职业苯暴露生物标志物的研究现状

苯作为有机化学生产过程中广泛使用的原料,在生产环境中多以蒸气形式由呼吸系统进入人体,主要分布在含类脂质较多的组织和器官,如骨髓、脑髓、脂肪组织和肝脏[1],体内苯主要在肝脏代谢,在肝微粒体上的细胞色素P450(CYP)介导下苯被氧化成环氧化苯.通过对DNA的直接损伤作用,而引起造血系统的损害[2].苯已被国际癌症研究机构定为Ⅰ类化学致癌物[3].发达国家现将苯接触阈值限值-时间加权平均浓度(TLV-TWA)降至32 mg/m3以下,美国则降至0.32 mg/m3,我国现行GBZ2-2002<工作场所有害因素职业接触限值>中规定生产环境空气中苯的时间加权平均容许浓度为6 mg/m3,而短时间接触容许浓度(PC-STEL)为10 mg/m3[4].1989年至2000年国内期刊报道有28例苯白血病[5].Stockstad等[6]报道在鞋厂工作的工人接触1 mg/m3的苯浓度仍可引起人体白细胞和淋巴细胞减少.Lan Q等[7]认为40 mg/m3以下苯作业工人易罹患骨髓瘤.苯还可诱导血清活性氧水平,引起细胞成分包括DNA氧化损伤[8].     

Evaluation of occupational exposure to benzene by urinalysis

Urinary phenol determinations have traditionally been used to monitor high levels of occupational benzene exposure. However, urinary phenol cannot be used to monitor low-level exposures. New biological indexes for exposure to low levels of benzene are thus needed. The aim of this study was to investigate the relations between exposure to benzene (Abenzene, ppm), as measured by personal air sampling, and the excretion of benzene (U-benzene, ng/l),trans,trans-muconic acid (MA, mg/g creatinine), andS-phenylmercapturic acid (PMA, g/g creatinine) in urine. The subjects of the study were 145 workers exposed to benzene in a chemical plant. The geometric mean exposure level was 0.1 ppm (geometric standard deviation = 4.16). After logarithmic transformation of the data the following linear regressions were found: log (U-benzene, ng/l) = 0.681 log (A-benzene ppm) + 4.018; log (MA, mg/g creatinine) = 0.429 log (A-benzen ppm) – 0.304; and log (PMA, g/g creatinine) = 0.712 log (A-benzene ppm) + 1.664. The correlation coefficients were, respectively, 0.66, 0.58, and 0.74. On the basis of the equations it was possible to establish tentative biological limit values corresponding to the respective occupational exposure limit values. In conclusion, the concentrations of benzene, mercapturic acid, and muconic acid in urine proved to be good parameters for monitoring low benzene exposure at the workplace.     

职业苯暴露生物标志物研究进展

苯是一种广泛存在于工业和生活环境中的化学污染物。长期、较大剂量接触苯可引起人体外周血白细胞减少、骨髓造血功能抑制,甚至导致白血病。1982年国际癌症研究中心（IARC）将苯列为确定的人类致癌物。基于苯对人体的危害性,世界诸多发达国家均制订了工作场所相应的职业卫生标准以保护职业苯接触工人的身体健康,但由于作业环境苯浓度的监测数据并不能完全客观地反映个体接触的实际情况和个体易感性,尤其不能反映机体体内蓄积作用（内暴露剂量）,用于对长期低剂量职业苯接触工人的危险度评价有一定的局限性。苯的生物标志物因其灵敏度高,特异性强,更能客观、全面、准确反映工人的实际接苯状况,因此更适合作为职业苯接触工人暴露水平检测、健康监护、暴露危害性评价。生物标志物根据性质不同可分为接触标志物、效应标志物和易感性标志物。     

Evaluation of biomarkers of occupational exposure to toluene at low levels

Objectives The purpose of the present study was to compare validity of various biomarkers of occupational exposure to toluene (Tol) at low levels. The focus was placed on the comparison of un-metabolized toluene in urine (Tol-U) and peripheral blood (Tol-B) with hippuric acid in urine (HA-U). Methods Surveys were conducted in 16 workplaces on the second half of working weeks, with participation of male solvent workers. Urine and peripheral blood samples were collected at the end of the shifts. After exclusion of cases with dense or diluted urine samples, 473 valid sets of samples were obtained for statistical evaluation. Time-weighted average exposure (for about 8-h) were monitored by diffusive sampling for toluene and other four solvents. Blood samples were subjected to the analyses for Tol-B, whereas urine samples were analyzed for HA-U and Tol-U. Results The solvent exposures were low, i.e., a grand geometric mean (GM) Tol concentration was 1.6 ppm, and the GM for the SUM in the additiveness equation was 0.12. The correlation analyses of the biomarkers in urine and blood with Tol exposure showed that Tol-U and Tol-B were more closely [correlation coefficients (r) being 0.67 and 0.60, respectively] related than HA-U (r = 0.27). Results of receiver operator characteristic analyses were in agreement with the correlation analysis results. Conclusions Taking the non-invasive nature of sampling together, Tol in the end-of-shift spot urine sample appears to be the marker of choice for biological monitoring of occupational exposure to Tol at low levels such as <2 ppm as a geometric mean.     

Malignancies due to occupational exposure to benzene

There is no doubt about the leukemogenic effect of benzene in man. The evidence is as follows: (1) The incidence of leukemia in shoeworkers exposed to benzene in a period of 8 years in Istanbul was 13.6/100,000, which is significantly higher than that for leukemia in the general population. (2) Following the phase-out of benzene in Istanbul, the number of leukemic workers decreased and none were reported in the subsequent 3 years. (3) The development of leukemia in pancytopenic patients with benzene exposure was observed in 13 out of 51 patients. (4) The differences in the distribution of the types of leukemia in individuals exposed and in nonexposed groups were as follows: acute leukemia 96.1% in the former group, and 46% in the latter group. The high percentages of acute erythroleukemia and preleukemia were other interesting findings in the exposed group. (5) Two cases of leukemia were observed in a 6-year period at a tire cord manufacturing plant with 550 workers. At one location in the plant the concentration of benzene measured by gas chromatography was nearly 110 ppm. Additionally, we have studied 12 cases of malignant lymphoma, four cases of multiple myeloma, and six cases of lung cancer, all of whom were chronically exposed to benzene. The possible role of benzene in the etiology of these malignancies is discussed.     

Hairy cell leukaemia and occupational exposure to benzene.

OBJECTIVES: The role of occupational exposures in hairy cell leukaemia (HCL) was investigated through a multicentre, hospital based, case-control study. This paper analyses the role of exposure to benzene in HCL. METHODS: A population of 226 male cases of HCL and 425 matched controls were included in the study. Benzene exposure was evaluated by expert review of the detailed data on occupational exposures generated by case-control interviews. RESULTS: No association was found between HCL and employment in a job exposed to benzene (odds ratio (OR) 0.9 (95% confidence interval (95% CI) 0.6-1.3)). The sample included 125 subjects, 34 cases (15%), and 91 controls (21%) who had been exposed to benzene, as individually assessed by the experts, for at least one hour a month during one of their jobs. Benzene exposure was not associated with a risk of HCL (OR 0.8 (0.5-1.2)). No trend towards an increase in OR was detected for increasing exposures, the percentage of work time involving exposure to > 1 ppm, or the duration of exposure. No findings suggested a particular risk period, when the OR associated with the time since first or last exposure, or since the end of exposure, were examined. CONCLUSIONS: In conclusion, with the low exposures prevalent in the sample, the study did not show any association between benzene exposure and HCL.     

Risk assessment of leukaemia and occupational exposure to benzene.

Experimental toxicological studies have offered clear evidence that benzene induces haematopoietic neoplasms, and it is generally accepted that exposure to benzene is a risk factor for leukaemia, in particular for acute non-lymphatic leukaemia. Quantitative aspects of benzene risk assessment are still a matter of controversy, however. In several risk assessments an estimated 50 deaths from leukaemia per 1000 deaths would arise from exposures to benzene of 10 ppm during a working life of 30 years. The assessment presented in this paper leads to lower estimates, which are more in agreement with the weak toxicological data. Furthermore, an approach is presented to incorporate the results of low exposure epidemiological studies into the process of quantitative risk assessment.     

Biological monitoring of occupational exposure to low levels of benzene.

To obtain reference values for the biological monitoring of benzene, the kinetics of benzene were studied in volunteers. Benzene in blood and expired air could easily be followed until the next morning after a 4-h exposure to a benzene concentration of 10 cm3.m-3. Even after exposure to 1.7 cm3.m-3 the benzene levels in the morning blood and expired air samples differed from those in unexposed subjects. One hour after exposure to 10 and 1.7 cm3.m-3 the mean levels of benzene were 238 and 25 nmol.l-1 in blood and 13.2 and 2.5 mumol.m-3 in exhaled air, respectively. It was concluded that, at high benzene levels (approximately 10 cm3.m-3), samples collected 16 h after exposure reflect the body burden of benzene, while at low exposure (< 1 cm3.m-3) samples collected 1 h after exposure may be used to estimate the exposure over the preceding few hours. Exposure to benzene from smoking is a potential confounder in estimating occupational exposure to low levels of benzene.     

Evaluation of urinary biomarkers of exposure to benzene: correlation with blood benzene and influence of confounding factors

Purpose   trans,trans-Muconic acid (t,t-MA) is generally considered as a useful biomarker of exposure to benzene. However, because of its lack of specificity, concerns about its value at low level of exposure have recently been raised. The aim of this study was (a) to compare t,t-MA, S-phenylmercapturic acid (SPMA) and benzene (B-U) as urinary biomarkers of exposure to low levels of benzene in petrochemical workers and, (b) to evaluate the influence of sorbic acid (SA) and genetic polymorphisms of biotransformation enzymes on the excretion of these biomarkers. Method  A total of 110 workers (including 24 smokers; 2–10 cigarettes/day) accepted to take part in the study. To assess external exposure to benzene, air samples were collected during the whole working period by a passive sampling device attached close to the breathing zone of 98 workers. Benzene was measured in blood (B-B) samples taken at the end of the shift, and was considered as the reference marker of internal dose. Urine was collected at the end of the shift for the determination of B-U, SPMA, t,t-MA, SA and creatinine (cr). B-U and B-B were determined by head-space/GC–MS, SPMA and SA by LC-MS, t,t-MA by HPLC-UV. Results  Most (89%) personal measurements of airborne benzene were below the limit of detection (0.1 ppm); B-B ranged from <0.10 to 13.58 μg/l (median 0.405 μg/l). The median (range) concentrations of the urinary biomarkers were as follows: B-U 0.27 μg/l (<0.10–5.35), t,t-MA 0.060 mg/l (<0.02–0.92), SPMA 1.40 μg/l (0.20–14.70). Urinary SA concentrations ranged between <3 and 2,211 μg/l (median 28.00). Benzene concentration in blood and in urine as well as SPMA, but not t,t-MA, were significantly higher in smokers than in non-smokers. The best correlation between B-B and urinary biomarkers of exposure were obtained with benzene in urine (μg/l r = 0.514, P < 0.001; μg/g cr r = 0.478, P < 0.001) and SPMA (μg/l r = 0.495, P < 0.001; μg/g cr r = 0.426, P < 0.001) followed by t,t-MA (mg/l r = 0.363, P < 0.001; mg/g cr r = 0.300, P = 0.002). SA and t,t-MA were highly correlated (r = 0.618, P < 0.001; corrected for cr r = 0.637). Multiple linear regression showed that the variation of t,t-MA was mostly explained by SA concentration in urine (30% of the explained variance) and by B-B (12%). Variations of SPMA and B-U were explained for 18 and 29%, respectively, by B-B. About 30% of the variance of B-U and SPMA were explained by B-B and smoking status. Genetic polymorphisms for biotransformation enzymes (CYP2E1, EPHX1, GSTM1, GSTT1, GSTP1) did not significantly influence the urinary concentration of any of the three urinary biomarkers at this low level of exposure. Conclusion  At low levels of benzene exposure (<0.1 ppm), (1) t,t-MA is definitely not a reliable biomarker of benzene exposure because of the clear influence of SA originating from food, (2) SPMA and B-U reflect the internal dose with almost similar accuracies, (3) genetically based inter-individual variability in urinary excretion of biomarkers seems negligible. It remains to assess which biomarker is the best predictor of health effects.     

Evaluation of exposure biomarkers in offshore workers exposed to low benzene and toluene concentrations

Purpose  

Characterize ethylbenzene and xylene air concentrations, and explore the biological exposure markers (urinary t,t-muconic acid (t,t-MA) and unmetabolized toluene) among petroleum workers offshore. Offshore workers have increased health risks due to simultaneous exposures to several hydrocarbons present in crude oil. We discuss the pooled benzene exposure results from our previous and current studies and possible co-exposure interactions.     

Risk assessment of leukaemia and occupational exposure to benzene

Experimental toxicological studies have offered clear evidence that benzene induces haematopoietic neoplasms, and it is generally accepted that exposure to benzene is a risk factor for leukaemia, in particular for acute non-lymphatic leukaemia. Quantitative aspects of benzene risk assessment are still a matter of controversy, however. In several risk assessments an estimated 50 deaths from leukaemia per 1000 deaths would arise from exposures to benzene of 10 ppm during a working life of 30 years. The assessment presented in this paper leads to lower estimates, which are more in agreement with the weak toxicological data. Furthermore, an approach is presented to incorporate the results of low exposure epidemiological studies into the process of quantitative risk assessment.     

Biological monitoring of occupational exposure to benzene and toluene

This study was carried out to evaluate the biological monitoring of occupational exposure to benzene and toluene in a total number of 31 male exposed workers and 30 control subjects. The present study showed a statistically significant higher level of biological indices of exposure (p < 0.01) of phenol and hippuric acid in urine of workers exposed to benzene and toluene than control subjects. Significant changes (p < 0.05, 0.01) in the levels of hematological and biochemical findings have been observed among exposed workers and control group. In addition, statistically significant higher levels of Mg, Mn and Ca were found among workers exposed to benzene and toluene while statistically significant lower levels of serum iron (p < 0.05) have been observed. No significant variations could be detected in the level of Zn and Cu between exposed and control subjects.     

Comparative evaluation of biomarkers of occupational exposure to toluene

Objectives This study was initiated to make comparative evaluation of five proposed urinary markers of occupational exposure to toluene, i.e., benzyl alcohol, benzylmercapturic acid, o-cresol, hippuric acid and un-metabolized toluene. Methods In practice, six plants in Japan were surveyed, and 122 Japanese workers (mostly printers; all men) together with 12 occupationally nonexposed control subjects (to be called controls; all men) agreed to participate in the study. Surveys were conducted in the second half of working weeks. Time-weighted average exposure (about 8 h) to toluene and other solvents were monitored by diffusive sampling. End-of-shift urine samples were collected and analyzed for the five markers by the methods previously described; simultaneous determination of o-cresol was possible by the method originally developed for benzyl alcohol analysis. Results The toluene concentration in the six plants was such that the grand geometric mean (GM) for the 122 cases was 10.4 ppm with the maximum of 121 ppm. Other solvents coexposed included ethyl acetate (26 ppm as GM), methyl ethyl ketone (26 ppm), butyl acetate (1 ppm) and xylenes (1 ppm). By simple regression analysis, hippuric acid correlated most closely with toluene in air (r = 0.85 for non-corrected observed values) followed by un-metabolized toluene (r = 0.83) and o-cresol (r = 0.81). In a plant where toluene in air was low (i.e., 2 ppm as GM), however, un-metabolized toluene and benzylmercapturic acid in urine showed better correlation with air-borne toluene (r = 0.79 and 0.61, respectively) than hippuric acid (r = 0.12) or o-cresol (r = 0.17). Benzyl alcohol tended to increase only when toluene exposure was intense. Correction for creatinine concentration or specific gravity of urine did not improve the correlation in any case. Multiple regression analysis showed that solvents other than toluene did not affect the levels of o-cresol, hippuric acid or un-metabolized toluene. Levels of benzylmercapturic acid and un-metabolized toluene were below the limits of detection [limit of detections (LODs); 0.2 and 2 μg/l, respectively] in the urine from the control subjects. Conclusions In over-all evaluation, hippuric acid, followed by un-metabolized toluene and o-cresol, is the marker of choice for occupational toluene exposure. When toluene exposure level is low (e.g., 2 ppm), un-metabolized toluene and benzylmercapturic acid in urine may be better indicators. Detection of un-metabolized toluene or benzylmercapturic acid in urine at the levels in excess of the LODs may be taken as a positive evidence of toluene exposure, because their levels in urine from the controls are below the LODs. The value of benzyl alcohol as an exposure marker should be limited.     

New PBPK model applied to old occupational exposure to benzene

An intensive program of benzene monitoring using new techniques was undertaken in Western Europe in the late 1960s and early 1970s. Significant exposure was found in the transport of benzene and gasoline, particularly during the loading of barges, and during the loading and operation of sea-going vessels. The ceiling threshold limit value of 25 ppm recommended at that time generated problems in assessing exposure, so alternative criteria were proposed. During that period some shore-based exposures were reported, and their significance was discussed in several articles. The information gained at that time is reexamined by physiologically based pharmacokinetic (PBPK) modeling and is used to help validate an improved PBPK model, which is described and tested on results from experimental exposure in a companion article. The old field data, comprising five specific studies, confirm the relevance of modeling to assessment of occupational exposure, and demonstrate its value for interpretation of field data, which is seldom as complete, systematic, or accurate as that obtained in experimental work. The model suggests that metabolism of benzene in humans may not be restricted to the liver. Sites and processes of metabolism merit further investigation.     

Projections of leukemia risk associated with occupational exposure to benzene

In 1982, White et al published an assessment of quantitative leukemia risk associated with lifetime occupational exposure to benzene. At about the same time, IARC (1982) published estimates of quantitative cancer risk associated with industrial chemicals. Benzene was one of the two chemicals selected by IARC for its risk estimation. This paper presents a summary of these assessments along with new study results demonstrating adverse effects on bone marrow and peripheral blood cells as a result of low-level benzene exposure. Mathematical extrapolations based on epidemiologic studies are consistent with a finding of significant risk of dying from leukemia under the current occupational permissible exposure limit of 10 ppm. Although a significant reduction of risk could be expected to be achieved by reducing exposure to 1 ppm, a significant risk may still remain. The uncertainty of the dose-response projections rests on the underlying estimates of relative risk of death from leukemia, the estimates of benzene exposure (dose), and the appropriateness of the mathematical model. Recent findings in experimental animals demonstrate chromosomal damage to bone marrow cells, significant depression of the bone marrow, and disturbances of immune system function as a result of less than 1 week of exposure to the current permissible benzene exposure limit of 10 ppm. This was the lowest dose tested. These experimental findings provide further evidence of a potentially significant risk of bone marrow proliferative cancer (leukemia) as a result of low-dose benzene exposure.     

Environmental and occupational exposure to benzene by analysis of breath and blood.

Benzene exposure of chemical workers was studied, during the entire workshift, by continuous monitoring of workplace benzene concentration, and 16 hours after the end of the workshift by the measurement of alveolar and blood benzene concentrations and excretion of urinary phenol. Exposure of hospital staff was studied by measuring benzene concentrations in the alveolar and blood samples collected during the hospital workshift. Instantaneous environmental air samples were also collected, at the moment of the biological sampling, for all the subjects tested. A group of 34 chemical workers showed an eight hour exposure to benzene, as a geometric mean, of 1.12 micrograms/l which corresponded, 16 hours after the end of the workshift, to a geometric mean benzene concentration of 70 ng/l in the alveolar air and 597 ng/l in the blood. Another group of 27 chemical workers (group A) turned out to be exposed to an indeterminable eight hour exposure to benzene that corresponded, the morning after, to a geometric mean benzene concentration of 28 ng/l in the alveolar air and 256 ng/l in the blood. The group of hospital staff (group B) had a benzene concentration of 14 ng/l in the alveolar air and 269 ng/l in the blood. Instantaneous environmental samples showed that in the infirmaries the geometric mean benzene concentration was 58 ng/l during the examination of the 34 chemical workers, 36 ng/l during the examination of the 27 chemical workers (group A), and 5 ng/l during the examination of the 19 subjects of the hospital staff (group B). Statistical analysis showed that the alveolar and blood benzene concentrations in the 34 workers exposed to 1.12 microgram/l of benzene differed significantly from those in groups A and B. It was found, moreover, that the alveolar and blood benzene concentrations were higher in the smokers in groups A and B but not in the smokers in the group of 34 chemical workers. The slope of the linear correlation between the alveolar and the instantaneous environmental benzene concentrations suggested a benzene alveolar retention of about 55%. Blood and alveolar benzene concentrations showed a highly significant correlation and the blood/air partition coefficient, obtained from the slope of the regression line, was 7.4. In the group of the 34 chemical workers no correlation was found between the TWA benzene exposure and the urinary phenol excretion.