职业铅接触对男性工人腰椎骨折的影响

目的探讨职业铅接触对男性工人腰椎骨折的影响。方法以上海某蓄电池厂152名男性铅作业工人为研究人群。采用石墨炉原子吸收分光光度法测定血铅（aPb）、尿铅（UPb），应用单光子骨密度仪（SPA-4）测定工人骨蛮度，并做Z评分。拍摄腰椎侧位x线平片，并诊断有无腰椎骨折。结果铅作业工人血铅浓度0．85（0．33-1．90）μmol／L，尿铅浓度4．84（0．46-21．31）μg／g Cr，腰椎骨折发病率为19．7％。工人腰椎骨折发病率随年龄和工龄增长而升高，但差异无统计学意义（P〉0．05）。工人骨密度随血铅、尿铅水平升高而明显下降，差异有统计学意义（P〈0．05）。工人随着体内铅接触水平的升高，腰椎骨折发病率随之明显升高，差异有统计学意义（P〈05）并呈线性相关（r血铅=-0．977，P〈0．05；r尿铅=0．994，P〈0．01）。随着骨量减少，工人腰椎骨折发病率明显升高，差异有统计学意义（P〈0．01）并呈线性相关（r=-0．980，P〈0．01）。结论职业铅接触可能引起职业人群骨密度下降，腰椎骨折发病率增高，腰椎骨折的发生可能与骨量减少有关。

Effects of occupational lead exposure on lumbar vertebral fracture in male workers

OBJECTIVE: To investigate the effects of occupational lead exposure on lumbar vertebral fracture in exposed male workers. METHODS: One hundred and fifty-two lead-exposed male workers in a storage battery plant in Shanghai were selected as the study population. The blood lead (BPb) and the urinary lead (UPb) were measured by graphite-furnace atomic absorption spectrometry (GF-AAS). Bone mineral density (BMD) was measured by the monophoton absorptiometry(SPA-4) and Z score was determined. Anteroposterior and lateral lumbar spinal X-ray films were taken to determine lumbar vertebral fracture. RESULTS: For the occupationally lead-exposed workers, geometric mean of BPb was 0.85 (0.33 approximately 1.90) micromol/L, geometric mean of UPb was 4.84 (0.46 approximately 21.31) microg/g Cr, and the prevalence of lumbar vertebral fracture was 19.7%. The prevalence of lumbar vertebral fracture would increase with the increase of age and work year, but with no significantly statistical difference (P > 0.05). The bone mineral density (BMD) would decrease with the increase of BPb and UPb (P < 0.05). The prevalence of lumbar vertebral fracture would increase significantly with the increase of the lead exposure (P < 0.05) with the linear correlation (P < 0.05). The prevalence of lumbar vertebral fracture would increase significantly with the decrease of the bone mass (P < 0.01) with the linear correlation (P < 0.01). CONCLUSION: The occupational exposure to lead could cause the decrease of the bone mineral density and the increase of the prevalence of lumbar vertebral fracture. The development of lumbar vertebral fracture is associated with the decrease of bone mass.