当前位置:主页 > 医学论文 > 预防医学论文 >

职业性低浓度铬接触肝肾损伤敏感指标的筛选

发布时间:2018-04-03 06:54

  本文选题: 切入点:职业接触 出处:《河北医科大学》2017年硕士论文


【摘要】:目的:长期接触低浓度铬及其化合物可对肝、肾等器官造成损害。本课题通过对铬接触人群肝肾损伤指标的研究及比较分析,以发现铬接触人群的早期健康损害,筛选敏感指标。方法:1以某电镀厂铬接触工人为接触组,以同一地区无铬接触的某企业后勤人员为对照组。2编制统一的调查问卷表,收集调查对象的基本情况、职业史、疾病史、生活卫生习惯等信息。3对调查对象使用前鼻镜进行常规耳鼻喉科检查,对阳性体征记录糜烂、溃疡和穿孔的部位及大小。4以5l/min流量采集15min空气样品,采用火焰原子吸收光谱法测定工作场所空气中铬浓度。5晨起空腹采集静脉血,样品采集量4ml,采用全自动生化分析仪检测肝、肾功能指标,8项肝功能指标有:总蛋白(total protein,TP),白蛋白(albumin,ALB),球蛋白(globulin,GLOB),白球比(albumin/globulin,A/G),丙氨酸氨基转移酶(alanine aminotransferase,ALT),总胆红素(total blilirubin,TBIL),间接胆红素(direct blilirubin,DBIL),直接胆红素(indirect blilirubin,IBIL);5项肾功能指标有:血尿酸(blood uric acid,BUA),血尿素氮(blood urea nitrogen,BUN),血清肌酐(serum creatinine,Scr),尿肌酐(urine creatinine,Ucr),尿β2-微球蛋白(urinary beta 2-microglobulin,Uβ2-MG);采集晨尿9ml,加入1ml纯硝酸,采用石墨炉原子吸收光谱法检测尿铬浓度;采集1.5ml唾液,采用电感耦合等离子体质谱法测定唾液铬浓度。所有样品采集前须征得本人同意。6数据采用Epidata3.1进行双录入,数据核对和整理采用Excel2010,数据统计学分析采用SPSS21.0。结果:1本次共调查工人183人,剔除资料不全者,共纳入174人,其中铬接触组88人,对照组86人,男性107人,女性67人,年龄范围在21~63岁间,接触组接铬工龄在1个月~35年。2接铬工龄1年组鼻粘膜糜烂检出率高于对照组,差异有统计学意义(p0.05);接铬工龄5~年组鼻中隔穿孔检出率高于对照组,差异有统计学意义(p0.05)。3作业环境空气铬浓度范围为0.013~0.016mg/m3,接触组和对照组尿铬浓度范围分别为0.97~36.87μg/l和0.27~3.86μg/l,接触组高于对照组(p0.05);接铬工龄1年组尿铬水平高于1~年组,(p0.05);接触组和对照组唾液铬浓度范围分别在0.51~169.85μg/l和7.00~32.37μg/l间,接触组高于对照组(p0.05);接铬工龄1年组唾液铬水平高于1~年组,(p0.05)。接触组尿铬浓度与唾液铬浓度呈正相关,相关系数为0.38(p0.01),对照组尿铬浓度与唾液铬浓度呈正相关,相关系数为0.23(p=0.04)。4接触组alb、a/g水平低于对照组(p0.05),接触组glob水平高于对照组(p0.05),tp、alt、tbil、dbil、ibil在接触组与对照组间差异无统计学意义(p0.05);接铬工龄1年组alb水平低于对照组(p0.05),接铬工龄1年组、1~年组和5~年组glob水平高于对照组(p0.05),接铬工龄1年组、1~年组和5~年组a/g水平均低于对照组(p0.05),tp、alt、tbil、dbil、ibil在同工龄间差异无统计学意义(p0.05)。5接触组尿铬浓度与alt呈负相关(p0.05),其余指标与尿铬和唾液铬相关均无统计学意义(p0.05)。6将接触组尿铬浓度分为5μg/l组和≥5μg/l组,尿铬水平在5μg/l组和≥5μg/l组alb、a/g均低于对照组,差异有统计学意义(p0.05),glob均高于对照组(p0.05);将接触组唾液铬浓度分为30μg/l组和≥30μg/l组,唾液铬水平在30μg/l组和≥30μg/l组alb、a/g均低于对照组(p0.05),glob均高于对照组(p0.05)。7在调整性别、年龄、吸烟和饮酒后,glob水平随着尿铬浓度升高而增加(p0.05),a/g随着尿铬浓度升高而降低(p0.05);按不同性别进行分层,男性尿铬浓度和唾液铬浓度均与glob水平呈正相关(p0.05),男性尿铬水平与a/g呈现负相关关系(p0.05),女性唾液铬浓度与alt水平呈正相关(P0.05);按年龄分组进行分层,35岁组尿铬和唾液铬浓度均与ALB呈负相关性(P0.05),35岁组尿铬和唾液铬浓度均与GLOB呈正相关性(P0.05),35岁组唾液铬浓度与A/G呈负相关性(P0.05)。8接触组Uβ2-MG水平高于对照组,(P0.05),接触组和对照组BUA、BUN、Scr、Ucr差异无统计学意义(P0.05);工龄1年组和5~年组Uβ2-MG水平高于对照组(P0.05),工龄5~年组Uβ2-MG水平高于1~年组(P0.05)。9接触组尿铬浓度与BUA间相关具有统计学意义(P0.05);对照组尿铬浓度与BUN间相关具有统计学意义(P0.05),唾液铬浓度与BUN间相关具有统计学意义(P0.05)。10尿铬浓度5μg/l和≥5μg/l组Uβ2-MG水平高于对照组(P0.05);唾液铬浓度30μg/l和≥30μg/l组Uβ2-MG水平高于对照组(P0.05)。11按不同性别进行分层,女性尿铬浓度与BUN呈正相关(P0.05);按不同年龄进行分层,35岁组尿铬和唾液铬浓度均与Uβ2-MG水平呈正相关(P0.05),≥35岁组尿铬和唾液铬浓度均与Ucr水平呈正相关(P0.05)。12接铬工龄1年组,Uβ2-MG异常率与A/G相同,其余各组间Uβ2-MG异常率均高于ALB、GLOB、A/G和鼻损害患病率。结论:1职业铬接触工人唾液铬水平高于对照组,且与尿铬呈现正相关性,提示唾液铬可作为铬接触工人的暴露指标。2职业铬接触可对肝肾产生损害,ALB、GLOB、A/G和Uβ2-MG在低浓度短时间铬接触时即产生改变,但应注意工人性别、年龄对指标的影响。3职业铬接触早期A/G、Uβ2-MG异常率比鼻损害率更高,提示A/G、Uβ2-MG今后有可能用作为铬职业接触的早期效应生物标志物。
[Abstract]:Objective: long term exposure to low concentrations of chromium and its compounds on liver, kidney and other organ damage. Through the analysis and comparison study on chromium contact crowd liver and kidney damage index, to find early health damage contact population, screening of sensitive index. Methods: 1 in a chromium electroplating factory workers to contact contact group. The same area without logistic personnel of a business contact as control group.2 for the unified questionnaire, the basic situation, collect survey of occupation history, disease history, living habits and other information before using the.3 nose routine Department of ENT examination to investigate the target to record positive signs of erosion, ulcer and perforation of the location and the size of.4 to 5l/min 15min flow collecting air samples, the fasting venous blood.5 morning determination of chromium concentration in workplace air by flame atomic absorption spectrometry, sample volume 4ml, using automatic The detection of liver biochemical analyzer, renal function, liver function index: 8 total protein (total protein, TP), albumin (albumin, ALB), immunoglobulins (globulin, GLOB), than the white ball (albumin/globulin, A/G), alanine aminotransferase (alanine, aminotransferase, ALT, total bilirubin (total) blilirubin, TBIL), indirect bilirubin (direct blilirubin, DBIL), direct bilirubin (indirect blilirubin, IBIL); 5 renal function index: serum uric acid (blood uric, acid, BUA), blood urea nitrogen (blood urea, nitrogen, BUN), serum creatinine (serum creatinine, Scr), urine creatinine (urine creatinine, Ucr), urine beta 2- microglobulin (urinary beta 2-microglobulin U, beta 2-MG); collection of morning urine 9ml, adding 1ml pure nitric acid by Graphite Furnace Atomic Absorption Spectrometry Determination of urinary chromium concentration; 1.5ml collected saliva, saliva chromium concentration was determined by inductively coupled plasma mass spectrometry. All samples were collected Prior consent of.6 data using Epidata3.1 double input, data checking and sorting using Excel2010 data, using SPSS21.0. statistical analysis results: 1 of the total survey of 183 workers, excluding incomplete data, 174 people were included in the contact group 88, control group of 86 people, 107 men and women 67, in the age range of 21~63 years old, the contact group CR seniority in 1 months ~35 years.2 with CR 1 working years group of nasal mucosa erosion detection rate is higher than that of control group, the difference was statistically significant (P0.05); the CR group of 5~ years of service the perforation of nasal septum with high detection rate in the control group, the difference was statistically significant (P0.05).3 air Cr concentration range of 0.013~0.016mg/m3, the contact group and the control group of urine chromium concentration ranges of 0.97~36.87 g/l and 0.27~3.86 g/l, the contact group was higher than control group (P0.05); with CR 1 years seniority group urinary chromium level is higher than 1~ years group (P0.05);. 瑙︾粍鍜屽鐓х粍鍞炬恫閾祿搴﹁寖鍥村垎鍒湪0.51~169.85渭g/l鍜,

本文编号:1704095

资料下载
论文发表

本文链接:https://www.wllwen.com/yixuelunwen/yufangyixuelunwen/1704095.html


Copyright(c)文论论文网All Rights Reserved | 网站地图 |

版权申明:资料由用户6957e***提供,本站仅收录摘要或目录,作者需要删除请E-mail邮箱bigeng88@qq.com