Mason H J, Davison A G, Wright A L, Guthrie C J, Fayers P M, Venables K M, Smith N J, Chettle D R, Franklin D M, Scott M C
Occupational Medicine Laboratory, Health and Safety Executive, London, UK.
Br J Ind Med. 1988 Dec;45(12):793-802. doi: 10.1136/oem.45.12.793.
Detailed biochemical investigations of renal function were made on 75 male workers exposed to cadmium and an equal number of referents matched for age, sex, and employment status. The exposed group consisted of current and retired workers who had been employed in the manufacture of copper-cadmium alloy at a single factory in the United Kingdom for periods of up to 39 years and for whom cumulative cadmium exposure indices could be calculated. In vivo measurements of liver and kidney cadmium burden were made on exposed and referent workers using a transportable neutron activation analysis facility. Significant increases in the urinary excretion of albumin, retinol binding protein, beta 2 microglobulin, N-acetylglucosaminidase (NAG), alkaline phosphatase, gamma-glutamyl transferase and significant decreases in the renal reabsorption of calcium, urate, and phosphate were found in the exposed group compared with the referent group. Measures of glomerular filtration rate (GFR) (creatinine clearance, serum creatinine, and beta 2 microglobulin) indicated a reduction in GFR in the exposed population. Many of these tubular and glomerular function indicators were significantly correlated with both cumulative exposure index and liver cadmium burden. Using cumulative exposure index and liver cadmium as estimates of dose, a two phase linear regression model was applied to identify an inflection point signifying a threshold level above which changes in renal function occur. Many biochemical variables fitted this model; urinary total protein, retinol binding protein, albumin, and beta 2 microglobulin gave similar inflection points at cumulative exposure levels of about 1100 y.micrograms/m3 whereas changes in the tubular reabsorption of urate and phosphate occurred at higher cumulative exposure indices. Measures of GFR, although fitting the threshold model did not give well defined inflection points. Fewer variables fitted the two phase model using liver cadmium; those that did gave threshold levels in the range 20.3-55.1 ppm. When cadmium workers with cumulative exposure indices of less than 1100 y.micrograms/m3 were compared with their respective referents only serum beta 2 microglobulin and urinary NAG were significantly increased in the exposed group and these differences were not related to the degree of cadmium exposure.(ABSTRACT TRUNCATED AT 400 WORDS)
对75名接触镉的男性工人以及同等数量在年龄、性别和就业状况上相匹配的对照人员进行了详细的肾功能生化研究。接触组由目前在职和已退休的工人组成，他们曾在英国一家工厂从事铜镉合金制造工作长达39年，并且能够计算其累积镉接触指数。利用可移动中子活化分析设备对接触组和对照组工人进行了肝脏和肾脏镉负荷的体内测量。与对照组相比，接触组中白蛋白、视黄醇结合蛋白、β2微球蛋白、N - 乙酰氨基葡萄糖苷酶（NAG）、碱性磷酸酶、γ - 谷氨酰转移酶的尿排泄量显著增加，而钙、尿酸盐和磷酸盐的肾脏重吸收显著减少。肾小球滤过率（GFR）的测量指标（肌酐清除率、血清肌酐和β2微球蛋白）表明接触人群的GFR有所降低。许多这些肾小管和肾小球功能指标与累积接触指数和肝脏镉负荷均显著相关。以累积接触指数和肝脏镉含量作为剂量估计值，应用两阶段线性回归模型来确定一个拐点，该拐点表示肾功能发生变化的阈值水平。许多生化变量符合该模型；尿总蛋白、视黄醇结合蛋白、白蛋白和β2微球蛋白在累积接触水平约为1100 y.μg/m³时给出了相似的拐点，而尿酸盐和磷酸盐的肾小管重吸收变化发生在更高的累积接触指数时。GFR的测量指标虽然符合阈值模型，但未给出明确的拐点。使用肝脏镉含量时，较少变量符合两阶段模型；符合的变量给出的阈值水平在20.3 - 55.1 ppm范围内。当将累积接触指数低于1100 y.μg/m³的镉作业工人与其各自的对照人员进行比较时，接触组中仅血清β2微球蛋白和尿NAG显著升高，且这些差异与镉接触程度无关。（摘要截选至400字）
