Gibson S L, Mackenzie J C, Goldberg A
Br J Ind Med. 1968 Jan;25(1):40-51. doi: 10.1136/oem.25.1.40.
A series of 100 lead workers from different industries, 91 at work and nine admitted to hospital with lead poisoning, was studied in order to define more clearly the clinical and biochemical criteria of lead poisoning in three stages—(A) a presymptomatic state of lead exposure (37 men), (B) a state of mild symptoms or mild anaemia (45 men), and (C) frank lead poisoning with severe symptoms and signs (18 men). The tests used were haemoglobin, reticulocyte count, and blood lead, and urinary lead, coproporphyrin, δ-aminolaevulinic acid (ALA), and porphobilinogen (PBG) estimations. Of these, the urinary lead was similar for all three groups and the blood lead estimation was of less value for determining the clinical group of the men than the haemoglobin and urinary coproporphyrin or ALA estimations, which correlated well with the clinical assessment and with each other but showed no correlation with the urinary and blood lead levels. PBG levels became raised only with the onset of symptoms of lead poisoning. A haemoglobin of 13 g./100 ml. (90%) or less is a cautionary sign. Urinary coproporphyrin above 80 μg./100 mg. creatinine (800 μg./litre), ALA above 2·0 mg./100 mg. creatinine (2·0 mg.%), and PBG above 0·15 mg./100 mg. creatinine (0·15 mg.%) were almost always associated with symptoms or signs and were therefore considered to be the upper safety limits. Although the blood lead level does not differentiate between lead toxicity and lead exposure, values above 60 μg. lead/100 g. blood should alert the physician to carry out other tests. In addition to the above tests, blood pressure, blood urea, and serum uric acid estimations were performed on all the men in order to elucidate the possible role of lead in the production of renal damage. Blood pressure and serum uric acid levels were similar for all three groups but the blood urea level was raised in group C. The reason for this finding was not established. It was found that scrap metal burning, battery manufacturing, and ship-breaking constituted the gravest lead hazards encountered in this survey whereas wire manufacture constituted the least. Workers in the most modern factory, a car-body pressing plant, gave average values just below the danger levels for the urinary coproporphyrin and ALA estimations despite apparently efficient protective measures. This finding underlines the importance of the medical supervision of lead workers.
对来自不同行业的100名铅作业工人进行了研究，其中91人仍在工作，9人因铅中毒入院。目的是更明确地界定铅中毒三个阶段的临床和生化标准：(A)铅暴露的无症状状态（37名男性）；(B)轻度症状或轻度贫血状态（45名男性）；(C)有严重症状和体征的明显铅中毒状态（18名男性）。所采用的检测方法包括血红蛋白、网织红细胞计数、血铅、尿铅、粪卟啉、δ-氨基乙酰丙酸(ALA)以及尿胆原(PBG)测定。其中，三组的尿铅情况相似，而血铅测定对于确定这些男性的临床分组，其价值不如血红蛋白及尿粪卟啉或ALA测定，后两者与临床评估以及彼此之间相关性良好，但与尿铅和血铅水平无相关性。仅在铅中毒症状出现时尿胆原水平才会升高。血红蛋白低于13g/100ml(90%)是一个警示信号。尿粪卟啉高于80μg/100mg肌酐(800μg/L)、ALA高于2.0mg/100mg肌酐(2.0mg%)以及尿胆原高于0.15mg/100mg肌酐(0.15mg%)几乎总是与症状或体征相关，因此被视为上限安全值。尽管血铅水平无法区分铅毒性和铅暴露，但血铅值高于60μg铅/100g血应提醒医生进行其他检测。除上述检测外，还对所有男性进行了血压、血尿素和血清尿酸测定，以阐明铅在肾损伤发生过程中可能发挥的作用。三组的血压和血清尿酸水平相似，但C组血尿素水平升高。该发现的原因未明确。结果发现，废金属焚烧、电池制造和拆船是本次调查中最严重的铅危害源，而电线制造危害最小。尽管采取了明显有效的防护措施，但在最现代化工厂（一家汽车车身冲压厂）工作的工人，其尿粪卟啉和ALA测定的平均值略低于危险水平。这一发现突出了对铅作业工人进行医学监督的重要性。
