汞作业工人肾损伤早期指标变化及其影响因素

Early changes in renal injury parameters and their influencing factors in workers exposed to mercury

目的 了解某温度计厂工作场所空气中汞浓度及汞作业工人尿汞超标情况,测定工人尿β2微球蛋白(β2-MG)和视黄醇结合蛋白(RBP)水平及其影响因素.方法 根据国家相关职业卫生标准对工作场所进行职业卫生学调查,对178名汞作业工人进行问卷调查和职业健康检查.冷原子分光吸收光谱法测定空气中汞浓度和尿汞浓度,免疫比浊法测定尿β2-MG,免疫透射比浊法测定尿RBP.用SPSS19.0软件对数据进行统计学分析.结果 工作场所空气中汞浓度共检测了8个岗位,短时接触浓度(STEL)有7个岗位超标,时间加权平均浓度(TWA)8个岗位全部超标.不同岗位空气中汞浓度比较,差异有统计学意义(F=138.714,P＜0.01).尿汞浓度共检测了154份尿样,几何均数为171.607μg/g Cr,其中127人超标,超标率为82.5％.不同岗位工人尿汞浓度比较,差异有统计学意义(x2=44.531,P＜0.01).工人尿汞浓度与空气中的汞浓度呈正相关(r=0.624,P＜0.01).共检测148份尿β2-MG,均值为0.142 mg/L;其中7人尿β2-MG浓度大于0.3 mg/L,异常率为4.7％.共检测153份尿RBP样品,均值为0.485 mg/L;其中19人尿RBP浓度大于0.7 mg/L,异常率为12.4％.有序多分类logistic回归分析发现,年龄＞34岁(OR=4.88,95％CI:2.24～10.62)、接汞工龄＞15年(OR=2.50,95％CI:1.06～5.92)为尿β2-MG升高的危险因素,年龄＞45岁(OR=7.52,95％CI:2.50～22.65)为尿RBP升高的危险因素.结论 该企业空气中汞浓度和工人尿汞浓度超标严重,严重危害工人健康.工作场所空气中汞浓度高、年龄大、工龄长为尿β2-MG和尿RBP升高的危险因素.

Objective To investigate atmospheric mercury concentration in the workplace and urinary mercury concentration in workers exposed to mercury in a thermometer factory,and to determine the levels and influencing factors of urinary β2-microglobulin (β2-MG) and retinol-binding protein (RBP) in these workers.Methods An occupational health survey of the workplace was completed according to relevant national occupational health standards.Questionnaire survey and occupational health examination were conducted in 178 workers exposed to mercury in the factory.Statistical analysis was accomplished using SPSS 19.0.Results In the workplace,atmospheric mercury concentration was out of limits at seven of eight detection points expressed by short-term exposure limit; it was out of limits at all the eight detection points shown by time-weighted average.Statistically significant difference in atmospheric mercury concentration was found among different detection points (F=138.714,P＜0.001).The geometric mean of urinary mercury concentration measured in 154 workers was 171.607 μg/g.There were 127 workers with urinary mercury concentration exceeding the standard (82.5％ over-standard rate).Significant difference in urinary mercury concentration was shown in the workers among different positions (x2=44.531,P＜0.01).Urinary mercury concentration was positively correlated with atmospheric mercury concentration (r=0.624,P＜0.01).The mean urinary β2-MG level measured in 148 workers was 0.142 mg/L,and seven workers had urinary β2-MG levels greater than 0.3 mg/L (4.7％ abnormal rate).The mean urinary RBP level measured in 153 workers was 0.485 mg/L,and 19 workers had urinary RBP levels greater than 0.7 mg/L (12.4％ abnormal rate).Ordinal logistic regression showed that age ＞34 years (OR=4.88,95％CI:2.24～10.62) and length of service ＞15 years (OR=2.50,95％CI:1.06-5.92) were risk factors for increased urinary β2-MG level.Age ＞45 years (OR=7.52,95％CI:2.50～22.65) was a risk factor for increased urinary RBP level.Conclusion In the thermometer factory under study,atmospheric and urinary mercury concentrations both seriously exceeded the standards,which were harmful to the health of workers.High atmospheric mercury concentration,old age,and long length of service were risk factors for increased urinary β2-MG and RBP levels in workers exposed to mercury.