Tompa Anna, Jakab Mátyás, Biró Anna, Magyar Balázs, Fodor Zoltán, Klupp Tibor, Major Jenö
Department of Public Health, Semmelweis University, P.O. Box 370, 1445 Budapest, Hungary.
Ann N Y Acad Sci. 2006 Sep;1076:635-48. doi: 10.1196/annals.1371.054.
In the present study genotoxicological and immunotoxicological follow-up investigations were made on 811 donors including 94 unexposed controls and 717 nurses with various working conditions from different hospitals (The Hungarian Nurse Study). The nurses were exposed to different chemicals: cytostatic drugs, anesthetic, and sterilizing gases, such as ethylene oxide (ETO) and formaldehyde. The measured biomarkers were: clinical laboratory routine tests, completed with genotoxicological (chromosome aberrations [CA], sister chromatid exchange [SCE]), and immune-toxicological monitoring (ratio of lymphocyte subpopulations, lymphocyte activation markers, and leukocyte oxidative burst). The highest rate of genotoxicologically affected donors (25.4%) was found in the group of cytostatic drug-exposed nurses. Comparing geno- and immunotoxicological effect markers, we found that among genotoxicologically affected donors the frequency of helper T cell (Th) lymphocytes, the ratio of activated T and B cells increased, whereas the oxidative burst of leukocytes decreased. In hospitals with lack of protective measures increased CA yields were observed compared to those with ISO 9001 quality control or equivalent measures. Anemia, serum glucose level, thyroid dysfunctions, benign, and malignant tumors were more frequent in the exposed groups than in controls. The hygienic standard of the working environment is the basic risk factor for the vulnerability of nurses. On the basis of these results, it is suggested, that the used cytogenetic and immunological biomarkers are appropriate to detect early susceptibility to diseases. The Hungarian Nurse Study proved that the use of safety measures could protect against occupational exposure at work sites handling cytostatic drugs, anesthetic, and sterilizing gases.
在本研究中，对811名捐赠者进行了遗传毒理学和免疫毒理学随访调查，其中包括94名未接触者对照和717名来自不同医院、具有不同工作条件的护士（匈牙利护士研究）。这些护士接触了不同的化学物质：细胞毒性药物、麻醉剂和消毒气体，如环氧乙烷（ETO）和甲醛。所测量的生物标志物包括：临床实验室常规检测，并辅以遗传毒理学（染色体畸变[CA]、姐妹染色单体交换[SCE]）和免疫毒理学监测（淋巴细胞亚群比例、淋巴细胞活化标志物和白细胞氧化爆发）。在接触细胞毒性药物的护士组中发现遗传毒理学受影响捐赠者的比例最高（25.4%）。比较遗传和免疫毒理学效应标志物时，我们发现，在遗传毒理学受影响的捐赠者中，辅助性T细胞（Th）淋巴细胞的频率、活化T细胞和B细胞的比例增加，而白细胞的氧化爆发减少。与采用ISO 9001质量管理或同等措施的医院相比，在缺乏防护措施的医院中观察到CA发生率更高。与对照组相比，暴露组中贫血、血糖水平、甲状腺功能障碍、良性和恶性肿瘤更为常见。工作环境的卫生标准是护士易受伤害的基本风险因素。基于这些结果，建议所使用的细胞遗传学和免疫学标志物适合于检测疾病的早期易感性。匈牙利护士研究证明，采取安全措施可以预防在处理细胞毒性药物、麻醉剂和消毒气体的工作场所的职业暴露。
