职业接触汞工人肾脏早期损伤指标的探讨

目的　探讨职业接触汞工人肾损伤的早期监控指标。方法　尿汞 (HgU)采用二硫腙化学法测定 ,尿视黄醇结合蛋白 (RBP)、尿 β2 微球蛋白 (β2 MG)和尿微量白蛋白 (mALB)采用全定量酶免疫法测定 ,尿N 乙酰 β D 氨基葡萄糖苷酶 (NAG)和γ 谷氨酰基转移酶 (γ GT)采用速率法测定 ,尿肌酐(Cr)采用苦味酸法测定。结果　职业接触汞工人尿RBP、β2 MG、NAG、γ GT测定结果分别为 (4 39.7±2 0 1.4 )、(14 1.4± 5 6 .3) μg gCr,(12 .3± 5 .7)、(6 0 .3± 18.5 )U gCr,均高于对照组 [分别为 (2 4 3.2±16 9.1)、(88.6± 4 1.2 ) μg gCr,(8.2± 1.6 )、(4 1.3± 13.2 )U gCr],差异均有显著性 (P <0 .0 5 ,P <0 .0 1)。随尿汞含量增加上述指标有逐渐增高的趋势 ;单项及两项检测RBP、β2 MG、NAG、γ GT的阳性率较低 ,联合其中 3项检测阳性率较高 ,联合 4项检测阳性率可达 85 .5 %。结论　联合检测RBP、β2 MG、NAG、γ GT是诊断职业接触汞工人早期肾损伤的灵敏指标。

Monitoring indexes for early renal injury in the workers exposed to mercury

OBJECTIVE: To study the diagnostic method for early renal injury in the workers exposed to mercury (Hg). METHODS: The contents of urinary Hg were determined by chemical method. Urinary microalbumin (mALB), beta(2)-microglodulin (beta(2)-MG) and retinol binding protein (RBP) levels were measured with total quantitative enzyme immunoassay. The activities of urinary N-acetyl-beta-D-glucosaminidase (NAG) and gamma-glutamyl transferase (gamma-GT) were determined by rate methods. Urinary creatinine (Cr) was measured by using picric acid method. RESULTS: The levels of urinary BRP, beta(2)-MG, NAG and gamma-GT in exposed workers [(439.7 +/- 201.4), (141.4 +/- 56.3) micro g/g Cr and (12.3 +/- 5.7), (60.3 +/- 18.5) U/g Cr respectively] were significantly higher than those in controls (P < 0.05, P < 0.01). The levels were increased gradually with the increasing contents of urinary Hg. The positive detection rate for single or two combined indexes was rather lower whereas that for 4 combined indexes was as high as 85.5%. A positive correlation was noted between the contents of urinary Hg and urinary BRP, beta(2)-MG, NAG and gamma-GT (r: 0.466, 0.379, 0.323, 0.311, P < 0.05). Urinary RBP was correlated to urinary beta(2)-MG, NAG and gamma-GT (r: 0.362, 0.354, 0.332, P < 0.05). CONCLUSION: Combined detection of urinary RBP, beta(2)-MG, NAG and gamma-GT is a sensitive method for the diagnosis of early renal injury in the workers exposed to Hg.