汞中毒肾脏损害的早期监测指标筛选

Screen of Early Indicators for Renal Damage in Mercury Workers

目的筛选汞作业者肾脏损害的早期监测指标并探讨其临床意义。方法85例汞作业者分为汞接触正常/观察对象组、汞中毒组,并以无汞接触史的65例健康成人作为对照组。分别进行临床体检并测定尿汞(HgU)、血肌酐(B-Cr)、尿肌酐(U-Cr)、血尿素氮(BUN)、尿-N-乙酰-β-D葡萄糖苷酶(NAG)、尿β2-微球蛋白(β2-MG)、尿α1-微球蛋白(α1-MG)和尿视黄醇结合蛋白(RBP),排除肾病史和患有肾脏疾病患者后对结果进行分析。结果汞作业者HgU、B-Cr、NAG、β2-MG、α1-MG和RBP均高于对照组(P<0.01);汞作业正常/观察对象组的β2-MG、NAG和RBP水平高于对照组(P<0.01),α1-MG有升高趋势,但与对照组相比差异无统计学意义,传统肾脏损害指标B-Cr和BUN与对照组相比差异亦无统计学意义。结论长期汞接触可造成肾功能损害,尿NAG、β2-MG、α1-MG、RBP可作为汞作业者肾脏损害的早期监测指标。

Objective To study the early indicators for renal damages in mercury workers and the clinical significance. Methods Eighty-five mercury workers were divided into 2 experimental groups： the normal subject-under-surveillance group and the mercury-poisoning group. Sixty-five healthy adults with no mercury exposure history were assigned as the control group. Any subjects with history of renal diseases or concurrent renal diseases were excluded. The results from physical examinations and measurements of HgU, B-Cr, U-Cr. BUN, N-acetyl-β-D-glucosaminidase （NAG）, β2-microglobulin （β2-MG）, urinary α1-microglobulin （α1-MG）, and retinol-binding protein （RBP） in all the groups were analyzed. Results The levels of HgU, NAG, α1-MG, β2- MG, and RBP were significantly higher in the experimental groups than in the control group. The levels of NAG, β2-MG and RBP were significantly higher in the nomal ＆ subject-under-surveillance group than in the control group. However, there was no statistically significant difference between the levels of B-Cr and BUN in the experimental groups and those of the control group. Conclusions Long-term exposure to mercury can cause renal damages. The level of NAG,α1-MG,β2-MG, and RBP can be used as sensitive indicators for detecting early renal damages caused by mercury