摘要
[目的]评价化学法尿铅筛选职业性铅接触的价值。[方法]收集157 名同一铅接触工人的血标本及尿标本,同时测定血铅、尿铅、红细胞游离原卟啉(FEP)、锌卟啉(ZPP)、尿δ-氨基酮戊酸(δ-ALA),以血铅≥40μg/dl,≥60μg/dl的铅接触水平为金标准,用Receiver-Operating Characteristic(ROC)曲线分析软件评价化学法尿铅及其它测定指标的准确性。在ROC曲线上制定各测定指标筛选血铅≥40μg/dl,≥60μg/dl的最佳临界点,用EPINFO统计软件比较两种平行试验的敏感度。[结果] 筛选血铅≥40μg/dl,尿铅的ROC曲线下面积(AUCROC)明显小于原卟啉及锌卟啉(P< 0.05);联合原卟啉与锌卟啉的平行试验敏感度显著高于联合尿铅与尿δ-ALA 的平行试验(P< 0.05)。筛选血铅≥60μg/dl,尿铅的AUCROC明显小于原卟啉、锌卟啉、尿δ-ALA(P< 0.05),联合原卟啉与锌卟啉平行试验的敏感度显著高于联合尿铅与尿δ-ALA的平行试验(P< 0.05)。[结论] 筛选血铅≥40μg/dl、≥60μg/dl水平的职业性铅接触,尿铅的准确性最低,二种平行试验中。
To determine the diagnostic value of urine lead for assessment of occupational lead exposure and to compare the sensitivity of parallel tests screening for occupational lead exposure,blood and urine lead levels,free erythrocyte protoporphyrin(FEP),zinc protoporphyrine(ZPP) and urine δ aminolevulinic acid levels were determined in 157 lead exposed workers.According to the gold standard:blood lead≥40μg/dl and ≥60μg/dl,the diagnostic value of above indicators was compared by Receiver operative characteristic curve(ROC) software.After determining the optimal cut points of above indicators for detecting the blood lead ≥40μg/dl and ≥60μg/dl,the sensitivity of parallel tests was compared by EPINFO software.For detecting blood lead level ≥40μg/dl and ≥60μg/dl,the area under curve(AUC ROC ) of urinary lead was significantly lower than that of ZPP and FEP.The sensitivity of parallel tests with ZPP and FEP was higher than that of parallel tests with PbU and Uδ ALA.
