Schulte P A
Screening & Notification Section, National Institute for Occupational Safety and Health, Cincinnati, OH 45226-1998.
Am J Ind Med. 1991;20(4):435-46. doi: 10.1002/ajim.4700200402.
Occupational diseases are now being assessed at the cellular and molecular levels; this presents new opportunities for prevention and control [Calleman et al., 1978; Ong et al., 1987; Stejskal et al., 1989; Welch and Cullen, 1988; Garry et al., 1989]. The key to these opportunities is the ability to detect biological markers that reflect exposure, response, and susceptibility. Biological markers are not new, however. Biological markers such as blood lead, urinary phenol levels in benzene exposure, and liver function assays have long been used in occupational and public health research and practice. What distinguishes the current generation of markers from previous markers is a greater degree of analytical sensitivity and the ability to describe events that occur earlier in the progression between exposure and clinical disease. There are now new domains of response that were not known to exist 20 years ago. Accompanying this sensitivity is the increased requirement to consider the numerous factors that can influence the appearance of biological markers. It has been observed that all workers with similar exposures do not develop disease or markers indicative of exposure or disease. Various acquired and hereditary host factors are responsible for this variation in responses. The role of assessing the nature and degree of variation between individuals is of paramount importance. Finally, the use of biological markers in occupational health research and practice also brings new ethical and legal considerations into high profile. This paper presents my personal opinions on how biological markers can contribute to occupational health efforts and the new requirements that they bring to the field. As with any technological change, the more we can anticipate the impact, the better our ability to adjust.
目前正在细胞和分子水平上评估职业病；这为预防和控制带来了新的机遇[卡勒曼等人，1978年；翁等人，1987年；斯特耶斯卡尔等人，1989年；韦尔奇和卡伦，1988年；加里等人，1989年]。这些机遇的关键在于能够检测反映接触、反应和易感性的生物标志物。然而，生物标志物并非新生事物。诸如血铅、苯接触时的尿酚水平以及肝功能检测等生物标志物长期以来一直用于职业和公共卫生研究及实践。当前这一代标志物与以往标志物的区别在于更高的分析灵敏度以及描述在接触与临床疾病进展过程中更早发生事件的能力。现在有一些20年前未知的新反应领域。伴随着这种灵敏度的提高，需要考虑众多可能影响生物标志物出现的因素。据观察，所有接触情况相似的工人并非都会患病或出现表明接触或患病的标志物。各种后天获得的和遗传的宿主因素导致了这种反应差异。评估个体间差异的性质和程度的作用至关重要。最后，生物标志物在职业健康研究和实践中的应用也使新的伦理和法律考量备受关注。本文就生物标志物如何有助于职业健康工作以及它们给该领域带来的新要求提出我个人的看法。与任何技术变革一样，我们对其影响的预测越多，我们进行调整的能力就越好。
