低浓度混苯作业工人肝损害的超声影像学和血清生化学研究

Ultrasonographic and serum biochemical studies on liver damage of workers exposed to mixed benzene in low concentration

目的探讨长期在低浓度混苯作业环境下,作业工人肝损害的超声影像学以及血清生化学变化及其临床意义。方法采用彩色多普勒超声显像仪,选择接触低浓度苯、甲苯和二甲苯(混苯)的作业工人110人(男80人,女30人)作为接触组。另选其他非接触混苯的在年龄、工龄、性别等构成方面无显著差异的人员110人(男72人,女38人)作为对照组。接触组和观察组均进行常规肝脏超声检查,肝中静脉管径及频谱,同时检查肝血清生化学指标。结果混苯接触组B超肝肿大检出率为10.90%,明显高于对照组的2.72%;脂肪肝检出率为16.36%,明显高于对照组的7.27%;肝异常回声检出率为33.63%,明显高于对照组的12.72%;肝中静脉血流频谱异常检出率为19.09%,明显高于对照组的8.18%。以上4组指标差异均有统计学意义(均P<0.05)。肝的血清生化学检查中,接触组的天冬氨酸转氨酶(AST)(15.45%)和丙氨酸转氨酶(ALT)(12.72%)活力升高的检出率明显高于对照组的5.45%和3.63%;差异均有统计学意义(均P<0.05)。结论混苯不仅会造成血液系统损害,也会造成肝脏损害。低浓度混苯作业工人肝声像肝中静脉频谱以及血清生化较对照组均有不同程度损害的改变,早期应用超声检查能更好地发现肝形态学和肝血流动力的变化,而血清生化学检查也可以判断肝脏功能改变,两者相结合诊断肝脏损害有助于早期判断肝脏受损的程度,为混苯作业人员早期发现肝损害、保护机体健康提供依据和方法,有一定临床实用价值。

[Objective]To study the uhrasonographic and serum biochemical changes of liver damage of workers exposed to mixed benzene in low concentration, investigate the clinical significance.[Methods]110 workers（80 men and 30 women） exposed to low concentration mixed benzene （benzene, toluene and xylene） were enrolled in the exposure group. According to the similar constitution of age, length of service, and gender, 110 healthy persons who have not exposed to mixed benzene were recruited in the control group. By the color Doppler uhrasonography, the exposure group and the control group received the routine liver ultrasound examination, middle hepatic vein diameter and frequency spectrum. And the serum liver biochemical indexes were detected. [Results]The detection rate of hepatomegaly, fatty liver, liver abnormal echo and abnormal results in hepatic vein spectrum in the exposure group was respectively 10.90%, 16.36%, 33.63% and 19.09%, which was higher than that in the control group （2.72%, 7.27%, 12.72% and 8.18%）, and the differences were statistically significant （all P〈0.05）. The serum biochemical examination showed that the detection rate of increased activity of AST and ALT in the exposure group was respectively 15.45% and 12.72%, which was higher than that in the control group （5.45% and 3.63%）, and the differences were statistically significant （both P〈0.05）.[Conclusion]The mixed benzene exposure injures not only blood system as but also liver. The workers exposed to mixed benzene in low concentration show significant damages in liver sonographic examination, middle hepatic vein spectrum and serum biochemical indexes as compared with the control group. The early ultrasound examination can discover the morphologic and hemodynamic changes of liver, and the serum biochemical tests can determine the hepatic functional change. The combination of two ways contributes to the early judgment of the liver damage, provides the basis and methods for early detection of liver damage and protection of health, which has the clinical significance.