Mauriello Maria Chiara, Sbordone Carmine, Montuori Paolo, Alfano Rossella, Triassi Maria, Iavicoli Ivo, Manno Maurizio
Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Naples, Italy.
Department of Public Health, Section of Hygiene, University of Naples Federico II, Naples, Italy.
Toxicol Lett. 2017 Apr 15;272:8-28. doi: 10.1016/j.toxlet.2017.02.021. Epub 2017 Mar 1.
Exposure to chemicals released during urban waste disposal and treatment is increasingly regarded as a potential occupational health issue. Indeed, several toxic metals emitted by an incinerator, including As, Be, Cd, Cr, Pb, Mn, Hg, Ni and V, have potentially toxic properties and their exposure, therefore, may be of concern for the health of the workers involved. The levels of exposure should therefore be carefully measured. Environmental monitoring, however, may be unable, alone, to assess true exposure, due to its intrinsic limitations mainly concerning its inability to assess oral and dermal absorption. In these cases biological monitoring may represent a fundamental supplementary tool for the definition of the workers' true occupational exposure and for the prevention of the related health effects. There is, therefore, an increasing interest in developing and using, in these workers, sensitive and specific biomarkers for health risk assessment, particularly at low or even very low levels of exposure. Despite the large number of original and review articles present in the literature on the biomonitoring of workers exposed to metals, the data on subjects employed in waste treatment activities are scattered and results are sometimes inconsistent. This is the first systematic review, performed according to PRISMA methodology, of the major studies investigating the levels of different toxic metals measured in the main biological matrices (blood, urine, hair) of incinerator workers. The results show that the levels of metals measured in incinerators' workers are generally low, with some notable exceptions for Cd and Pb. These results, though, can be affected by several confounders related either to non-occupational exposure, including diet, area of residence and others, and/or by a number of methodological limitations, as we found in the reported studies. Future work should focus on an integrated approach, using ideally both biological and environmental monitoring. A particular emphasis should be given to the measurement of the different granulometric fractions of the dust containing metals, i.e. inhalable, thoracic, respirable and ultrafine fractions. Moreover, an accurate description of the work tasks and the characteristics and levels of non-occupational exposure should always be provided.
城市垃圾处理和处置过程中释放的化学物质暴露，越来越被视为一个潜在的职业健康问题。事实上，焚烧炉排放的几种有毒金属，包括砷、铍、镉、铬、铅、锰、汞、镍和钒，都具有潜在毒性，因此，它们的暴露可能会引起相关工作人员健康方面的担忧。所以，应该仔细测量暴露水平。然而，由于环境监测存在内在局限性，主要是无法评估经口和经皮吸收，所以仅靠环境监测可能无法评估真实暴露情况。在这些情况下，生物监测可能是确定工人真实职业暴露以及预防相关健康影响的重要补充工具。因此，人们越来越有兴趣在这些工人中开发和使用敏感且特异的生物标志物，用于健康风险评估，尤其是在低暴露甚至极低暴露水平时。尽管文献中有大量关于金属暴露工人生物监测的原创和综述文章，但关于从事废物处理活动人员的数据却很分散，结果有时也不一致。这是根据PRISMA方法对调查焚烧炉工人主要生物基质（血液、尿液、头发）中不同有毒金属水平的主要研究进行的首次系统综述。结果表明，焚烧炉工人中测量到的金属水平总体较低，但镉和铅有一些显著例外。不过，这些结果可能会受到一些混杂因素的影响，这些混杂因素要么与非职业暴露有关，包括饮食、居住地区等，要么与一些方法学局限性有关，正如我们在所报道的研究中发现的那样。未来的工作应侧重于采用综合方法，理想情况下同时使用生物监测和环境监测。应特别强调测量含金属粉尘的不同粒度级分，即可吸入、胸腔、可呼吸和超细级分。此外，应始终准确描述工作任务以及非职业暴露的特征和水平。
