氯乙烯对作业工人健康的影响

氯乙烯对作业工人健康的影响上海医科大学附属华山医院职业病科（２０００４０）黄开莲，丁钺，高晶，朱国培，郭华氯乙烯为合成聚氯乙烯单体，是制造聚氯乙烯的原料，广泛应用于工农业生产和日常生活中。业已证实氯乙烯经呼吸道、皮肤进入人体，主要引起神经衰弱症候群、...     

氯乙烯作业工人健康状况调查

目的进一步探索氯乙烯的职业危害。方法对350名氯乙烯作业工人(接触组)和140名不接触氯乙烯(对照组)的体检结果进行统计分析。结果接触组工人头痛、头晕、乏力、失眠、睡眠障碍、记忆力减退等体征出现率与对照组比较,差异有显著性(P<0·05);接触组工人的脂肪肝、丙氨酸转氨酶活力升高等检出率与对照组比较,差异有显著性(P<0·05);同时,接触组也出现了胆结石,脾肿大、脾萎缩、胆囊炎、肝内小囊肿、胆囊息肉、肝内回声粗、白细胞减少等症状,但与对照组比较,差异无显著性(P>0·05)。结论长期接触氯乙烯工人健康状况受到影响.     

氯乙烯作业工人恶性肿瘤死亡调查

对250名氯乙烯作业工人恶性肿瘤死亡情况的回顾性队列研究结果表明,氯乙烯接触组4例癌亡者均为男性,其中3例足维修工,死亡病例工龄均在5—9年,30—44岁年龄组的标化比例死亡比最高为555。可能与维修工在检修设备时接触较高浓度的氯乙烯有关。     

氯乙烯对作业工人健康影响的调查

<正> 长期接触氯乙烯可对人体健康有不同程度的影响,并有致癌性,为摸清其职业危害,笔者对某厂氯乙烯作业环境进行了现场调查,并对其作业工人做了健康检查,现将结果报告如下。1 调查对象和方法1.1 对象 选择氯乙烯聚合车间作业工人284人(男96人,女188人),平均年龄37岁(20～45岁),平均工龄13.50年(1～24年),选择婚姻状况、文化程度、吸烟、饮酒等基本情     

氯乙烯作业工人神经系统变化的探讨

氯乙烯作业工人神经系统变化的探讨金玉珂，张玉兰，张福生，张英廷，孟月，周耀虹本文通过时接触氯乙烯作业工人神经系统临床体征、神经肌电图检查结果的报道，对慢性氯乙烯中毒的诊断指标进行初步探讨。１材料和方法１．１对象选自某化工厂接触氯乙烯作业工人４８～５９...     

氯乙烯对作业工人脂质过氧化的影响

氯乙烯对作业工人脂质过氧化的影响任恒岩，王作尚，范志涛，侯光萍，任永清，王化，杜祖源氯乙烯（ＶＣＭ）可引起神衰综合征、肝脏损害、指端溶骨症等；也已明确证实有致癌、致畸、致突变的作用。其作用机理至今尚不清楚。动物实验证明ＶＣＭ可引起自由基（ＦＲ）代谢障...     

氯乙烯作业工人恶性肿瘤发病情况的研究

本文对某聚氯乙烯树脂厂氯乙烯接触者４０５名工人（男３１９名，女８６名）和不接触任何毒物的某建筑部门４１１名工人（男３４２名，女６９名）对照组，进行了恶性肿瘤发病情况的对比研究。结果表明，作业环境空气中氯乙烯浓度为０．５～５６９６．６ｍｇ／ｍ３，男性接触氯乙烯者恶性肿瘤和肝癌死亡率分别为１５４．３１／１０万和６８．５６／１０万，略高于对照组，未见显著性差异；全肿瘤、肝癌死亡年龄比对照组显著提前；接触组发现１例肝血管肉瘤。     

Screening for liver disease in vinyl chloride workers.

Following the occurrence of hepatic fibrosis and angiosarcoma in polyvinyl chloride autoclave workers, a screening programme was set up for workers at risk in a large production plant. There was no significant difference in liver function tests between workers and a control group of men in the same factory, not exposed to vinyl chloride. Four exposed workers out of 422 were found to have enlarged spleens compared with none out of 202 controls. Liver biopsies from selected cases showed no significant pathological changes, although there was minimal increase in portal tract and sinusoidal fibrosis in exposed workers.     

氯乙烯致肝损伤与毒物代谢酶基因多态性的关系

目的 探讨毒物代谢酶基因多态性与接触氯乙烯致肝损伤的关系。方法 以肝B－超检查异常或丙氨酸转氨酶（ALT）＞40作为肝损伤指标,应用聚合酶链反应（PCR）检测谷胱甘肽转移酶（GSTT1,GSTM1）基因型;应用PCR和限制性酶切片段长度多态分析技术（RFLP）检测细胞色素P4502E1酶基因型（CYP2E1）,然后对实验结果进行统计分析。结果 尽管GSTT1基因型分布在肝损伤组与对照组比较,差异均无显著性（P＞0．05）。当将低、中接触组合并后,阳性型肝损组与对照组比较,差异有显著性（OR为0．35,95％CI为0．12－0．97,P＜0．05）;在高接触损伤组,CYP2E1组比较,差异有显著性（OR为0．35,95％CI为0．12－0．97,P＜0．05）;在高接触损伤组,CYP2E1clc2/c2c2基因型有更高的频率,与对照组比较,差异有显著性（OR为4．55,95％CI为1．37－15．08,P＜0．05）,多元Logistic回归分析显示,CYP2E1基因型、氯乙烯接触与CYP2E1基因型,CYP2E1与GSTT1基因型,GSTT1与GSTM1基因型间的联合作用与肝脏损伤有关联,经χ^2检验,P＜0．05。结论 高剂量接触氯乙烯时,CYP2E1、clc2/c2c2基因型在氯乙烯致肝损伤方面可能是主要感性原因之一,而GSTT1在氯乙烯代谢中可起到解毒作用,尤其在低剂量接触时有保护作用。本研究结果初步表明,毒物代谢酶基因间联合作用与累积接触剂量,最终决定毒物是否产生危害。氯乙烯接触所致肝脏损伤,是由接触剂量以及个体的遗传特性所共同决定的。     

氯乙烯作业工人肝脏功能损伤的影响因素研究

目的 探讨氯乙烯作业工人肝脏功能损伤的影响因素.方法 以肝B超检查异常或丙氨酸转氨酶(ALT)≥40U作为肝损伤指标,结合历年体检资料,对遗传因素(氯乙烯代谢酶基因多态性)、生活习惯(吸烟、饮酒)、氯乙烯作业等影响因素进行统计学处理分析.结果 多元Logistic分析和秩和检验显示细胞色素P450 2E1(CYP2E1)基因型、饮酒与氯乙烯作业工人肝功能损伤有关.Spearman等级相关分析显示,日均氯乙烯吸入量与肝功能ALT值成正相关.结论 氯乙烯工人肝功能损伤情况受遗传、生活习惯、氯乙烯作业综合影响,对氯乙烯工人的健康监护应全面考虑.     

Polymorphisms for vinyl chloride metabolism in French vinyl chloride workers

Genetic polymorphisms of aldehyde dehydrogenase 2 (ALDH2) and cytochrome P450 2E1 (CYP2E1) have been shown to influence the degree of genetic damage in Taiwanese workers exposed to the carcinogen - vinyl chloride(VC). Certain French VC workers have been found to express biomarkers of mutant forms of cancer-related proteins (ras-p21 and p53) that have been related to their exposure. ALDH2 and CYP2E1 polymorphisms were investigated in 211 of these workers in an attempt to correlate differences in VC metabolic capacity with differences in the presence of these biomarkers. All of the workers were found to have the normal, wild-type ALDH2 gene, and none of them were found to be homozygous for the variant CYP2E1 allele. Sixteen workers were found to be heterozygous for the variant CYP2E1 allele. After adjusting for age, smoking, drinking and cumulative VC exposure, the odds ratio for the presence of either the mutant ras-p21 or the mutant p53 biomarker in these heterozygous workers was found to be statistically significantly increased in comparison to their homozygous, wild-type counterparts (OR = 5.05; 95% CI = 1.10-23.25). However, as opposed to the case in Taiwanese workers, these polymorphisms are relatively uncommon, and thus differences in ALDH2 and CYP2E1 can account for only a small proportion of the variability in mutagenic response to VC exposure in a Caucasian population.     

Periportal fibrosis and other liver ultrasonography findings in vinyl chloride workers

Aims: To investigate the presence of liver lesions and their relation with vinyl chloride monomer (VCM) exposure or other personal risk factors, in workers involved in the production of VCM and polyvinyl chloride (PVC).

Methods: A liver ultrasonography examination was conducted in 757 workers, some of whom had long standing service in the production of VCM and PVC. The study involved: assessment of individual past and present VCM exposure of each worker; collection of past personal health history, lifestyle and personal data; routine liver function tests; and liver ultrasonography.

Results: No cases of liver malignancies were detected. Angiomas and liver cysts were found with a frequency of occurrence within the expected range of the general population. The main findings consisted of hepatomegaly (34.7%), steatosis (31.8%), and periportal fibrosis (16.0%). A logistic regression analysis indicated that hepatomegaly and steatosis were associated with obesity and lipid metabolism disturbances and not with VCM exposure. Periportal fibrosis, in addition to constitutional or dietary factors, was shown to be associated with VCM exposure, but only when maximum exposure in the subject's history had been at least 200 ppm as a yearly average; no effects were observed at 50 ppm or below.

Conclusions: Workers exposed to 200 ppm VCM for at least one year have a fourfold increased risk of developing periportal liver fibrosis. Liver ultrasonography is a suitable and important diagnostic test for the medical surveillance of vinyl chloride workers.

     

Monitoring liver disorders in vinyl chloride monomer workers using greyscale ultrasonography.

Recognition that vinyl chloride could be hepatotoxic led to a survey of workers to determine whether changes had been induced by past exposure, and to evaluate standard liver function tests as monitors of early liver abnormalities. Standard liver function tests were found to be unsuitable for the detection of such abnormalities in the population at risk. Of 487 workers examined, 102 (20-9%) had abnormalities on initial testing but only two were finally shown to have portal hypertension; in both cases, thrombocytopaenia provided the first diagnostic evidence since liver function tests were normal. Furthermore, 40 (35-7%) of 112 control subjects had initial test abnormalities. A sample of 19 workers with various exposures to vinyl chloride monomer were examined blind by greyscale ultrasonography. Five with minimal or no exposure were confirmed as normal but 12 of the remainder had abnormalities. These consisted of an enlarged portal vein (seven instances), splenomegaly (eight), and changes in hepatic texture (seven). Five of these 12 cases had previously been considered normal. It was concluded that greyscale ultrasonography had many advantages over standard methods for screening workers exposed to hepatotoxic chemicals, and should be the subject of a large scale evaluation.     

单纯性肥胖儿童脂肪肝影响因素分析

目的探讨单纯性肥胖儿童脂肪肝的影响因素,为预防和治疗儿童脂肪肝提供参考依据。方法采用多级整群分层抽样,对江苏省徐州市10所学校中121名8～13岁单纯性肥胖儿童进行问卷调查、体格检查、B超检查及血脂检测。结果单纯性肥胖儿童脂肪肝的检出率为71.9%;脂肪肝组体质指数(BMI)、低密度脂蛋白(LDL)、甘油三酯(TG)分别为29.36,3.30,2.45mmol/L,明显高于非脂肪肝组,差异有统计学意义(P0.01);多因素非条件Logistic逐步回归结果显示,腰围、每次食用煎炸食品量多、体质指数、不吃早餐和LDL、TG为单纯性肥胖儿童脂肪肝危险因素;不吃零食、喜欢运动为保护因素。结论单纯性肥胖儿童脂肪肝与肥胖程度和血脂密切相关。