Greenberg A, Parkinson D K, Fetterolf D E, Puschett J B, Ellis K J, Wielopolski L, Vaswani A N, Cohn S H, Landrigan P J
Arch Environ Health. 1986 Mar-Apr;41(2):69-76. doi: 10.1080/00039896.1986.9937412.
To assess the pathophysiologic significance of increased body burdens of lead and cadmium, detailed renal function studies and evaluation of calcium, phosphorus, and vitamin D metabolism were carried out in 38 industrial workers exposed to lead and cadmium for 11 to 37 yr. Body burden of lead, as assessed by x-ray fluorescence measurement of tibia lead content, was elevated in 58% of the men and, when assessed by excretion of lead after Ca-EDTA infusion, was elevated in 36%. Liver or kidney cadmium burden, as assessed by neutron activation analysis, was elevated in 31%. Creatinine clearance was normal in all workers. One worker was hyperuricemic and two were proteinuric; three had increased beta 2 microglobulin excretion and one had diminished urinary acidifying ability. Maximal urinary concentrating ability was abnormal in a significant fraction, i.e., 52% of the men. Individuals with a high lead burden had a slight decrease in mean serum phosphorus but no accompanying phosphaturia. There was no abnormality of serum calcium. Twenty-two percent of subjects were hypercalciuric and two had low vitamin D levels, but these abnormalities bore no relation to heavy metal burden. In this carefully characterized group of men with chronic lead and calcium exposure, definite, if subclinical, effects on renal function and serum phosphorus but not calcium or vitamin D metabolism were demonstrable.
为评估铅和镉体内负荷增加的病理生理意义，对38名接触铅和镉11至37年的产业工人进行了详细的肾功能研究以及钙、磷和维生素D代谢评估。通过胫骨铅含量的X射线荧光测量评估，58%的男性铅体内负荷升高；通过Ca-EDTA输注后铅的排泄评估，36%的男性铅体内负荷升高。通过中子活化分析评估，31%的工人肝脏或肾脏镉负荷升高。所有工人的肌酐清除率均正常。一名工人血尿酸过高，两名工人蛋白尿；三名工人β2微球蛋白排泄增加，一名工人尿酸酸化能力下降。相当一部分男性，即52%，最大尿浓缩能力异常。铅负荷高的个体平均血清磷略有下降，但无伴随的磷尿症。血清钙无异常。22%的受试者高钙尿，两名受试者维生素D水平低，但这些异常与重金属负荷无关。在这组经过仔细特征描述的慢性铅和镉暴露男性中，对肾功能和血清磷有明确的（即使是亚临床的）影响，但对钙或维生素D代谢无影响。
