铅接触对工人神经行为功能的影响

目的评价铅接触对工人精神及神经行为功能的改变及其接触水平-效应关系.方法采用 SCL-90症状自评量表和计算机化神经行为评价系统(NES-C)对65名铅接触工人和65名对照工人进行精神及神经行为功能状况调查,同时测定铅接触工人血铅、尿铅浓度.结果 SCL-90症状自评量表结果显示,铅作业工人阳性项目数平均57.2,对照工人为15.0,两者差异有非常显著意义(P＜0.001);神经行为功能测试结果显示,与对照组相比,信息感知、记忆能力差异有非常显著意义(P＜0.001);尿铅浓度与躯体化、强迫、焦虑和偏执因子分间存在正相关.结论职业性铅接触可影响工人的精神和神经行为功能,尿铅浓度与心理卫生状态存在一定接触水平-效应关系.     

Evaluation of peripheral blood neutrophil leucocytes in lead-exposed workers

Background: Inorganic lead can interfere with humoral and especially cell-mediated immunity even at frequently occurring (<50 μg/dl) blood lead (Pb-B) levels. Occupational exposure to lead causes a primary impairment of the chemotactic and phagocytic activities of neutrophil leucocytes. Objective: To verify whether, after taking into account the main confounding factors, occupational lead exposure is shown to induce changes in the number of blood neutrophil leucocytes, and to assess a possible dose-response relationship between Pb-B and the circulating neutrophil count in exposed workers. Subjects and methods: The study included 68 male lead-exposed (E) workers and 59 male workers in a food plant, recruited as controls (NE). A standardized questionnaire probing work, social, familial and personal medical history was administered to all the subjects. Blood and urine samples were collected to determine the dose and effect biological indices of lead and the total white blood cell and neutrophil counts. Results: Pb-B levels were significantly higher in E (geometric mean (GM): 20.5 μg/dl; 3.2–120 μg/dl) than in NE workers (GM: 3.5 μg/dl; 1–11 μg/dl). The mean absolute neutrophil count (ANC) was significantly higher in E workers with respect to NE workers. ANC correlated significantly with the biological lead dose and effect indices. Moreover, there was a dose-dependent increase of ANC with increasing Pb-B levels. The linear relationship between ANC and Pb-B was confirmed even after correction for age, body mass index and smoking habit. We also found an interaction between Pb-B level and smoking habit in increasing the number of blood neutrophils in lead-exposed workers. Conclusion: Our study is the first to describe a dose-dependent effect of lead on ANC in exposed workers. Our results underline the importance of promoting a further reduction of occupational lead exposure levels, adopting adequate individual protection means, as well as conducting medical campaigns against smoking, at the workplace.     

Surveillance of workers exposed to mercury vapour:validation of a previously proposed biological threshold limit value for mercury concentration in urine

A cross-sectional epidemiological study was carried out among subjects exposed to mercury (Hg) vapour, ie, a group of 131 male workers (mean age: 30.9 yr; average duration of exposure, 4.8 yr) and a group of 54 female workers (mean age, 29.9 yr; average duration of exposure 7 yr). The results were compared with those obtained in well-matched control groups comprising 114 and 48 male and female workers, respectively. The intensity of current Hg vapour exposure was rather moderate as reflected by the levels of mercury in urine (HgU) (mean and 95th percentile: males 52 and 147 micrograms/g creatinine; females 37 and 63 micrograms/g creatinine) and of mercury in blood (mean and 95th percentile: males 1.4 and 3.7 micrograms/dl; females 0.9 and 1.4 microgram/dl). Several symptoms mainly related to the central nervous system (memory disturbances, depressive feelings, fatigue, irritability) were more prevalent in the Hg-exposed subjects. They were, however, not related to exposure parameters. In both male and female Hg-exposed workers no significant disturbances were found in short-term memory (audioverbal), simple reaction time (visual), critical flicker fusion, and colour discrimination ability. Only slight renal tubular effects were detected in Hg-exposed males and females, ie, an increased urinary beta-galactosidase activity and an increased urinary excretion of retinol-binding protein. The prevalence of these preclinical renal effects was more related to the current exposure intensity (HgU) than to the duration of exposure and was detected mainly when HgU exceeds 50 micrograms/g creatinine. Changes in hand tremor spectrum recorded with an accelerometer were found in the Hg-exposed males only. The prevalence of abnormal values for some hand tremor parameters (total velocity and total displacement in the 2-50-Hz band) was mainly increased in male workers exposed for more than 10 yr. Unlike the renal tubular effects, the preclinical signs of tremor were more related to the integrated exposure than to the current exposure. Since the female workers, who have been exposed to Hg vapour levels usually insufficient to increase their HgU levels above 50 micrograms/g creatinine, did not exhibit any change in hand tremor pattern, the results of the present study tend to validate our previously proposed biological threshold limit value of a HgU of 50 micrograms/g creatinine for workers chronically exposed to mercury vapour.     

职业性铅暴露工人血铅和血尿酸的相关性分析

目的 研究职业性铅作业工人血铅和尿酸的变化,探讨血铅浓度变化和血尿酸指标之间的关系.方法 车间空气中铅烟的短时间接触浓度用原子吸收火焰法检测.选择一般情况可比的非铅作业工人作为对照,根据接触铅的浓度是否超过职业限值将263名铅接触工人分为职业限值内组及超职业限值组.分析不同血铅水平和血尿酸指标的变化.结果 (1)车间空气中铅烟的时间加权平均容许浓度(PC-TWA)达0.13 mg/m3,超标率为68.61％; (2)接铅超职业限值组血铅浓度达(3.16±0.03) μmol/L、尿酸为(528±109.48) μmol/L,均显著高于对照组(P＜0.05); (3)血铅浓度的变化和尿酸异常率存在一致的变化趋势.结论 职业性铅接触引起血铅浓度升高和血尿酸升高,且血铅浓度越高,血尿酸升高程度越大.     

某铅锌冶炼厂工人血铅水平的影响因素分析

目的 对某铅锌冶炼厂职业接铅人员血铅水平进行生物监测,分析血铅水平的影响因素,为采取有效的职业病预防控制措施,预防职业性慢性铅中毒提供参考。方法 以该厂182名职业性铅暴露工人为研究对象,通过调查问卷获取研究对象的基础资料和工作中接触铅的情况;采集肘静脉血用石墨炉原子吸收光谱法测定血铅浓度。应用SPSS统计软件分析不同因素与血铅水平之间的关系并确定造成血铅水平升高的影响因素。结果 研究对象的血铅浓度中位数为326.9(237.6,471.0)μg/L,其中男性血铅浓度高于女性（Z=-5.300,P<0.05）。各工龄组间血铅浓度差异具有统计学意义（H=22.126,P<0.05）,工龄≥15年组血铅浓度高于其他工龄组,各车间及各工作岗位之间血铅浓度差异亦分别具有统计学意义（H=41.386,P<0.05;H=69.773,P<0.05）,铅锌冶炼车间工人血铅水平高于电解锌车间和稀贵金属车间,其中烧结岗位、熔炼前床岗位工人血铅浓度高于其他岗位。中位数回归分析结果表明工作场所空气中铅浓度、工龄、男性、烧结岗位和熔炼前床岗位是接铅人员血铅水平升高的影响因素。结论 该铅...     

某冶炼厂铅职业接触者血铅水平的影响因素分析

目的分析某冶炼厂影响铅职业接触者血铅水平的因素。方法采集观察对象静脉血,用原子吸收光谱法测定血铅浓度,用SPSS16.0统计软件进行血铅影响因素的分析。结果铅职业接触者的血铅水平显著高于非职业接触者;不同年龄、性别、工龄、工作车间和岗位的职业接触者血铅水平差异均有统计学意义。结论该冶炼厂铅职业接触者血液中铅水平显著升高;铅职业接触者的年龄、性别、工龄、作业车间和岗位均为影响血铅水平的因素。     

佛山市高明区283名铅作业工人职业健康检查结果分析

目的通过了解铅对作业工人健康状况的影响,为采取有效的保护措施提供依据。方法选取2012年佛山市高明区某企业283名铅作业工人的职业健康检查结果进行分析。结果283名铅作业工人平均血铅浓度为（388．30±197．49）μ/L,有130人的血铅超过400μg/L,超标率为45．94％;心电图异常检出率最高,达20．85％;血铅与血红蛋白间不存在显著的线性相关关系。结论企业应积极改进生产工艺,改善生产环境,加强防护措施,定期对工人进行体检。     

The relevance of arguments for excluding ALAD from the recommended biological limit values in occupational exposure to inorganic lead (WHO 1980)

Summary Data on 394 simultaneous measurements of blood lead (PbB) and biological indicators of effect are considered with regard to dose-effect and dose-response relationships, as well as the association between the biological indicators of effect themselves. The indicators are delta-aminolevulinic acid dehydratase (ALAD) and zinc-protoporphyrin (ZPP) in blood, delta-amino-levulinic acid (ALAU) and coproporphyrin (CPU) in 24-h urine specimens. The specimens were taken from periodically controlled male workers moderately to excessively exposed to inorganic lead. In addition, data are presented on the spontaneous recovery of biological indicators in 14 male workers examined immediately after, approximately 4.5 months and 10 months after cessation of lead exposure. Highly significant (P<0.001) correlations were found between all of the indicators examined, with the following order of agreement with regard to PbB: ALAD>ZPP>ALAU>CPU. Comparative advantages of ALAD in typical (variable) occupational exposure conditions were found to include: (a) the highest sensitivity at both low and relatively high lead exposure levels, (b) better reflection of biologically active lead as opposed to PbB (particularly compared to ALAU and CPU), (c) higher specificity compared to other indicators of lead effect, and (d) generally higher reliability with regard to both biologically and methodologically induced variations. The data obtained undoubtedly demonstrate that urinary indicators ALAU and CPU are not sensitive enough for the recommended health-based occupational exposure limit, as defined by relatively low PbB concentration (WHO 1980). Despite possible theoretical considerations resulting in recommendations for ZPP and ALAU but excluding ALAD (WHO 1980), practical implications seem to be far more in favour of ALAD, which permits a maximal safety margin in preventing adverse effects in the entire work population because of its sensitivity and absence of time-lag with regard to lead exposure.Presented at the 20th International Congress on Occupational Health, Cairo, 25 September –1 October, 1981     

Reentrainment of diurnal variation of psychological and physiological performance at the end of a slowly rotated shift system in hospital workers

Summary Eighteen normal male nurses were tested on a battery of simple psychomotor tasks, subjective self-ratings and physiological tests on three weekly occasions, during the 6th day of each shift (morning, afternoon, night) of their actual job rotation pattern.The shift order was assigned according to a fully balanced design and the tests were carried out between the 3rd and the 5th h from the beginning of work (approximately at 10 a.m., 6 p.m., and 2 a.m.). During the night shift, the subjects rated themselves as most tired and reported higher perceived exertion at different work loads performed on a bicycle ergometer. None of the psychological and physiological variables showed significant inter-shift differences except heart rate and blood pressure: both were lower in the night, the former only at rest and after a light effort, the latter only under hardest work loads. A very high correlation was found between perceived exertion and heart rate in all three shift conditions while a negative correlation between perceived exertion and extraversion emerged in the night occasion only. The present results are discussed and the hypothesis of an adaptation of performance, on most of the tests used, to this weekly rotating shift system is suggested.Paper presented at the 4th International Symposium on Night and Shift Work, Dortmund, 14–17 November 1977     

国家最大容许浓度内二硫化碳暴露对血压和心电图的影响

目的 探讨国家最大容许浓度(MAC)内二硫化碳(CS_2)暴露对血压、心电图的影响及其相互之间的关系.方法 根据工种的不同,将化纤厂职工按CS_2接触浓度分为高浓度接触组(821人)、低浓度接触组(259人),工作场所CS_2浓度控制在MAC范围内.随机抽取同期来医院健康体检人员250人作为对照组.测量臂部收缩压、舒张压,计算脉压、平均动脉压,与常规同步12导联静息心电图描记结果 、性别、年龄、工龄、工种、甘油三酯、胆固醇、血糖结果 汇总,分析接触CS_2后血压升高和心电图异常的危险因素,以及它们之间的关系.结果 高、低浓度接触组间及高浓度接触组与对照组间收缩压、舒张压、平均动脉压均数及异常发生率的差异均有统计学意义(P<0.01);高、低浓度接触组工人舒张压异常发生率均高于收缩压异常发生率近2倍.工种因素在高收缩压、高舒张压组中是最大的危险因素,高浓度接触的危险度是低浓度接触的2倍多,OR值分别为2.086、2.331.高、低浓度接触组与对照组间心电图异常发生率的差异有统计学意义(P<0.01);在低浓度接触组中筛出高收缩压,在高浓度接触组中筛出高舒张压2个OR值(3.531,1.638)较高的危险因素和值得探究的血糖(OR=0.747)保护因素,而低浓度接触的高收缩压组、高浓度接触的高舒张压组又分别筛出工龄、胆固醇等危险因素.与血压相关的心电图左心室高电压诊断在高浓度接触组中仪筛出高舒张压一个危险因素(OR=4.140),在低浓度接触组中仅筛出高收缩压一个危险因素(OR=4.776);在低浓度接触组中高脉压是复极异常的唯一危险因素(OR值达20.417);血糖在起源异常方面是危险因素,而在左心室高电压方面却是保护因素(OR=0.633).结论 CS_2对心血管的损害是一个循序渐进的过程,接触CS_2的早期、或接触浓度很低都会损伤人们的循环系统,在国家MAC内CS_2对心血管的毒性作用仍然随接触时间、接触浓度的增加而增加.CS_2对舒张压的作用大于对收缩压的作用,间接说明CS_2对外周阻力血管的作用可能大于对大动脉的作用.心电网结果 的异常不仅有血压异常后作用于心脏的结果 ,还有CS_2作用于心脏及外周血管的共同表现.     

Differences in national legislation for the implementation of lead regulations included in the European directive for the protection of the health and safety of workers with occupational exposure to chemical agents (98/24/EC)

Background The European Council Directive 98/24 on the protection of the health and safety of workers exposed to chemical agents sets out provisions for environmental and biological monitoring, making specific reference to binding limit values and health surveillance measures for those with exposure to lead Objectives To compare how the Directive has been implemented at a national level in EU countries and to determine whether workers receive equivalent protection. Methods Information on selected key issues was collected from 14 EU countries by means of a structured questionnaire. Results National occupational exposure limit values generally reflect that set by the Directive (0.15 mg/m³), but in five cases lower limits are set. National binding biological limit values range from 20 μg/100 ml blood in one country up to 80 μg/100 ml blood in others. The risk to the unborn child is generally recognised with specific measures for women of child-bearing potential or those that are pregnant or breast feeding. In only three countries are special arrangements included for young workers. Limits at which medical surveillance is put into effect are more consistent at 40 μg/100 ml in most countries. The Directive also refers to guidelines for health surveillance but none have been issued with respect to lead. Thus monitoring strategies and requirements for analytical performance vary considerably. Conclusions The results of this survey suggest that protection of workers against the risk of exposure to lead at work is far from uniform across the European Union. Such disparity may also have implications on the requirements set at national level for laboratories measuring lead in blood and/or air. In the interest of harmonisation within the EU, further consideration should be given to the Annex II of the EC Directive 98/24, taking into account the suggestions for lower binding limit values for lead; this should include full guidelines for medical surveillance and requirements for laboratories should be issued. A report from the Members of the Thematic Network: “European Organisers of External Quality Assessment/Proficiency Testing Schemes Related to Occupational and Environmental Laboratory Medicine” with contributions from P. Apostoli, University of Brescia, Italy; J. Macedo, LabMED Center, Porto, Portugal; M. Naray, National Center for Public Health, Budapest, Hungary; D. Adamonienė, Institute of Hygiene, Laboratory of Chemical Hazards Investigation, Lithuania and A. Prokopowicz, Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland.     

综合护理对改善初发2型糖尿病患者心理状态及遵医行为的效果探讨

目的 观察综合护理对改善初发2型糖尿病患者心理状态及遵医行为的效果.方法 选取2017年9月至2019年9月我院收治的94例初发2型糖尿病患者,随机分为对照组(n=47,常规护理)与观察组(n=47,综合护理).对比两组的护理效果.结果 护理后,观察组的空腹血糖、餐后2h血糖及糖化血红蛋白水平均低于对照组(P＜0.05...     

The distribution of blood concentrations of lead (Pb), cadmium (Cd), chromium (Cr) and manganese (Mn) in residents of the German Ruhr area and its potential association with occupational exposure in metal industry and/or other risk factors

Objective

This study investigated the metal distribution in blood samples from the general population and the risk of having high metal concentration for metal workers.