职业性接触铅引起血铅变化和肾损害及其关系的研究

Study on the relationship between changes on blood 4 and renal injury induced by occupational lead exposure

目的 研究职业性铅接触的肾脏毒性，探讨血铅浓度变化和肾脏损害指标之间的关系。方法 车间空气中铅烟、铅尘的短时间接触浓度用石墨炉原子吸收法检测。选择一般情况可比的无铅接触史的石棉厂个人作为对照，根据接触铅的浓度是否超过职业限值将233名铅接触工人分为职业限值内组及超职业限值组。选择尿N-乙酰-B-D-氨基葡萄糖苷酶（NAG）和β2-微球蛋白（β2-MG）作为肾脏损伤的效应指标，分析不同血铅水平肾损伤效应指标的变化。结果 ①车间空气中铅烟、铅尘的短时间接触浓度分别达0．15mg／m^3和0.14mg／m^3，超标率分别为71．67％和44．51％；②接铅超职业限值组血铅浓度迭（3．46±0．07）μmol／L、尿NAG为（1．82±0．12）U／mmol Cr，均显著高于对照组（P〈0．01）；③血铅浓度的变化和尿NAG、β2-MG的异常率存在一致的变化趋势，趋势X^2分别为96．27和7．18（P〈0．01）；④Logistic回归分析发现接铅水平引起尿NAG和β2-MG改变的0R（95％CI）分别为2．77（1.70～4．52）和1.68（1.08～3．17）。结论 职业性铅接触引起血铅浓度升高和肾脏损伤，且血铅浓度越高，肾脏损伤的程度越大。

Objective To analyze kidney toxicity induced by occupational lead exposure and to explore the changes on blood lead and indexes for renal injury. Methods Blood lead of 233 workers exposed to lead and 178 non-exposed workers were determined, then urinary N-acetyl-β-D-glucosamindase and β2-microglobin of those workers were detected to inspect renal inju- ry. Changes on activities of urinary NAG and β2-MG were observed under different lead dose and blood lead levels, respectively. Results The concentration of lead in workshops was high. The frequency of lead monitoring samples higher than national standard in the workershops was 71.67%. The level of blood lead in two groups was significantly different. The activities of urinary NAG and β2-MG in group of exposure were statistically higher than those in the control group, P 〈 O. 01. Analysis on Logistic regression confirmed lead exposure and ascending blood lead were responsible for renal injury[ OR = 2.77 （ 1.70 - 4.52 ）, 1.68 （ 1. 08 -3.17） ]. Conclusion Occupational lead exposure might cause elevation of blood lead level as well as renal injury. The higher blood lead level, the more serious kidney damage.