中国临床康复
中國臨床康複
중국림상강복
CHINESE JOURNAL OF CLINICAL REHABILITATION
2005年
29期
227-229
,共3页
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[(50.11±4.76),(47.59±4.86)m/s,P＜0.05],尺神经比对照组加快[(63.11±2.58),(61.83±3.03)m/s,P＜0.05].②接触组工龄＞10年工人血铅高于＜10年工人[(0.568±0.28),(0.425±0.31)μmol/L,P＜0.05],接触组工龄＞10年工人血游离原卟啉高于＜10年工人[(2.24±0.32),(2.09±0.27)μmol/L,P＜0.05],接触组工龄＞10年工人尿铅高于＜10年工人[(0.087±0.008),(0.083±0.007)mg/L,P＜0.05].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[(1.25±0.35)μmol/L,P＜0.05]及对照组[(1.22±0.44)μmol/L,P＜0.05].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[(14.55±4.81)μmol/L,P＜0.05]及对照组[(14.88±4.30)μmol/L,P＜0.05].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.
揹景:在國傢最高容許鉛濃度範圍內作業長期接觸鉛時,是否仍可對人體健康產生影響?目的:調查分析低濃度鉛作業工人週圍神經傳導速度和生物學指標的變化.設計:以低濃度鉛作業工人為觀察對象的檢驗.單位:上海第二醫科大學新華醫院職業病科及電生理科.對象:以2000-09/2002-10上海第二醫科大學附屬新華醫院職業病科職業健康體檢的鉛作業工人和同地科室人員為調查對象,共106例.接觸組為熱處理工人66人,對照組為同期同地科室人員40人.方法:採用問捲調查和實驗室檢查對接觸組和對照組進行週圍神經傳導速度和生物學指標血鉛、血鋅原卟啉、遊離原卟啉、血紅蛋白的檢測.對檢測數據進行相對危險度分析.主要觀察指標:①接觸組和對照組週圍神經傳導速度.②各項生物學指標變化.結果:進入結果分析106人,對照組40人,接觸組66人,接觸組中工齡＞10年34例,＜10年32例.①接觸組工齡＞10年工人週圍神經運動傳導速度中正中神經比對照組加快[(50.11±4.76),(47.59±4.86)m/s,P＜0.05],呎神經比對照組加快[(63.11±2.58),(61.83±3.03)m/s,P＜0.05].②接觸組工齡＞10年工人血鉛高于＜10年工人[(0.568±0.28),(0.425±0.31)μmol/L,P＜0.05],接觸組工齡＞10年工人血遊離原卟啉高于＜10年工人[(2.24±0.32),(2.09±0.27)μmol/L,P＜0.05],接觸組工齡＞10年工人尿鉛高于＜10年工人[(0.087±0.008),(0.083±0.007)mg/L,P＜0.05].接觸組工齡＞10年工人血鋅原卟啉為(1.42±0.33)μmol/L,高于接觸組工齡＜10年工人[(1.25±0.35)μmol/L,P＜0.05]及對照組[(1.22±0.44)μmol/L,P＜0.05].接觸組工齡＞10年工人血紅蛋白為(12.26±4.5)g/L,低于接觸組工齡＜10年工人[(14.55±4.81)μmol/L,P＜0.05]及對照組[(14.88±4.30)μmol/L,P＜0.05].③接觸組工齡＜10年工人週圍神經感覺傳導異常1例,異常率3%(1/32),接觸組工齡＞10年工人4例,異常率12%(4/34).接觸組工齡＜10年工人有生物指標超過正常範圍1例,異常率3%(1/32),接觸組工齡＞10年工人5例,異常率15%(5/34).工齡＞10年工人神經傳導速度、生物指標異常率較工齡＜10年工人高,相對危險度分彆為4.1,5.3倍.結論:長期接觸低濃度鉛不僅能使生物學指標有改變,同時會對週圍神經繫統產生不同程度的損害,以下肢感覺神經、上肢運動神經潛伏期較先受纍.工齡大于10年的鉛作業工人已存在週圍神經病損.由于神經繫統再生能力差,損害往往是不可逆的,神經電生理變化是預示神經損害的早期變化,可以此做為預防的鑑測手段.
배경:재국가최고용허연농도범위내작업장기접촉연시,시부잉가대인체건강산생영향?목적:조사분석저농도연작업공인주위신경전도속도화생물학지표적변화.설계:이저농도연작업공인위관찰대상적검험.단위:상해제이의과대학신화의원직업병과급전생이과.대상:이2000-09/2002-10상해제이의과대학부속신화의원직업병과직업건강체검적연작업공인화동지과실인원위조사대상,공106례.접촉조위열처리공인66인,대조조위동기동지과실인원40인.방법:채용문권조사화실험실검사대접촉조화대조조진행주위신경전도속도화생물학지표혈연、혈자원계람、유리원계람、혈홍단백적검측.대검측수거진행상대위험도분석.주요관찰지표:①접촉조화대조조주위신경전도속도.②각항생물학지표변화.결과:진입결과분석106인,대조조40인,접촉조66인,접촉조중공령＞10년34례,＜10년32례.①접촉조공령＞10년공인주위신경운동전도속도중정중신경비대조조가쾌[(50.11±4.76),(47.59±4.86)m/s,P＜0.05],척신경비대조조가쾌[(63.11±2.58),(61.83±3.03)m/s,P＜0.05].②접촉조공령＞10년공인혈연고우＜10년공인[(0.568±0.28),(0.425±0.31)μmol/L,P＜0.05],접촉조공령＞10년공인혈유리원계람고우＜10년공인[(2.24±0.32),(2.09±0.27)μmol/L,P＜0.05],접촉조공령＞10년공인뇨연고우＜10년공인[(0.087±0.008),(0.083±0.007)mg/L,P＜0.05].접촉조공령＞10년공인혈자원계람위(1.42±0.33)μmol/L,고우접촉조공령＜10년공인[(1.25±0.35)μmol/L,P＜0.05]급대조조[(1.22±0.44)μmol/L,P＜0.05].접촉조공령＞10년공인혈홍단백위(12.26±4.5)g/L,저우접촉조공령＜10년공인[(14.55±4.81)μmol/L,P＜0.05]급대조조[(14.88±4.30)μmol/L,P＜0.05].③접촉조공령＜10년공인주위신경감각전도이상1례,이상솔3%(1/32),접촉조공령＞10년공인4례,이상솔12%(4/34).접촉조공령＜10년공인유생물지표초과정상범위1례,이상솔3%(1/32),접촉조공령＞10년공인5례,이상솔15%(5/34).공령＞10년공인신경전도속도、생물지표이상솔교공령＜10년공인고,상대위험도분별위4.1,5.3배.결론:장기접촉저농도연불부능사생물학지표유개변,동시회대주위신경계통산생불동정도적손해,이하지감각신경、상지운동신경잠복기교선수루.공령대우10년적연작업공인이존재주위신경병손.유우신경계통재생능력차,손해왕왕시불가역적,신경전생리변화시예시신경손해적조기변화,가이차주위예방적감측수단.
BACKGROUND:Whether long time exposure to the lead concentration which is withinthe state allowed range will cause any bad effects on people's health?OBJECTIVE: To investigate the nerve conducting velocity (NCV) and other biological indices of workers who are exposed to low concentration lead.DESIGN: It was an investigation and the subjects were workers exposed to low concentration lead.SETTING: Occupational Disease Department and Electrophysiological Department of Xinhua Affiliated Hospital of the Shanghai Second Medical University.PARTICIPANTS: In lead contact group were 66 heat treatment workers who were exposed to lead and received physical examination from September 2000 to October 2002. In control group were 40 office workers that worked at the same factory but were not exposed to lead.METHODS: Questionnaire and laboratory examination were adopted for measurement of NCV and other biological indices like blood lead, blood zinc protoaetioporphyrin (ZPP), blood free protoporphyrin (FPP) and hemoglobin content in the two groups. And the relative risk analysis was conducted.biological indices in both groups.RESULTS: All the 106 subjects entered analysis stage. In lead contact group there were 34 workers of more than 10 working years and the other ulnar nerve in those of over 10 working years were faster than those in control group [(50.11 ±4.76) m/s, (63.11±2.58) m/s vs (47.59±4.86)m/s,those of over 10 working years was higher than those of less than 10years [(0.568±0.28), (0.425±0.31) μmol/ L, P ＜ 0.05]. So was the FPP level [(2.24±0.32), (2.09±0.27) μmol/L, P ＜ 0.05] and urine lead level [(0.087±0.008), (0.083±0.007) μmg/L, P ＜ 0.05]. The ZPP level of those of over 10 working years was also higher than those less than 10 years [(1.42±0.33) μmol/L vs (1.25±0.35) μmol/L, P ＜ 0.05] and control [(1.42±0.33) μmol/L vs (1.22±0.44) μmol/L, P＜ 0.05]. The hemoglobin of those of over 10 working years was lower than those of less than 10 years [(12.26±4.5) g/L vs (14.55±4.81) μmol/L, P ＜ 0.05] and control [(12.26±4.5) g/L years presented abnormality in conducting sensory signals and the abnormality rate was 3% (1/32). Whereas four cases in those with more than 10working years did so and the abnormality rate was 12% (4/34). As for biological indices, one case in those less than 10 working years was beyond normal values (abnormality rate 3%) and five did so in those of over 10working years (abnormality rate 15%). It could be seen that changes in both NCV and biological indices of those of over 10 working years were more serious than those les than 10 years exposure with the relative risks of 4.1 and 5.3 respectively.CONCLUSION: Persistent exposure to lead not only alters biological indices but also damages nervous system in different degrees. Sensory verve of lower extremities and motor nerves of upper extremities are usually damaged first. Peripheral nerve injury is common in workers of over 10 working years. Because the regeneration of nervous system is poor, so the nerve injury is usually irreversible. Therefore the neuroelectrophysiological changes always predict early nerve injury and so neuroelectrophysiological monitoring can be adopted for prevention of nerve injury.
