Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Int Arch Occup Environ Health. 2013 Oct;86(7):741-8. doi: 10.1007/s00420-012-0811-3. Epub 2012 Aug 23.
We present data from the Korean National Health and Nutrition Examination Survey 2008-2010 on the association between blood lead and hemoglobin levels in a representative sample of the adult South Korean population.
The analysis was restricted to participants ≥20 years of age who completed the health examination survey, including blood lead measurements (n = 5,951). Multivariate linear regression analyses were performed to estimate adjusted mean differences in hemoglobin level associated with doubling of whole blood and erythrocyte lead or quartiles of the metal after covariate adjustment. Odds ratios (ORs) for having borderline anemia or clinical anemia were calculated for log-transformed whole blood and erythrocyte lead or quartiles of the metal after covariate adjustment.
A twofold increase in whole blood lead or erythrocyte lead was associated with a 0.285 g/dL increase or 0.088 g/dL decrease in hemoglobin level, respectively. There was a 0.416 g/dL increase or 0.143 g/dL decrease in hemoglobin, respectively, in the highest, compared with the lowest tertile of whole blood lead and erythrocyte lead, respectively. Based on ORs, doubling of whole blood lead or erythrocyte lead resulted in a 36.3 % decrease or 36.2 % increase, respectively, in the risk of borderline anemia.
The association of whole blood lead versus erythrocyte lead with hemoglobin level was opposite. In the case of anemia, which is frequently caused by iron deficiency, the effect on the whole blood lead concentration may be very significant, leading to a considerable underestimation of the person's lead status. Therefore, hematocrit-adjusted blood lead level (i.e., erythrocyte lead) should be applied to the general population. To our knowledge, this is the first study to show that erythrocyte lead levels showed a significant inverse relationship with hemoglobin level at lead levels <10 μg/dL in the general Korean population. In conclusion, increased erythrocyte lead levels may be associated with mildly decreased hemoglobin levels, after adjusting for covariates, in a representative sample of the adult Korean population.
我们呈现了 2008-2010 年韩国国家健康和营养检查调查的数据，该调查在韩国成年人代表性样本中研究了全血铅和血红蛋白水平之间的关联。
分析仅限于完成健康检查调查的≥20 岁参与者，包括全血铅测量（n=5951）。进行多变量线性回归分析，以估计调整后的血红蛋白水平平均差异，这些差异与全血和红细胞铅的两倍或金属的四分位数相关，调整了协变量。在调整了协变量后，对全血和红细胞铅的对数或金属的四分位数进行了计算，以计算出边缘性贫血或临床贫血的比值比（OR）。
全血铅或红细胞铅增加一倍，血红蛋白水平分别增加 0.285g/dL 或减少 0.088g/dL。与全血铅和红细胞铅的最低三分位相比，最高三分位的血红蛋白水平分别增加 0.416g/dL 或减少 0.143g/dL。基于 OR，全血铅或红细胞铅翻倍导致边缘性贫血的风险分别降低 36.3%或增加 36.2%。
全血铅与红细胞铅与血红蛋白水平的关联相反。在贫血的情况下，这通常是由缺铁引起的，对全血铅浓度的影响可能非常显著，导致对人的铅状况的估计大大低估。因此，应该应用血细胞比容调整的血铅水平（即红细胞铅）来评估普通人群。据我们所知，这是第一项表明在普通韩国人群中，当铅水平<10μg/dL 时，红细胞铅水平与血红蛋白水平呈显著负相关的研究。总之，在调整了协变量后，在韩国成年人代表性样本中，红细胞铅水平升高可能与血红蛋白水平轻度下降有关。
