefore 'Endemic Gangrenous Panaritium, endemic GP' is a more appropriate term. The endemic geographic cluster characteristics have received the academic attention on the arsenic and humic acid concentrations in the artesian wells of that region. But the causation has been confused, for the new cases keep sprouting even the usage of the deep wells have been ceased. Obviously, other than arsenic (As) other factors have to be investigated. Therefore a case-control study was designed to explore other risk factors apart from the outside of arsenic, antioxidant activity index and gene polymorphism re1ated with Gangrenous Panaritium. Methods. It was a case-control study based on a total of 88 consenters (case 40, contro148). Questionnaire, blood and urine samples were collected. The biochemical examination, urinary metal levels detection and the glutathione S-transferase gene polymorphism analysis was carried out. Results. The resu1ts showed that the case group has higher kidney function disorder index, homocysteine and metallic Pb concentrations than the control group. The results showed that GST P1 null type had no association with Gangrenous Panaritium, but proportions of GST M1 null type and GST T1 null type combination was significant1y higher in cases than control. In multiple logistic regression, after adjusted by sex and age, years resident at Black Foot area (OR=1.07 per year), GSH level (OR=0.88 per μM), and both null type in GST M1 and GST T1 (OR=49.19) were the significant risk factors, while high-fiber or seldom-salt diets might be the preventive factors. Conclusions. The longer period of resident at Black Foot area, the higher GSH level, and both null type in GST M1 and GST T1 were the significant risk factors of endemic Gangrenous Panaritium, whi1e high-fiber or seldom-salt diets might reduce this risk.

並列摘要


Objectives. Since 1954, an endemic-specific spontaneous gangrene happened in the South-Western Sea Coast of Taiwan. Patients experienced numbness, cold and intermittent limping of the lower extremities, gradually symptoms getting worse, skin color of the affected parts getting darker and spreading upward, tissue necrosis and the affected foot turning into black color, which derived the name of 'Black Foot Disease, BFD'. Actually, BFO does not limited itself to lower extremities only, according to Dr. Ming-yi Wang, hands of the upper extremities are also affected, therefore 'Endemic Gangrenous Panaritium, endemic GP' is a more appropriate term. The endemic geographic cluster characteristics have received the academic attention on the arsenic and humic acid concentrations in the artesian wells of that region. But the causation has been confused, for the new cases keep sprouting even the usage of the deep wells have been ceased. Obviously, other than arsenic (As) other factors have to be investigated. Therefore a case-control study was designed to explore other risk factors apart from the outside of arsenic, antioxidant activity index and gene polymorphism re1ated with Gangrenous Panaritium. Methods. It was a case-control study based on a total of 88 consenters (case 40, contro148). Questionnaire, blood and urine samples were collected. The biochemical examination, urinary metal levels detection and the glutathione S-transferase gene polymorphism analysis was carried out. Results. The resu1ts showed that the case group has higher kidney function disorder index, homocysteine and metallic Pb concentrations than the control group. The results showed that GST P1 null type had no association with Gangrenous Panaritium, but proportions of GST M1 null type and GST T1 null type combination was significant1y higher in cases than control. In multiple logistic regression, after adjusted by sex and age, years resident at Black Foot area (OR=1.07 per year), GSH level (OR=0.88 per μM), and both null type in GST M1 and GST T1 (OR=49.19) were the significant risk factors, while high-fiber or seldom-salt diets might be the preventive factors. Conclusions. The longer period of resident at Black Foot area, the higher GSH level, and both null type in GST M1 and GST T1 were the significant risk factors of endemic Gangrenous Panaritium, whi1e high-fiber or seldom-salt diets might reduce this risk.

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