尿粘康酸在苯的生物监测中的应用价值

为研究苯暴露的生物标志物，应用改进的高压液相色谱法检测了１２８名苯接触工人及４０名对照人群的尿粘康酸含量，同时测定了其尿酚含量。结果表明，当空气苯浓度为４１．４９ｍｇ／ｍ３时，接触工人的尿粘康酸含量为（５．４７±７．９４）ｍｇ／ｇＣｒ，尿酚为（３９．０９±４２．５９）ｍｇ／ｇＣｒ。对照人群的尿粘康酸含量为（０．１３±０．０９）ｍｇ／ｇＣｒ，尿酚为（１６．０１±１１．３３）ｍｇ／ｇＣｒ（均为肌酐校正值，ｘＧ±ｓ）。苯接触工人的尿粘康酸含量与所接触的空气苯浓度及尿酚含量呈良好的相关，相关系数分别为０．９１８７，０．８２０４。尿粘康酸在人群中本底值低，反映苯的内吸收情况比尿酚更特异、敏感，更适于低浓度苯暴露的生物监测。     

镉对肾损害与尿酶活性的研究

镉对肾早期损害的研究中，我们对４７名镉作业者采用尿中γ－谷氨酰转肽酶活性（γ－ＣＴ／ｇ·Ｃｒ），同时对尿镉、β２－微球蛋白（β２－ＭＧ）以及血中的γ－ＧＴ进行检测。结果表明：作业场所氧化镉在０．０５２～０．１２ｍｇ／ｍ３，平均工龄为６．６年的作业者，尿γ－ＧＴ／ｇ·Ｃｒ活性高于对照组（Ｐ＜０．０１）。其中超标者占２９．７％，而尿β２－ＭＧ超标者１２．７％。在尿γ－ＧＴ／ｇ·Ｃｒ异常的病例中有５０％尿β２－ＭＧ尚属正常。说明检测尿γ－ＧＴ／ｇ·Ｃｒ活性是镉对肾早期损害的敏感指标。     

细菌性肺炎患者尿五项蛋白放射免疫检测的临床分析（附32例分析）

本文通过放射免疫检测（ＲＩＡ）３２例细菌性肺炎尿五项蛋白（β＿２ｍ，ＴＨＰ，ＡＬｂ，ＩｇＧ，ＳＩｇＡ）分析结果表明：β＿２ｍ，ＴＨＰ，ＡＬｂ在肺炎急性期增高，统计学结果β＿２ｍＰ＜０．００１，ＴＨＰＰ＜０．０５，ＡＬｂＰ＜０．０５（与对照组比较）。说明肺炎急性期患者肾小球、肾小管有一过性轻度损伤，但为可逆性。本文研究结果表明尿五项蛋白检测较常规ＢＵＮ、Ｃｒ检测灵敏，并且提示肺炎急性期应尽量避免使用对肾脏有损害之药物。     

三硝基甲苯,铅,黄磷接触者唾液咖啡因清除率的改变

分别暴露三硝基甲苯（ＴＮＴ）、铅、黄磷的工人，空腹口服１７０ｍｇ咖啡因，约８ｈ后收集唾液，用ＨＰＬＣ法测定咖啡因含量，根据药动学公式求出唾液咖啡因清除率（ＳＣＬｃａ），同时测定其它肝功能指标。结果表明，对照组（２７例）ＳＣＬｃａ为１３４．３±５９．７ｍｇ／ｍｉｎ，ＴＮＴ接触者（３７例）为６６．５±３３．８ｍｌ／ｍｉｎ，铅接触者（３４例）为６４．１±３０．３ｍｌ／ｍｉｎ，黄磷接触者（３８例）为１４９．９±６８．７ｍｌ／ｍｉｎ。ＴＮＴ和铅接触者ＳＣＬｃａ下降（Ｐ＜０．０１），说明接触者肝代谢功能下降。黄磷接触者ＳＣＬｃａ与对照组相比差别无显著性。以对照组ＳＣＬｃａ９５％可信限作正常范围，３种接触者ＳＣＬｃａ的异常检出率均比血清谷雨转氨酶（ＳＧＰＴ）和ｒ－谷氨酸转肽酶（ｒ—ＧＴ）异常检出率为高（Ｐ＜０．０１），凡ＳＧＰＴ和（ｒ—ＧＴ）异常者ＳＣＬｃａ大多有改变。     

尿微量白蛋白/肌酐比值及尿钙/肌酐比值预测妊高征的临床研究

２４８例孕妇在妊娠２０～３４ｗ时留晨尿，用放射免疫方法（ＲＩＡ）测定尿微量白蛋白，用生化自动分析仪测定尿肌酐、尿钙，以尿白蛋白／肌酐比值（ＵＡｌｂ／Ｃｒ）≥１０（ｍｇ／ｇ）作为临界值，预测妊高征。其敏感性、特异性、阳性和阴性预测率分别为７７．８％、９７．０％、６６．７％和９８．２％。与尿钙／肌酐比值（ＵＣａ／Ｃｒ）预测妊高征比较，各项指标均优于后者。认为ＵＡｌｂ／Ｃｒ比值是较ＵＣａ／Ｃｒ更为有效的预测妊高征的手段。     

长期接触铅作业工人肾功能损害探讨

［目的］探讨长期接触铅作业工人肾功能损害。［方法］选择三组接触铅作业工人（第一组为长期接铅仍在岗位的工人;第二组为长期接铅但已脱离岗位退休的工人;第三组为短期接铅的工人）和对照组同样测定血铅（Ｂ－Ｐｂ）、尿β２ －微球蛋白（Ｕ－β２－ＭＧ）、尿δ－氨基酮戊酸（Ｕ－δ－ＡＬＡ）内生肌酐清除率（ＣＣｒ）等指标。［结果］三组接铅工人的血铅浓度平均值均与对照组之间存在明显差异,第一组工人的Ｕ－β２－ＭＧ和Ｕ－δ－ＡＬＡ 浓度最高并与其他各组之间有显著性差异,而第二组与第三组此两项指标与对照组之间没有显著性差异。临床体检各组人员中均未发现有异常症状和体征。［结论］长期接触铅作业工人肾功能将受到损害,但早期的肾功能损害是可恢复的,Ｕ－β２ －ＭＧ作为肾小球早期损害指标是较为敏感的,建议将其作为接铅工人肾损控制的监护指标。     

镉对大鼠睾丸间质细胞脂质过氧化的影响

目的观察镉对离体睾丸间质细胞的毒性作用。方法测定不同ＣｄＣｌ２染毒浓度下（含镉０、１０、２０和４０μｍｏｌ／Ｌ）间质细胞的脂质过氧化水平。结果染毒２４小时后，染毒组的细胞存活率显著低于对照组（Ｐ＜０．０１），且存在剂量－效应关系；随染毒浓度的增高，丙二醛（ＭＤＡ）含量和谷胱甘肽过氧化物酶（ＧＳＨ－Ｐｘ）活力显著增高（Ｐ＜０．０５），而超氧化物歧化酶（ＳＯＤ）活力则显著下降（Ｐ＜０．０１）。相关分析结果显示：ＳＯＤ与ＭＤＡ呈负相关、与ＧＳＨ－Ｐｘ呈显著负相关（ｒ＝－０．４３３９，Ｐ＜０．０５）；ＭＤＡ与ＧＳＨ－Ｐｘ呈显著正相关（ｒ＝０．４３２９，Ｐ＜０．０５），表明镉可使睾丸间质细胞的脂质过氧化作用增强、抗氧化能力减弱。结论镉对睾丸间质细胞具有直接毒性作用。     

主观全面营养评价法在腹膜透析患者中的应用

目的与方法：用主观全面营养评价（ＳｕｂｊｅｃｔｉｖｅＧｌｏｂａｌＡｓｓｅｓｓｍｅｎｔ，ＳＧＡ）结合部分生化指标对３３例持续性不卧床腹膜透析（ＣｏｎｔｉｎｕｏｕｓＡｍｂｕｌａｔｏｒｙＰｅｒｉｔｏｎｅａｌＤｉａｌｙｓｉｓ，ＣＡＰＤ）患者进行了５５例次营养评价。结果：营养良好的患者血清白蛋白、氮表现率相当蛋白（ＮｏｒｍａｌｉｚｅｄＰｒｏｔｅｉｎＥｑｕｉｖａｌｅｎｔｏｆＮｉｔｒｏｇｅｎＡｐｐｅａｒａｎｃｅＲａｔｅ，ＮＰＮＡ）较高。各组间上臂围、三头肌皮褶厚度、上臂肌围无明显差别。ＳＧＡ评分与血清白蛋白（ｒ＝－０．７１，Ｐ＜０．０１）、转铁蛋白（ｒ＝－０．３２，Ｐ＜０．０５）、前白蛋白（ｒ＝－０．３６，Ｐ＜０．０５）浓度和ＮＰＮＡ（ｒ＝－０．４３，Ｐ＜０．０５）明显相关。Ｋａｐｐａ检验发现ＳＧＡ与血清白蛋白浓度评价结果比较一致（Ｋａｐｐａ＝０．５４１，Ｐ＜０．０５）且ＳＧＡ能够发现早期的营养不良。     

人类精子DNA氧化损伤与精子质量和精液中镉、铅浓度的关系

用高压液相色谱—光电检测系统和高压液相色谱—紫外线检测器同时检测发现人精子ＤＮＡ８ＯＨｄＧ 和ｄＧ 水平,用原子吸收光谱检测精液中镉、铅浓度。确定５６ 名非吸烟者精子ＤＮＡ８羟脱氧核糖核酸（８ＯＨｄＧ） 水平,探讨人类精子ＮＤＡ氧化性损伤与精子质量和精液中镉、铅浓度的关系。发现８ＯＨｄＧ／１０６ｄＧ平均几何均数为４８．３（９５ ％ ＣＩ：２０．８ － １１１．８ ,ｎ ＝ ５６） ;８ＯＨｄＧ／１０６ｄＧ 与精子密度（ｒ＝ － ０．４６ ,Ｐ＝ ０．００１ ,ｎ ＝ ５６） 和精子总数之间（ｒ＝ － ０．３７ ,Ｐ＝ ０．００５ ,ｎ ＝ ５６） 呈明显的负相关;８ＯＨｄＧ／１０６ｄＧ 与精液镉（ｒ＝ ０．４９ ,Ｐ＝ ０．００１） 、铅（ｒ＝ ０．３０ 、Ｐ＝ ０．０２５） 浓度呈明显的正相关。提示人类精子氧化性损伤影响精子质量,精液中镉、铅浓度可能是人类精子氧化性损伤的重要因素     

三硝基甲苯,铅,黄磷接触者唾液咖啡因清除率对肝毒作用的早期评价

毒物对肝脏的早期作用常表现为肝混合功能氧化酶（ＭＦＯ）的变化，咖啡因主要经肝ＭＦＯ代谢，因此测定其唾液清除率（ＳＣＬｃａ）可用于早期评价某些毒物的肝毒作用。三硝基甲笨（ＴＮＴ）、铅、黄磷接触者口服１７０ｍｇ咖啡因，８小时后收集唾液测定咖啡因含量及求出ＳＣＬｃａ，对照组（１７例）为１３４．３±５９．７ｍｌ／ｍｉｎ，ＴＮＴ接触者（３７例）为６６．５±３３．８ｍｌ／ｍｉｎ（Ｐ＜０．０１），铅接触者（３４例）为６４．１±３０．３ｍｌ／ｍｉｎ（Ｐ＜０．０１），黄磷接触者（３８例）为１４９．９±６８．７ｍｌ／ｍｉｎ。以对照组ＳＣＬｃａ９５％可信限作正常范围，三种接触者ＳＣＬｃａ的异常检出率均比ＳＧＰＴ和γ－ＧＴ的异常检出率高（Ｐ＜０．０１），凡ＳＧＰＴ和γ－ＧＴ异常者ＳＣＬｃａ大多有改变。结果表明ＳＣＬｃａ作为一种无损伤性的肝代谢功能检测方法，对ＴＮＴ、铅接触者早期肝代谢功能改变的评价有一定的意义。     

不同校正方法对尿铅、尿镉浓度影响的研究

分析了肌酐代谢无明显异常的17名铅、镉接触者在自由饮水条件下收集的132份尿样。用尿比重(U_(SG))、尿肌酐(U_(Cr))、尿流速调整的肌酐比率(U_(CF))等方法校正尿测定浓度(U),比较其对尿铅、尿镉浓度的影响。结果表明,不同方法校正后的变异程度,以U_(CF)时最大,其次为U_(Cr)、U_(SG)校正,未校正的测定浓度(U)的变异程度最小。因此,可以认为,U_(SG)、U_(Cr)、U_(CF)校正与测定浓度相比,并未提供明显的优点。就尿铅、尿镉而言,在特殊情况下需校正时,以尿比重为参数较为合适。     

Tubular and glomerular kidney effects in Swedish women with low environmental cadmium exposure

Cadmium is a well-known nephrotoxic agent in food and tobacco, but the exposure level that is critical for kidney effects in the general population is not defined. Within a population-based women's health survey in southern Sweden (Women's Health in the Lund Area, WHILA), we investigated cadmium exposure in relation to tubular and glomerular function, from 1999 through early 2000 in 820 women (71% participation rate) 53-64 years of age. Multiple linear regression showed cadmium in blood (median, 0.38 microg/L) and urine (0.52 microg/L; density adjusted = 0.67 microg/g creatinine) to be significantly associated with effects on renal tubules (as indicated by increased levels of human complex-forming protein and N-acetyl-beta-D-glucosaminidase in urine), after adjusting for age, body mass index, blood lead, diabetes, hypertension, and regular use of nephrotoxic drugs. The associations remained significant even at the low exposure in women who had never smoked. We also found associations with markers of glomerular effects: glomerular filtration rate and creatinine clearance. Significant effects were seen already at a mean urinary cadmium level of 0.6 microg/L (0.8 microg/g creatinine). Cadmium potentiated diabetes-induced effects on kidney. In conclusion, tubular renal effects occurred at lower cadmium levels than previously demonstrated, and more important, glomerular effects were also observed. Although the effects were small, they may represent early signs of adverse effects, affecting large segments of the population. Subjects with diabetes seem to be at increased risk.     

Effects of exposure to low levels of environmental cadmium on renal biomarkers

We conducted a study among residents of a small community contaminated with heavy metals from a defunct zinc smelter and residents from a comparison community to determine whether biologic measures of cadmium exposure were associated with biomarkers of early kidney damage. Creatinine-adjusted urinary cadmium levels did not differ between the smelter and comparison communities; thus we combined individuals from both communities (n = 361) for further analyses. The overall mean urinary cadmium level was low, 0.26 microg/g creatinine, similar to reference values observed in the U.S. general population. For children ages 6-17 years, urinary concentration of N-acetyl-beta-D-glucosaminidase (NAG), alanine aminopeptidase (AAP), and albumin were positively associated with urinary cadmium, but these associations did not remain statistically significant after adjusting for urinary creatinine and other potential confounders. For adults ages 18 or older, urinary concentration of NAG, AAP, and albumin were positively associated with urinary cadmium. The associations with NAG and AAP but not with albumin remained statistically significant after adjusting for creatinine and other potential confounders. We found a positive dose-effect relationship between levels of creatinine-adjusted urinary cadmium and NAG and AAP activity, and statistically significant differences in mean activity for these two enzymes between the highest (> or =1.0 microg cadmium/g creatinine) and the lowest (< or =0.25 microg cadmium/g creatinine) exposure groups. The findings of this study indicate that biologic measures of cadmium exposure at levels below 2.0 microg/g creatinine may produce measurable changes in kidney biomarkers.     

八种校正参数对尿汞浓度影响的研究

本研究分析了23名汞接触者在自由饮水条件下24h内收集的127个尿样,用尿比重(U_(SG))、尿肌酐(U_(Cr))、比重校正的尿肌酐(U_(SG—Cr))、尿流速调整的肌酐比率(U_(CF~b),b值分别为0.67、0.33、0.27和0.16)等参数校正尿汞测定浓度(U),以揭示其对尿汞浓度的影响。结果表明,尿肌酐、汞排泄具有明显的个体差异和体内差异。不同参数校正后尿汞浓度的变异系数,以U_(CF~0.67)最大,尿汞的测定浓度(U)的变异系数为最小。因此可以认为,U_(SG)、U_(Cr)、U_(SG-Cr)、U_(CF~b)的校正与未校正的测定浓度(U)相比并未提供明显的优点。在需作校在时,则以U_(SG-Cr)为参数较为合适。就U_(CF~b)而言,其变导系数随校正指数的减小而减小,U_(CF~0.67)的校正效果较U_(CF~0.33)、U_(CF~0.27)和U_(CF~0.16)要差。     

Cadmium-induced effects on bone in a population-based study of women

High cadmium exposure is known to cause bone damage, but the association between low-level cadmium exposure and osteoporosis remains to be clarified. Using a population-based women's health survey in southern Sweden [Women's Health in the Lund Area (WHILA) ] with no known historical cadmium contamination, we investigated cadmium-related effects on bone in 820 women (53-64 years of age) . We measured cadmium in blood and urine and lead in blood, an array of markers of bone metabolism, and forearm bone mineral density (BMD) . Associations were evaluated in multiple linear regression analysis including information on the possible confounders or effect modifiers: weight, menopausal status, use of hormone replacement therapy, age at menarche, alcohol consumption, smoking history, and physical activity. Median urinary cadmium was 0.52 microg/L adjusted to density (0.67 microg/g creatinine) . After multivariate adjustment, BMD, parathyroid hormone, and urinary deoxypyridinoline (U-DPD) were adversely associated with concentrations of urinary cadmium (p < 0.05) in all subjects. These associations persisted in the group of never-smokers, which had the lowest cadmium exposure (mainly dietary) . For U-DPD, there was a significant interaction between cadmium and menopause (p = 0.022) . Our results suggest negative effects of low-level cadmium exposure on bone, possibly exerted via increased bone resorption, which seemed to be intensified after menopause. Based on the prevalence of osteoporosis and the low level of exposure, the observed effects, although slight, should be considered as early signals of potentially more adverse health effects. Key words: biochemical bone markers, bone mineral density, cadmium, lead, osteoporosis, women.     

Circadian rhythms of seven heavy metals in plasma, erythrocytes and urine in men: observation in metal workers

To elucidate circadian rhythms (variation within a day) of 7 toxic or essential metals in plasma and erythrocytes in relation to the rhythms in urine in men, 19 male metal foundry workers were examined; they were exposed to lead (Pb), zinc (Zn) and copper (Cu) occupationally but separated from the exposure during the study. Circadian rhythms were found for plasma concentration of Pb, cadmium (Cd), Zn, Cu and chromium (Cr) in the workers. Circadian rhythms were also found for Pb, inorganic mercury (Hg), Zn and Cr in erythrocytes and for all metals except Zn in urine. Both the plasma and urinary levels of Pb, Cd, Cu and Cr together with urinary excretion of Mn and creatinine tended to decrease during night hours; both the erythrocyte and urinary levels of Hg together with both the plasma and erythrocyte levels of Zn tended to increase during morning hours. The results of profile analysis suggested that the circadian rhythm of Pb in urine was affected more strongly by its plasma and erythrocyte rhythms than by the rhythm of creatinine in urine, i.e. the rhythm of glomerular filtration; the urinary rhythms of Cd, Cr, and Mn were affected more by the creatinine rhythm; and the urinary rhythm of Cu was affected by both its plasma and creatinine rhythms. On the other hand, the urinary rhythm of Hg was assumed to be independent of the creatinine rhythm and be affected by its erythrocyte rhythm. The present study suggested that different biological limit values might be needed for different hours of the day especially for shift workers who are exposed to various heavy metals. Instead, further studies should be conducted to find the adjustment methods by which no circadian rhythms are discerned.     

Association of urinary cadmium and myocardial infarction

We conducted a cross-sectional analysis of individuals 45-79 years old in the National Health and Nutrition Examination Survey III (1988-1994) (NHANES III). Myocardial infarction was determined by electrocardiogram (ECG). Our sample included 4912 participants, which when weighted represented 52,234,055 Americans. We performed adjusted logistic regressions with the Framingham risk score, pack-years of smoking, race-ethnicity, and family history of heart attack, and diabetes as covariates. Urinary cadmium >or= 0.88 microg/g creatinine had an odds ratio of 1.86 (95% CI 1.26-2.75) compared to urinary cadmium <0.43 microg/g creatinine. This result supports the hypothesis that cadmium is associated with coronary heart disease. When logistic regressions were done by gender, women, but not men, showed a significant association of urinary cadmium with myocardial infarction. Women with urinary cadmium >or= 0.88 microg/g creatinine had an odds ratio of 1.80 (95% CI 1.06-3.04) compared to urinary cadmium <0.43 microg/g creatinine. When the analysis was restricted to never smokers (N=2187) urinary cadmium >or= 0.88 microg/g creatinine had an odds ratio of 1.85 (95% CI 1.10-3.14) compared to urinary cadmium <0.43 microg/g creatinine.     

Urinary concentrations of toxic substances: an assessment of alternative approaches to adjusting for specific gravity

Alternative approaches of adjusting urinary concentration of cadmium for differences in specific gravity of biological samples were assessed. The main analysis used 2922 cadmium-in-urine samples collected in the period 1968-1989 from workers at a UK nickel-cadmium battery facility. Geometric means of cadmium-in-urine, adjusted and unadjusted for specific gravity, were obtained for 21 different values of specific gravity ranging from 1.010 to 1.030. There was a highly significant positive trend (P < 0.001) of unadjusted cadmium-in-urine with specific gravity. Conventional adjustment for specific gravity led to a highly significant negative trend (P < 0.001) of adjusted cadmium-in-urine with specific gravity, SG. An approach proposed by Vij and Howell, involving the introduction of a z coefficient, led to satisfactory adjustment. Conventional adjustment of specific gravity leads to overcompensation of the confounding effects of specific gravity. An alternative method is available and should probably be adopted when interpreting urine biological samples for all chemical substances.     

血中铅,镉水平与其尿排泄关系的研究

报道了肌酐代谢无明显异常的17名职业性铅、镉接触者在自由饮水情况下血中铅、镉水平与其尿排泄的关系。结果表明,血中铅、镉浓度以及铅、镉、肌酐的尿排泄存在明显的个体差异。血铅浓度与24h尿铅排泄量呈明显正相关,血镉浓度与24h尿镉排泄量无明显相关,而与每天吸烟量明显相关。17人的132份尿样的尿流速与肌酐、镉排泄率呈显著正相关,但与尿铅排泄率无显著相关。本研究还表明,尿中肌酐排泄率与尿铅、镉排泄率之间也有显著的正相关性。     

Cadmium exposure and neurodevelopmental outcomes in U.S. children

Background: Low-level environmental cadmium exposure in children may be associated with adverse neurodevelopmental outcomes.Objective: Our aim was to evaluate associations between urinary cadmium concentration and reported learning disability (LD), special education utilization, and attention deficit hyperactivity disorder (ADHD) in U.S. children using National Health and Nutrition Examination Survey (NHANES) data.Methods: We analyzed data from a subset of participants in NHANES (1999–2004) who were 6–15 years of age and had spot urine samples analyzed for cadmium. Outcomes were assessed by parent or proxy-respondent report. We fit multivariable-adjusted logistic regression models to estimate associations between urinary cadmium and the outcomes.Results: When we compared children in the highest quartile of urinary cadmium with those in the lowest quartile, odds ratios adjusted for several potential confounders were 3.21 [95% confidence interval (CI): 1.43, 7.17] for LD, 3.00 (95% CI: 1.12, 8.01) for special education, and 0.67 (95% CI: 0.28, 1.61) for ADHD. There were no significant interactions with sex, but associations with LD and special education were somewhat stronger in males, and the trend in the ADHD analysis was only evident among those with blood lead levels above the median.Conclusions: These findings suggest that children who have higher urinary cadmium concentrations may have increased risk of both LD and special education. Importantly, we observed these associations at exposure levels that were previously considered to be without adverse effects, and these levels are common among U.S. children.