氟乙酰胺中毒对几种生化指标影响的研究

目的 观察氟乙酰胺中毒后SD大鼠血清生化酶的改变，探讨急性氟乙酰胺中毒的早期临床生化诊断指标，为临床快速、准确诊疗提供参考。方法 以SD大鼠作为实验对象，通过灌胃染毒制备氟乙酰胺中毒的急性动物试验模型，测定血清、SOD、MDA、CK、ACP活性及血清羟脯氨酸、氨基已糖的含量。结果 氟乙酰胺能引起大鼠血SOD、MDA、CK活力升高，血清羟脯氨酸、氨基已糖含量升高，血清ACP含量略有改变。结论 SOD、MDA、CK、羟脯氨酸、氨基已糖可望作为检测氟乙酰胺中毒的生化指标。     

氯乙烯接触工人氧化损伤指标研究

目的通过对5项氧化损伤指标的检测,探讨氯乙烯(vinyl chloride monomer,VCM)对机体的氧化损伤作用及其影响因素。方法选择某公司VCM生产车间所有工人223人为接触组,其他单位行政办公人员149人为对照组,检测血清中乳酸脱氢酶(lactate dehydrogenase,LDH)、总抗氧化能力(total antioxidant capacity,T-AOC)、羟脯氨酸(hydroxyproline,HYP)、总超氧化物歧化酶(total superoxide dismutase,T-SOD)及丙二醛(malondialdehyde,MDA)等5项氧化损伤指标的含量。结果单因素分析发现,性别、年龄、吸烟、饮酒等因素对LDH、T-SOD的含量并无明显影响,差异无统计学意义(P0.05),而接触VCM对LDH与T-SOD水平有明显影响(P0.01),吸烟对HYP的水平产生影响(P0.05),性别差异和接触VCM对MDA有影响(P0.05)。多因素分析发现,LDH和MDA含量升高,而T-SOD含量降低。结论在目前的接触浓度下,VCM可使LDH、T-SOD和MDA等氧化损伤指标水平改变,而本次研究并未发现性别、吸烟、饮酒、年龄、工龄等因素对氧化损伤指标的影响。     

献血者丙氨酸氨基转移酶参考值的探讨

丙氨酸氨基转移酶(alanine aminotransferase,ALT)是肝细胞胞浆中的一种氨基转移酶,正常状态时血清中含量很少。肝脏细胞受损时会大量释放入血,血清中的ALT会升高数倍乃至几百倍。ALT作为肝细胞损伤的敏感指标[1],广泛应用于健康查体、入学、招工、献血等多项检查中,作为对肝脏疾病的早期筛查试验。目前我国ALT检测方法除少数地区及血站仍使用赖氏法外,最常用的是速率法。在临床     

氯乙烯染毒大鼠DNA损伤与肝脏某些生化指标的变化

目的　研究氯乙烯 (VCM)对大鼠肝细胞和血淋巴细胞DNA的损伤作用 ,及肝脏某些生化指标的变化。方法　DNA损伤采用单细胞凝胶电泳 (彗星实验 )法 ,代谢酶活性采用分光光度法 ,肝功能测定使用自动生化分析仪。结果　彗星发生率染毒组显著高于对照组 ,肝细胞和血淋巴细胞彗星发生率显著相关。结论　VCM可导致大鼠肝细胞和血淋巴细胞DNA发生损伤 ,且存在剂量 效应 反应关系。     

职业接触铬盐导致血清酶活力的变化

目的探讨职业接触铬盐者肝线粒体损伤相关血清酶活力的变化,为选择职业接触铬盐者血清酶学指标监测提供参考依据。方法利用原子吸收分光光度法检测车间空气中铬浓度,体检并询问自觉症状,肉眼观察呼吸道、皮肤损害;实验室检查职业接触铬盐者血清中丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转移酶(γ-GT)、谷氨酸脱氢酶(GDH),鸟氨酸氨基甲酰转移酶(OCT)、精氨酸酶(Arg)、腺苷脱氨酶(ADA)、谷胱甘肽硫转酶(GST)等指标,并对检测结果进行统计学分析。结果铬盐车间空气中铬盐浓度超过国家标准0.05 mg/m3的样品29份,合格率为78.67%(107/136);与正常对照组比较,职业接触铬盐者血清中ALT、AST、γ-GT、GDH、OCT、Arg、GST活力升高,ADA活力降低,差异有统计学意义(P0.01);不同工段间职业接触铬盐者血清酶学指标比较,红矾钠、铬酸、转窑工段的血清酶学指标与红矾钾和还原工段间比较,差异有统计学意义(P0.01)。结论铬盐车间空气铬浓度超标,对职业接触铬盐者身体健康造成了严重损害,为保护职业接触铬盐者身体健康,建议改造生产工艺,降低车间空气中铬浓度;职业接触铬盐可使血清中有关肝细胞线粒体功能酶活力升高,对肝细胞及其线粒体功能有损害作用,对于职业接触铬盐者肝脏损伤检查可能具有一定的价值。     

氯乙烯接触工人氧化损伤指标的变化

[目的]探讨氯乙烯（VCM）接触工人体内氧化损伤指标的变化,筛选可能的氯乙烯接触效应生物标志物。[方法]以359名氯乙烯接触工人为接触组,158名不接触氯乙烯的工人为对照组,测定血清中超氧化物歧化酶（SOD）、丙二醛（MDA）以及谷胱甘肽硫转移酶（GST）的含量。[结果]多元线性回归分析结果显示,各VCM累积接触剂量组与对照组相比,SOD活性降低（P〈0．001）而MDA活性增高（P〈O．001）。低剂量组和高剂量组与对照组相比,GST水平增高（P〈0．05）。趋势卡方检验结果显示,VCM累积接触剂量与SOD和GST活性间存在明显的剂量一反应关系。[结论]在目前的VCM接触浓度下,VCM可造成氧化损伤指标的改变。认为MDA、SOD、GST可作为VCM暴露评价的效应生物标志物。     

肝功能相关酶检测在婴儿HCMV感染中的意义

目的探讨丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、γ-谷氨酰转移酶(GGT)等生化指标在判断小儿人巨细胞病毒(HCMV)感染中有无肝细胞损伤的参考价值。方法应用荧光定量聚合酶链反应(FQ-PCR)方法检测246例临床疑诊HCMV感染住院患儿血清HCMV-DNA含量,从而将其分为实验组和对照组,并同时检测其ALT、AST、GGT等生化指标。结果巨细胞病毒感染的实验组ALT、AST、GGT均比对照组增高,差异有统计学意义(P<0.05)。结论 ALT、AST、GGT等肝功能相关酶活性升高程度对判断巨细胞病毒感染是否有肝细胞肝脏损害有一定的参考价值,提示在巨细胞病毒感染治疗中注意护肝治疗。     

血羟脯氨酸微量测定

羟脯氨酸(Hydroxyproline,HYP)作为衡量机体胶原代谢状况的一项指标,已在一些临床中得到应用。关于血尿羟脯氨酸的比色测定法,以往资料已有报导,这些报导的方法虽各有差异,但基本原理相同,即用酸将含有羟脯氨酸的多肽水解,然后用氯胺-T将羟脯氨酸氧化成吡咯,再与对二甲氨基苯甲醛(P-DMAB)反应,生成红色化合物,在560nm波长处比色测定。本文根据Ga-bor Huszar提出的碱水解法,对NaOH水解血清样品,比色测定血羟脯氨酸的方法     

氯乙烯致大鼠肝细胞DNA损伤与DNA修复基因表达

目的　研究氯乙烯 (VCM)对大鼠肝细胞DNA的损伤作用 ,及对DNA损伤修复酶 [O6 甲基鸟嘌呤 DNA甲基转移酶 (MGMT)、X线修复交叉互补基团 1(XRCC1)和X线修复交叉互补基团 3(XRCC3) ]表达的影响 ;探索VCM所致DNA损伤的修复机制。方法　采用腹腔注射VCM染毒 ,实验组按不同染毒剂量分为 3个剂量组 ,分别为低剂量 5mg kg、中剂量 10mg kg和高剂量 2 0mg kg ,染毒12周 ,以单细胞凝胶电泳 (彗星试验 )测DNA损伤 ,免疫组化法测DNA损伤修复酶的表达。结果　低、中和高剂量组大鼠肝细胞DNA损伤细胞百分率分别为 11.75 %、12 .38%和 17.6 3% ,均高于对照组(5 .6 7% ) ,且中、高剂量与对照组比较 ,差异有显著性 (P <0 .0 5 ,P <0 .0 1)。MGMT和XRCC1表达随染毒剂量增加而减少 ,而XRCC3的表达随染毒剂量的增加而增加。VCM致DNA损伤与XRCC3表达有相关关系 (r=0 .4 38,P =0 .0 6 7)。结论　VCM可导致肝细胞DNA发生损伤 ,且存在剂量 -反应关系 ;DNA损伤修复酶参与修复VCM所致的DNA损伤。     

过量饮酒者血清透明质酸、Ⅳ型胶原测定的临床分析

目的探讨血清透明质酸(HA)、Ⅳ型胶原(Ⅳ·C)含量测定在过量饮酒者肝细胞损伤早期诊断中的应用价值.方法采用放射免疫分析法检测血清中HA、Ⅳ型胶原.结果血清HA含量明显高于对照组(P＜0.001),且58例过量饮酒者中有33例B超诊断为脂肪肝者HA含量较该组中非脂肪肝者为高(P＜0.05).Ⅳ型胶原含量无明显变化.结论血清HA的含量增高提示过量饮酒已引起肝细胞的损伤,随着酒精性脂肪肝的形成,HA的增高更为明显.     

氯乙烯职业接触评估及其健康危害调查

目的评估氯乙烯累积接触剂量与氯乙烯职业健康的危害关系。方法选取某厂接触氯乙烯工龄超过1年的211名接触人群和其他工厂212名非接触人群 ,登录该厂氯乙烯浓度监测资料和工人健康监护资料 ,比较接触组与对照组工人症状和体征方面的差异。结果发现接触组血清谷丙转氨酶(ALT)、脾脏肿大和白细胞减少的发生率均高于对照组 ,并具有显著统计意义。同时 ,在接触组随累积接触剂量的增加 ,肝功异常(ALT)、脾肿大发生率均有升高的趋势。结论肝、脾损害与接触氯乙烯有明显的关系 ,长期、高浓度接触氯乙烯对工人的健康危害值得关注。     

Abnormal liver function in workers exposed to low levels of ethylene dichloride and vinyl chloride monomer

We investigated whether exposure to ethylene dichloride (EDC) and vinyl chloride monomer (VCM) resulted in increased risk of liver damage. Epidemiological information, including occupational, medical, smoking, and drinking history, was obtained by interview from 251 male workers. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) were used as indicators of liver damage. Exposure to moderate or low levels of ECD and VCM resulted in a higher risk of developing abnormal ALT levels than did exposure to lower levels of the chemicals. Results were similar for AST. GGT was not associated with EDC or VCM exposure. Combined exposure to EDC and VCM showed a dose-response relationship in association with abnormal ALT levels. We concluded that relatively low concentrations of VCM and EDC cause liver damage.     

Liver function assessment in workers exposed to vinyl chloride

Objective: To investigate liver function in vinyl chloride workers and assess its relation with current/past occupational exposure to vinyl chloride monomer (VCM). Methods: A medical examination including the execution of liver function tests (LFTs) and liver ultrasonography was executed in a group of 757 workers with a long-standing service in the production of VCM/polyvinylchloride (PVC). Cumulative and maximum VCM exposures were calculated. History of viral hepatitis and alcohol intake were carefully investigated. Regression analysis explored the association between abnormal LFTs and a group of possible determinants (VCM cumulative and maximum exposure, BMI, age, history of viral hepatitis, alcohol and triglyceride levels). Also, synergistic effect between VCM and a history of hepatitis was analysed, as well as the possible association between VCM exposure and aspartate aminotransferase/alanine amino transferase (AST/ALT) ratio >1. Distribution of abnormal LFTs was also assessed in relation to the results provided by liver ultrasonography. Results: The most frequently abnormal serum parameters were, in decreasing order: total cholesterol (27.3%), triglycerides (12.2%), total bilirubin (9.1%), gamma glutamil transpeptidase (GGT; 9.0%) and ALT (8.2%). The AST/ALT ratio >1 was present in 28.1% of workers. Abnormal LFTs were not found to be associated with current or past VCM exposure. High ALT resulted positively associated with BMI, AST with alcohol intake, GGT with alcohol intake and triglycerides. No synergistic effect on LFTs of exposure to VCM and a history of hepatitis was observed. The AST/ALT ratio >1 was not found to be associated with VCM exposure. The prevalence of abnormal LFTs was higher in case of liver steatosis (ALT) or periportal fibrosis (GGT), but not in case of pure hepatomegaly, as documented by ultrasonography. Conclusions: Liver function assessment only including LFTs is not able to detect VCM-induced liver damage, but reveals alterations due to non-occupational factors, such as dietary and/or metabolic disfunctions. The LFTs are however of importance to detect conditions that could recommend avoidance of exposure to VCM and are useful for medical counselling and health promotion purposes.     

腹部超声检查在氯乙烯接触者职业普查中的应用价值

目的探讨腹部超声检查在氯乙烯接触者职业健康检查中的诊断价值。方法选择职业接触氯乙烯工龄超过1年的作业工人8610名和不接触氯乙烯的工人10628名作对照组,进行腹部二维超声检查并分析结果。结果氯乙烯接触组腹部二维超声发现肝肿大、肝弥漫性病变、脾肿大发生率明显高于对照组,有统计学意义(P<0.01)。同时,接触组随累积接触剂量的增加,肝肿大、肝弥漫性病变、脾肿大发生率有升高的趋势(P<0.01)。结论腹部二维超声检查是氯乙烯接触者职业健康检查的重要方法。     

Liver fibrosis in asymptomatic polyvinyl chloride workers

This study was designed to determine whether vinyl chloride monomer (VCM) exposure is associated with liver fibrosis. A total of 347 workers with occupational exposure to VCM were systemically examined using liver ultrasonography and routine liver function tests. Vinyl chloride monomer cumulative dose (ppm-month) was estimated by summing the products of air VCM concentration levels and months of employment. Liver fibrosis was defined in subjects with precirrhosis and cirrhosis of liver diagnosed using ultrasonography. Significantly increased risks of developing liver fibrosis were found in workers who had history of high exposure jobs (odds ratio 5.5, 95% confidence interval 1.7-25.4) when compared with workers who did not have history of high exposure jobs. We concluded that there was an increased risk of developing liver fibrosis in PVC workers who had high exposure to VCM.     

Vinyl chloride: its impact on occupational medicine practice in Iran

Upon the establishment of a positive relationship between occupational exposure to VCM and angiosarcoma of the liver, strict precautionary measures for the protection of VCM exposed employees in the Abadan Petrochemical Company have been instituted. All such workers have been required to have pre-employment and annual medical examinations with emphasis on liver functions. Among 43 such employees who have undergone regular medical evaluation in the past three years, no instance of liver dysfunction of angiosarcoma has been discovered. The Iranian Standards Institute reviewing occupational health data and local conditions provisionally set in 1976 a TLV of VCM of 25 ppm TWA for 8 hours with revision foreseen for 1977. It is believed that such precautionary measures should be revised and improved according to available data and knowledge and that variations in other environmental and local factors which may well play an important role in the potential pathogenicity of the exposure should be carefully considered in determining the extent of the precautionary measures and standards in each locality.     

Exposure to vinyl chloride monomer: report on a cohort study.

In 1980 a prospective exposed/non-exposed cohort study was initiated in France by the Institut National de la Santé et de la Recherche Médicale (INSERM U 287) to evaluate the association between mortality and cancer morbidity and occupational exposure to vinyl chloride monomer (VCM). Eleven hundred VCM exposed subjects and 1100 VCM non-exposed controls matched for age (+/- 2 years), plant, and physician were included and followed up over a five year period for vital, health, and occupational status. The percentages of deaths observed among the exposed (1.8%) and non-exposed subjects (1.6%) did not differ. Eighteen (1.6%) and 15 (1.4%) cases of cancer were reported among exposed and non-exposed subjects, respectively (NS). One case of angiosarcoma of the liver occurred among the exposed group; six cases of lung cancer occurred among exposed subjects and two among non-exposed subjects (NS). The percentage of diseases of the circulatory system was higher (p less than 0.02) in the exposed group than in the non-exposed group: this difference was explained mainly by the high incidence of Raynaud's disease (p less than 0.006). The percentages of diseases of the respiratory system did not differ between the two groups.     

Increased morbidity odds ratio of primary liver cancer and cirrhosis of the liver among vinyl chloride monomer workers

OBJECTIVES: To determine if there is an increased risk of admission to hospital for various diseases among vinyl chloride monomer (VCM) workers. METHODS: 2224 workers with occupational exposure to VCM were identified for occurrence of disease based on a search of hospital computer files on labour insurance. These data were compared with those of workers manufacturing optical equipment and motorcycles from 1 January 1985 to 31 March 1994. Cardiovascular and cerebrovascular diseases were used as reference diseases, and the age adjusted morbidity odds ratio (MOR) was calculated. RESULTS: A significantly increased risk of admission to hospital among VCM workers due to primary liver cancer (MOR 4.5-6.5), cirrhosis of the liver (MOR 1.7- 2.1), and other chronic diseases (MOR 1.5-2.0) was found. There were eight cases of primary liver cancer, all with heavy previous exposure to VCM. Another four cases of hepatoma in polyvinyl chloride (PVC) workers were found in the death registry. Ten out of 11 cases of hepatoma, with detailed medical information, were carriers of hepatitis B virus. The average latent period (20 years) was not different from other studies. Alternative agents of primary liver cancer were largely ruled out, suggesting that the combination of hepatitis B and VCM may lead to primary liver cancer. CONCLUSION: There is an increased risk of primary liver cancer in workers exposed to VCM, although the incomplete coverage of the Labor Insurance Bureau data warrants cautious interpretation of the results. Further study exploring the synergistic effects of VCM and hepatitis B is also indicated.     

Exposure to vinyl chloride monomer: report on a cohort study

In 1980 a prospective exposed/non-exposed cohort study was initiated in France by the Institut National de la Santé et de la Recherche Médicale (INSERM U 287) to evaluate the association between mortality and cancer morbidity and occupational exposure to vinyl chloride monomer (VCM). Eleven hundred VCM exposed subjects and 1100 VCM non-exposed controls matched for age (+/- 2 years), plant, and physician were included and followed up over a five year period for vital, health, and occupational status. The percentages of deaths observed among the exposed (1.8%) and non-exposed subjects (1.6%) did not differ. Eighteen (1.6%) and 15 (1.4%) cases of cancer were reported among exposed and non-exposed subjects, respectively (NS). One case of angiosarcoma of the liver occurred among the exposed group; six cases of lung cancer occurred among exposed subjects and two among non-exposed subjects (NS). The percentage of diseases of the circulatory system was higher (p less than 0.02) in the exposed group than in the non-exposed group: this difference was explained mainly by the high incidence of Raynaud's disease (p less than 0.006). The percentages of diseases of the respiratory system did not differ between the two groups.