二甲基甲酰胺对作业工人肾损害和心血管系统的影响

目的探讨二甲基甲酰胺（DMF）对作业工人肾损害和心血管系统的影响。方法选择2010年某合成革企业直接接触DMF工人139人作为接触组,根据DMF接触浓度和工龄把接触组分为高、中、低浓度接触组和工龄〈5年、工龄≥5年接触组。另选98名不接触DMF和其他有害因素的食品加工企业人员作为对照组,对2组进行肾功能、尿中β2-微球蛋白（β2-MG）、甲基甲酰胺（NMF）及心电图等检查,并对DMF作业环境进行职业卫生调查。结果共采集6个作业点DMF空气样品150份,浓度范围为2.6～282.6 mg/m3。其中超标作业点4个,超标率66.7%;有随接触DMF浓度增高肾功能指标（BUN）浓度增高的趋势,但各组别之间差异均无统计学意义（P〉0.05）;尿β2-MG检出值高浓度组高于其他各组,差异有统计学意义（P〈0.05）,中、低浓度组与对照组比较,差异无统计学意义（P〉0.05）;DMF接触者班末尿中NMF浓度与作业场所DMF暴露水平呈显著的相关性;DMF作业工人心电图异常以窦性过缓、过速、窦性心律不齐为主,且中、高浓度组、≥5 a工龄组与对照组差异有统计学意义（P〈0.05）;其次异常为ST-T段改变、不完全性右束支传导阻滞、左心室高电压,虽然这3种心电图异常率随接触DMF浓度和时间而增加,但各组别之间差异均无统计学意义（P〉0.05）。结论 DMF接触浓度与肾功能指标（BUN、Cr）值呈正相关;尿β2-MG可考虑作为急性DMF中毒检测指标之一;尿中NMF含量可作为DMF作业工人的生物监测指标;DMF作业工人心脏功能受到不同程度的影响。

Effect of Dimethylformamide Exposure on Kidney and Cardiovascular System of Workers

Objective]To study the effect of dimethylformamide（DMF） exposure on kidney and cardiovascular system of workers. Methods]A total of 139 workers with DMF exposure from a synthetic leather enterprise were selected as exposure group in 2010 which was divided into subgroups according to exposure concentration（high,medium and low concentration subgroups）and service length（5 years subgroup and ≥5 years subgroup）.Another 98 workers without DMF and other occupational hazards exposure from food processing enterprises were recruited as control group.The 2 groups were examined for renal function,urinary β2 microglobulin（β2-MG）,urinary dimethyl formamide（NMF） and electrocardiogram.Occupational health survey was performed in working environment with DMF exposure. Results]150 DMF air samples were collected in 6 operating points,with concentration of（2.6~282.6）mg/m3.Four points exceeded standard,accounting for 66.7%;Although exposure to DMF concentration was positively correlated with renal function,But there was no significant difference（P0.05） between groups;The detection of urinary β2-MG in high concentration group was significantly higher than that of other groups,（P0.05）,comparing medium and low concentration groups with control group,the differences were not significant（P0.05）;the NMF concentration in urine of shift end was significantly correlated with DMF exposure level in workplace;the main ECG abnormalities of DMF exposed workers were sinus bradycardia,sinus tachycardia,sinus arrhythmia,and the differences between medium concentration group,the high concentration group,service length ≥5 years subgroup and the control group were significant（P0.05）;the second abnormalities were ST-T segment changes,incomplete right bundle branch block,left ventricular high voltage.Although the three types of abnormal ECG rates increased with exposure to DMF level and time increase,but differences between groups were not significantly different（P0.05）. Conclusion]DMF exposure concentration and renal function（BUN,Cr） is positively correlated;Urine β2-MG can be considered as one of the indicators of acute DMF poisoning detection;NMF concentration in urine can be used as biological monitoring index of workers exposed to DMF;Cardiac function of workers are affected by exposure of DMF to varying degrees.