Neuberger M, Rappe C, Bergek S, Cai H, Hansson M, Jäger R, Kundi M, Lim C K, Wingfors H, Smith A G
Institute of Environmental Hygiene, University of Vienna, Austria.
Environ Res. 1999 Oct;81(3):206-14. doi: 10.1006/enrs.1999.3983.
A total of 159 cases of chloracne reported in 1969-1975 in TCDD-contaminated production of the herbicide 2,4,5-T have been followed for mortality and morbidity up to 1996 when blood and urine tests were performed on 50 survivors of these exposed chemical workers and matched controls. In exposed, the most frequent cause of sick leave was chloracne which persisted in 32%. Neurological symptoms were reported frequently (44% sleep disturbance, 32% headache, 30% neuralgia). BSR, leucocytes, gamma-GT, SGOT, and SGPT were significantly higher in exposed than in controls. The effects of exposure (P= 0.002) and alcohol (P= 0.002) on gamma-GT were found to be independent of each other. Comparisons within the chloracne cohort showed significantly exposed TCDD per gram blood lipid in patients with a history of liver disease (mean 801 pg/g) than without (mean 407 pg/g). Other congeners were not found elevated but some higher chlorinated furans and PCBs were found reduced in patients with liver disease. In multiple regression analysis with the factors age, alcohol, and log TCDD, the effects of TCDD and its interaction with age were found significant, indicative of chronic liver damage after high TCDD exposure at a young age. The prevalence of neurological symptoms and signs of chronic liver disease were related to TCDD in blood and abnormal poryphyrins in urine. In 48% coproporphyrin I > III ratio was elevated, this group showing increased TCDD (mean 719 pg/g). These results contribute to the evidence that chloracne is not the only chronic disease which can be related to TCDD exposure, even 23 years after exposure and despite high intersubject variability of TCDD half-life and other exposures.
1969年至1975年期间，在受2,4,5-T除草剂污染、含有四氯二苯并二恶英（TCDD）的生产过程中报告了159例氯痤疮病例。对这些病例进行了随访，直至1996年，对其中50名幸存的接触化学物质工人及其匹配的对照组进行了血液和尿液检测。在接触组中，病假最常见的原因是氯痤疮，32%的患者氯痤疮持续存在。经常报告有神经症状（44%睡眠障碍、32%头痛、30%神经痛）。接触组的碱性磷酸酶（BSR）、白细胞、γ-谷氨酰转移酶（gamma-GT）、谷草转氨酶（SGOT）和谷丙转氨酶（SGPT）显著高于对照组。发现接触（P = 0.002）和酒精（P = 0.002）对γ-谷氨酰转移酶的影响相互独立。在氯痤疮队列中进行比较发现，有肝病病史的患者每克血脂中的TCDD暴露量（平均801皮克/克）显著高于无肝病病史的患者（平均407皮克/克）。未发现其他同系物升高，但在肝病患者中发现一些高氯代呋喃和多氯联苯减少。在对年龄、酒精和TCDD对数等因素进行的多元回归分析中，发现TCDD的影响及其与年龄的相互作用具有显著性，表明年轻时高剂量接触TCDD后会出现慢性肝损伤。神经症状的患病率和慢性肝病的体征与血液中的TCDD以及尿液中异常卟啉有关。48%的患者粪卟啉I/III比值升高，该组患者的TCDD增加（平均719皮克/克）。这些结果进一步证明，氯痤疮并非唯一可与TCDD接触相关的慢性病，即使在接触23年后，尽管TCDD半衰期和其他接触存在很大个体差异。
