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背景:在国家最高容许铅浓度范围内作业长期接触铅时,是否仍可对人体健康产生影响?目的:调查分析低浓度铅作业工人周围神经传导速度和生物学指标的变化。设计:以低浓度铅作业工人为观察对象的检验。单位:上海第二医科大学新华医院职业病科及电生理科。对象:以2000-09/2002-10上海第二医科大学附属新华医院职业病科职业健康体检的铅作业工人和同地科室人员为调查对象,共106例。接触组为热处理工人66人,对照组为同期同地科室人员40人。方法:采用问卷调查和实验室检查对接触组和对照组进行周围神经传导速度和生物学指标血铅、血锌原卟啉、游离原卟啉、血红蛋白的检测。对检测数据进行相对危险度分析。主要观察指标:①接触组和对照组周围神经传导速度。②各项生物学指标变化。结果:进入结果分析106人,对照组40人,接触组66人,接触组中工龄>10年34例,<10年32例。①接触组工龄>10年工人周围神经运动传导速度中正中神经比对照组加快犤(50.11±4.76),(47.59±4.86)m/s,P<0.05犦,尺神经比对照组加快犤(63.11±2.58),(61.83±3.03)m/s,P<0.05犦。②接触组工龄>10年工人血铅高于<10年工人犤(0.568±0.28),(0.425±0.31)μmol/L,P<0.05犦,接触组工龄>10年工人血游离原卟啉高于<10年工人犤(2.24±0.32),(2.09±0.27)μmol/L,P<0.05犦,接触组工龄>10年工人尿铅高于<10年工人犤(0.087±0.008),(0.083±0.007)mg/L,P<0.05犦。接触组工龄>10年工人血锌原卟啉为(1.42±0.33)μmol/L,高于接触组工龄<10年工人犤(1.25±0.35)μmol/L,P<0.05犦及对照组犤(1.22±0.44)μmol/L,P<0.05犦。接触组工龄>10年工人血红蛋白为(12.26±4.5)g/L,低于接触组工龄<10年工人犤(14.55±4.81)μmol/L,P<0.05犦及对照组犤(14.88±4.30)μmol/L,P<0.05犦。③接触组工龄<10年工人周围神经感觉传导异常1例,异常率3%(1/32),接触组工龄>10年工人4例,异常率12%(4/34)。接触组工龄<10年工人有生物指标超过正常范围1例,异常率3%(1/32),接触组工龄>10年工人5例,异常率15%(5/34)。工龄>10年工人神经传导速度、生物指标异常率较工龄<10年工人高,相对危险度分别为4.1,5.3倍。结论:长期接触低浓度铅不仅能使生物学指标有改变,同时会对周围神经系统产生不同程度的损害,以下肢感觉神经、上肢运动神经潜伏期较先受累。工龄大于10年的铅作业工人已存在周围神经病损。由于神经系统再生能力差,损害往往是不可逆的,神经电生理变化是预示神经损害的早期变化,可以此做为预防的监测手段。
Background: Can human health be affected when long-term exposure to lead is exposed to lead within the highest national concentration? Objective: To investigate the changes of peripheral nerve conduction velocity and biological indexes in low-concentration lead workers. Design: Inspection of low-concentration lead workers. SETTING: Department of Occupational Diseases and Electrophysiology, Xinhua Hospital, Shanghai Second Medical University. PARTICIPANTS: A total of 106 lead workers and their staff in the same department of occupational health examination at Xinhua Hospital affiliated to Shanghai Second Medical University from September 2000 to October 2002 were investigated. The contact group was heat treatment workers 66 people, the control group for the same period with the same department staff 40 people. Methods: Peripheral nerve conduction velocity and biological indexes of blood lead, zinc protoporphyrin, free protoporphyrin and hemoglobin were detected in the contact group and the control group by questionnaire and laboratory tests. The test data relative risk analysis. MAIN OUTCOME MEASURES: ① peripheral nerve conduction velocity in contact group and control group. ② changes in various biological indicators. Results: There were 106 participants in the analysis of results, 40 in the control group and 66 in the contact group. There were 34 patients with more than 10 years of work in the exposure group and 32 in <10 years. (1) The median nerve conduction velocity in peripheral nerve of workers in working group> 50 years (50.11 ± 4.76) and (47.59 ± 4.86) m / s, P <0.05 and the ulnar nerve increased faster than control group ± 2.58), (61.83 ± 3.03) m / s, P <0.05 犦. ② The blood lead level of workers in the exposure group was higher than that of the workers in <10 years (0.568 ± 0.28), (0.425 ± 0.31) μmol / L, P <0.05 犦, The urinary lead levels were higher in workers <10 years than in workers <10 years (0.087 ± 0.008), (0.083 ± 0.008), (0.083 ± 0.08) and (2.08 ± 0.27) ± 0.007) mg / L, P <0.05 犦. (1.42 ± 0.33) μmol / L in workers exposed to AGE for more than 10 years was higher than that of workers in contact age <10 years (1.25 ± 0.35) μmol / L, P <0.05 犦 and control group 犤 ( 1.22 ± 0.44) μmol / L, P <0.05 犦. (12.26 ± 4.5) g / L for workers who worked for more than 10 years, which was lower than that of workers in contact group <10 years (14.55 ± 4.81) μmol / L, P <0.05 犦 and control group 犤 (14.88 ± 4.30) μmol / L, P <0.05 犦. ③ The contact group was less than 10 years old workers with peripheral nerve sensory conduction abnormalities in 1 case, the abnormal rate of 3% (1/32), contact group length of service> 10 years in 4 cases, the abnormal rate of 12% (4/34). In the contact group, the workers whose working years were less than 10 years had 1 patient whose biological index exceeded the normal range, the abnormality rate was 3% (1/32), and the contact group was 10 years with 5 working hours (5/34). Workers with a working life> 10 years had higher nerve conduction velocity and abnormal rate of biological indexes than workers <10 years old, with relative risks 4.1 and 5.3 times respectively. Conclusion: Long-term exposure to low concentrations of lead can not only change the biological indicators, but also damage the peripheral nervous system to varying degrees. Sensory nerves of the lower extremities and upper extremity motor nerves are involved earlier. Lead workers older than 10 years already have peripheral neuropathy. As the nervous system regenerative ability is poor, damage is often irreversible, neurophysiological changes are predictive of early changes in nerve damage, this can be used as a means of monitoring prevention.