A comparison of different lead biomarkers in their associations with lead-related symptoms |
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Authors: | B -K Lee K -D Ahn S -S Lee G -S Lee Y -B Kim B S Schwartz |
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Institution: | (1) Institute of Industrial Medicine, Soonchunhyang University, 23-20 Bongmyung-Dong, Chonan, Choongnam 330-100, Republic of Korea, KR;(2) Department of Environmental Health Sciences, Division of Occupational and Environmental Health, Johns Hopkins University School of Hygiene and Public Health, Baltimore, USA, US |
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Abstract: | Objectives: To evaluate whether dimercaptosuccinic acid (DMSA) -chelatable lead, an estimate of current bioavailable lead stores, is
a better predictor of lead-related symptoms than are other commonly used lead biomarkers. Methods: A total of 95 male lead workers from three lead industries (one secondary lead smelting facility, one polyvinyl chloride-stabilizer
manufacturing plant, and one lead-acid storage battery factory), and 13 workers without occupational lead exposure recruited
from an occupational health institute, were studied. Blood lead, blood zinc protoporphyrin (ZPP), 4 h DMSA-chelatable lead
(after oral administration of 10 mg/kg DMSA), urine lead, and urinary δ-aminolevulinic acid levels were evaluated as predictors
of 15 lead-related symptoms, assessed by self-administered questionnaire, with linear and logistic regression controlling
for covariates. Total symptoms and symptoms in three categories (gastrointestinal, neuromuscular, and general) were evaluated.
Results: The mean (SD) 4 h DMSA-chelatable lead level was 288.7 (167.7) μg, with a range from 32.4 to 789 μg in the 95 lead workers.
The mean (SD) in the non-exposed subjects was 23.7 (11.5) μg with a range from 10.5 to 43.5 μg. Blood lead, blood ZPP, and
spot urine lead levels ranged from 21.4 to 78.4 μg/dl, 40 to 331 μg/l, and 7.5 to 153.0 μg/l, respectively, in the lead workers,
and from 4.0 to 7.2 μg/dl, 27 to 52 μg/l, and 2.9 to 15.5 μg/l in the non-exposed controls, respectively. The overall mean
symptom score (SD), derived as the sum of 0 or 1 point for absence or presence of 15 symptoms, of the lead workers was 3.7
(2.0), compared to 1.2 (1.5) for the non-exposed workers. DMSA-chelatable lead was the best predictor of symptom scores in
both crude and adjusted analyses, compared with the other biomarkers. Lead workers with DMSA-chelatable lead values greater
than the median (260.5 μg) were 6.2 times more likely to have frequent tingling or numbness of the arms or legs and 3.3 times
more likely to have muscle pain than subjects with lower chelatable lead values. Three symptoms (tingling or numbness of arm
or leg, muscle pain, and feeling irritation at the slightest disturbance) evidenced a dose-dependent relationship with DMSA-chelatable
lead levels. Conclusions: DMSA-chelatable lead was found to be the best predictor of lead-related symptoms, particularly of both total symptom scores
and neuromuscular symptoms, than were the other other lead biomarkers.
Received: 27 January 1999 / Accepted: 29 January 2000 |
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