Ehrlich R, Robins T, Jordaan E, Miller S, Mbuli S, Selby P, Wynchank S, Cantrell A, De Broe M, D'Haese P, Todd A, Landrigan P
Department of Community Health, University of Cape Town, South Africa.
Occup Environ Med. 1998 Jul;55(7):453-60. doi: 10.1136/oem.55.7.453.
To test the association between inorganic lead (Pb) exposure, blood pressure, and renal function in South African battery factory workers, with both conventional and newer measures of renal function and integrity.
Renal function measures included serum creatinine, urea, and urate (n = 382). Urinary markers (n = 199) included urinary N-acetyl-beta-D-glucosaminidase (NAG), retinol binding protein, intestinal alkaline phosphatase, tissue non-specific alkaline phosphatase, Tamm-Horsfall glycoprotein, epidermal growth factor, and microalbuminuria.
Mean current blood Pb was 53.5 micrograms/dl (range 23 to 110), median zinc protoporphyrin 10.9 micrograms/g haemoglobin (range 1.9 to 104), and mean exposure duration 11.6 years (range 0.5 to 44.5). Mean historical blood Pb, available on 246 workers, was 57.3 micrograms/dl (range 14 to 96.3). After adjustment for age, weight and height, positive exposure response relations were found between current blood Pb, historical blood Pb, zinc protoporphyrin (ZPP), and serum creatinine and urate. Blood pressure was not associated with Pb exposure. Among the urinary markers, only NAG showed a positive association with current and historical blood Pb.
An exposure-response relation between Pb and renal dysfunction across the range from < 40 to > 70 micrograms/dl blood Pb was found in this workforce, with conventional measures of short and long term Pb exposure and of renal function. This could not be explained by an effect on blood pressure, which was not associated with Pb exposure. The findings probably reflect a higher cumulative renal burden of Pb absorption in this workforce in comparison with those in recent negative studies. The results also confirm the need for strategies to reduce Pb exposure among industrial workers in South Africa.
采用传统及更新的肾功能和完整性测量方法，检测南非电池厂工人无机铅（Pb）暴露、血压和肾功能之间的关联。
肾功能测量指标包括血清肌酐、尿素和尿酸（n = 382）。尿液标志物（n = 199）包括尿N - 乙酰 - β - D - 氨基葡萄糖苷酶（NAG）、视黄醇结合蛋白、肠碱性磷酸酶、组织非特异性碱性磷酸酶、Tamm - Horsfall糖蛋白、表皮生长因子和微量白蛋白尿。
当前血液铅平均水平为53.5微克/分升（范围23至110），锌原卟啉中位数为10.9微克/克血红蛋白（范围1.9至104），平均暴露时长为11.6年（范围0.5至44.5）。246名工人有可用的既往血液铅平均水平为57.3微克/分升（范围14至96.3）。在对年龄、体重和身高进行校正后，发现当前血液铅、既往血液铅、锌原卟啉（ZPP）与血清肌酐和尿酸之间存在正暴露反应关系。血压与铅暴露无关。在尿液标志物中，只有NAG与当前和既往血液铅呈正相关。
在该劳动力群体中，采用传统的短期和长期铅暴露及肾功能测量方法，发现血液铅水平在<40至>70微克/分升范围内，铅与肾功能障碍之间存在暴露反应关系。这无法用对血压的影响来解释，因为血压与铅暴露无关。这些发现可能反映出与近期阴性研究中的人群相比，该劳动力群体中铅吸收的累积肾负担更高。结果还证实了南非需要采取策略减少产业工人的铅暴露。
