發(fā)布時間：2018-04-03 06:54

  本文選題：鉻　切入點：職業(yè)接觸　出處：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:長期接觸低濃度鉻及其化合物可對肝、腎等器官造成損害。本課題通過對鉻接觸人群肝腎損傷指標(biāo)的研究及比較分析,以發(fā)現(xiàn)鉻接觸人群的早期健康損害,篩選敏感指標(biāo)。方法:1以某電鍍廠鉻接觸工人為接觸組,以同一地區(qū)無鉻接觸的某企業(yè)后勤人員為對照組。2編制統(tǒng)一的調(diào)查問卷表,收集調(diào)查對象的基本情況、職業(yè)史、疾病史、生活衛(wèi)生習(xí)慣等信息。3對調(diào)查對象使用前鼻鏡進(jìn)行常規(guī)耳鼻喉科檢查,對陽性體征記錄糜爛、潰瘍和穿孔的部位及大小。4以5l/min流量采集15min空氣樣品,采用火焰原子吸收光譜法測定工作場所空氣中鉻濃度。5晨起空腹采集靜脈血,樣品采集量4ml,采用全自動生化分析儀檢測肝、腎功能指標(biāo),8項肝功能指標(biāo)有:總蛋白(total protein,TP),白蛋白(albumin,ALB),球蛋白(globulin,GLOB),白球比(albumin/globulin,A/G),丙氨酸氨基轉(zhuǎn)移酶(alanine aminotransferase,ALT),總膽紅素(total blilirubin,TBIL),間接膽紅素(direct blilirubin,DBIL),直接膽紅素(indirect blilirubin,IBIL);5項腎功能指標(biāo)有:血尿酸(blood uric acid,BUA),血尿素氮(blood urea nitrogen,BUN),血清肌酐(serum creatinine,Scr),尿肌酐(urine creatinine,Ucr),尿β2-微球蛋白(urinary beta 2-microglobulin,Uβ2-MG);采集晨尿9ml,加入1ml純硝酸,采用石墨爐原子吸收光譜法檢測尿鉻濃度;采集1.5ml唾液,采用電感耦合等離子體質(zhì)譜法測定唾液鉻濃度。所有樣品采集前須征得本人同意。6數(shù)據(jù)采用Epidata3.1進(jìn)行雙錄入,數(shù)據(jù)核對和整理采用Excel2010,數(shù)據(jù)統(tǒng)計學(xué)分析采用SPSS21.0。結(jié)果:1本次共調(diào)查工人183人,剔除資料不全者,共納入174人,其中鉻接觸組88人,對照組86人,男性107人,女性67人,年齡范圍在21~63歲間,接觸組接鉻工齡在1個月~35年。2接鉻工齡1年組鼻粘膜糜爛檢出率高于對照組,差異有統(tǒng)計學(xué)意義(p0.05);接鉻工齡5~年組鼻中隔穿孔檢出率高于對照組,差異有統(tǒng)計學(xué)意義(p0.05)。3作業(yè)環(huán)境空氣鉻濃度范圍為0.013~0.016mg/m3,接觸組和對照組尿鉻濃度范圍分別為0.97~36.87μg/l和0.27~3.86μg/l,接觸組高于對照組(p0.05);接鉻工齡1年組尿鉻水平高于1~年組,(p0.05);接觸組和對照組唾液鉻濃度范圍分別在0.51~169.85μg/l和7.00~32.37μg/l間,接觸組高于對照組(p0.05);接鉻工齡1年組唾液鉻水平高于1~年組,(p0.05)。接觸組尿鉻濃度與唾液鉻濃度呈正相關(guān),相關(guān)系數(shù)為0.38(p0.01),對照組尿鉻濃度與唾液鉻濃度呈正相關(guān),相關(guān)系數(shù)為0.23(p=0.04)。4接觸組alb、a/g水平低于對照組(p0.05),接觸組glob水平高于對照組(p0.05),tp、alt、tbil、dbil、ibil在接觸組與對照組間差異無統(tǒng)計學(xué)意義(p0.05);接鉻工齡1年組alb水平低于對照組(p0.05),接鉻工齡1年組、1~年組和5~年組glob水平高于對照組(p0.05),接鉻工齡1年組、1~年組和5~年組a/g水平均低于對照組(p0.05),tp、alt、tbil、dbil、ibil在同工齡間差異無統(tǒng)計學(xué)意義(p0.05)。5接觸組尿鉻濃度與alt呈負(fù)相關(guān)(p0.05),其余指標(biāo)與尿鉻和唾液鉻相關(guān)均無統(tǒng)計學(xué)意義(p0.05)。6將接觸組尿鉻濃度分為5μg/l組和≥5μg/l組,尿鉻水平在5μg/l組和≥5μg/l組alb、a/g均低于對照組,差異有統(tǒng)計學(xué)意義(p0.05),glob均高于對照組(p0.05);將接觸組唾液鉻濃度分為30μg/l組和≥30μg/l組,唾液鉻水平在30μg/l組和≥30μg/l組alb、a/g均低于對照組(p0.05),glob均高于對照組(p0.05)。7在調(diào)整性別、年齡、吸煙和飲酒后,glob水平隨著尿鉻濃度升高而增加(p0.05),a/g隨著尿鉻濃度升高而降低(p0.05);按不同性別進(jìn)行分層,男性尿鉻濃度和唾液鉻濃度均與glob水平呈正相關(guān)(p0.05),男性尿鉻水平與a/g呈現(xiàn)負(fù)相關(guān)關(guān)系(p0.05),女性唾液鉻濃度與alt水平呈正相關(guān)(P0.05);按年齡分組進(jìn)行分層,35歲組尿鉻和唾液鉻濃度均與ALB呈負(fù)相關(guān)性(P0.05),35歲組尿鉻和唾液鉻濃度均與GLOB呈正相關(guān)性(P0.05),35歲組唾液鉻濃度與A/G呈負(fù)相關(guān)性(P0.05)。8接觸組Uβ2-MG水平高于對照組,(P0.05),接觸組和對照組BUA、BUN、Scr、Ucr差異無統(tǒng)計學(xué)意義(P0.05);工齡1年組和5~年組Uβ2-MG水平高于對照組(P0.05),工齡5~年組Uβ2-MG水平高于1~年組(P0.05)。9接觸組尿鉻濃度與BUA間相關(guān)具有統(tǒng)計學(xué)意義(P0.05);對照組尿鉻濃度與BUN間相關(guān)具有統(tǒng)計學(xué)意義(P0.05),唾液鉻濃度與BUN間相關(guān)具有統(tǒng)計學(xué)意義(P0.05)。10尿鉻濃度5μg/l和≥5μg/l組Uβ2-MG水平高于對照組(P0.05);唾液鉻濃度30μg/l和≥30μg/l組Uβ2-MG水平高于對照組(P0.05)。11按不同性別進(jìn)行分層,女性尿鉻濃度與BUN呈正相關(guān)(P0.05);按不同年齡進(jìn)行分層,35歲組尿鉻和唾液鉻濃度均與Uβ2-MG水平呈正相關(guān)(P0.05),≥35歲組尿鉻和唾液鉻濃度均與Ucr水平呈正相關(guān)(P0.05)。12接鉻工齡1年組,Uβ2-MG異常率與A/G相同,其余各組間Uβ2-MG異常率均高于ALB、GLOB、A/G和鼻損害患病率。結(jié)論:1職業(yè)鉻接觸工人唾液鉻水平高于對照組,且與尿鉻呈現(xiàn)正相關(guān)性,提示唾液鉻可作為鉻接觸工人的暴露指標(biāo)。2職業(yè)鉻接觸可對肝腎產(chǎn)生損害,ALB、GLOB、A/G和Uβ2-MG在低濃度短時間鉻接觸時即產(chǎn)生改變,但應(yīng)注意工人性別、年齡對指標(biāo)的影響。3職業(yè)鉻接觸早期A/G、Uβ2-MG異常率比鼻損害率更高,提示A/G、Uβ2-MG今后有可能用作為鉻職業(yè)接觸的早期效應(yīng)生物標(biāo)志物。
[Abstract]:Objective: long term exposure to low concentrations of chromium and its compounds on liver, kidney and other organ damage. Through the analysis and comparison study on chromium contact crowd liver and kidney damage index, to find early health damage contact population, screening of sensitive index. Methods: 1 in a chromium electroplating factory workers to contact contact group. The same area without logistic personnel of a business contact as control group.2 for the unified questionnaire, the basic situation, collect survey of occupation history, disease history, living habits and other information before using the.3 nose routine Department of ENT examination to investigate the target to record positive signs of erosion, ulcer and perforation of the location and the size of.4 to 5l/min 15min flow collecting air samples, the fasting venous blood.5 morning determination of chromium concentration in workplace air by flame atomic absorption spectrometry, sample volume 4ml, using automatic The detection of liver biochemical analyzer, renal function, liver function index: 8 total protein (total protein, TP), albumin (albumin, ALB), immunoglobulins (globulin, GLOB), than the white ball (albumin/globulin, A/G), alanine aminotransferase (alanine, aminotransferase, ALT, total bilirubin (total) blilirubin, TBIL), indirect bilirubin (direct blilirubin, DBIL), direct bilirubin (indirect blilirubin, IBIL); 5 renal function index: serum uric acid (blood uric, acid, BUA), blood urea nitrogen (blood urea, nitrogen, BUN), serum creatinine (serum creatinine, Scr), urine creatinine (urine creatinine, Ucr), urine beta 2- microglobulin (urinary beta 2-microglobulin U, beta 2-MG); collection of morning urine 9ml, adding 1ml pure nitric acid by Graphite Furnace Atomic Absorption Spectrometry Determination of urinary chromium concentration; 1.5ml collected saliva, saliva chromium concentration was determined by inductively coupled plasma mass spectrometry. All samples were collected Prior consent of.6 data using Epidata3.1 double input, data checking and sorting using Excel2010 data, using SPSS21.0. statistical analysis results: 1 of the total survey of 183 workers, excluding incomplete data, 174 people were included in the contact group 88, control group of 86 people, 107 men and women 67, in the age range of 21~63 years old, the contact group CR seniority in 1 months ~35 years.2 with CR 1 working years group of nasal mucosa erosion detection rate is higher than that of control group, the difference was statistically significant (P0.05); the CR group of 5~ years of service the perforation of nasal septum with high detection rate in the control group, the difference was statistically significant (P0.05).3 air Cr concentration range of 0.013~0.016mg/m3, the contact group and the control group of urine chromium concentration ranges of 0.97~36.87 g/l and 0.27~3.86 g/l, the contact group was higher than control group (P0.05); with CR 1 years seniority group urinary chromium level is higher than 1~ years group (P0.05);. 瑙︾粍鍜屽鐓х粍鍞炬恫閾祿搴﹁寖鍥村垎鍒湪0.51~169.85渭g/l鍜，

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