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KMID : 0606019950010010041
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Soonchunhyang Journal of Industrial Medicine
1995 Volume.1 No. 1 p.41 ~ p.64
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The Alteration of Urinary Total protein and NAG in High Risk Lead Workers
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Abstract
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To clarify the effect of occupational lead exposure on renal function 265 lead workers working in 5 lead acid battery industries and 2 secondary smelting industries were studied in 1992 and 263 lead workers from same lead using industries were
studied
in 1993. Due to the high turn-over rate lead industries only 148 lead workers were followed up for two consecutive year study.
Study variables for renal effect were urinary total protein (U-TP), urinary NAG, blood urea nitrogen(BUN), serum creatinine (S0Cr), and serum uric acid (S-Ua). On the other hand, blood lead (PbB), zinc protoporphyrin in whole blood(ZPP),
delta-aminolevulinic acid in urine (DALA), hemoglobin(Bb) and hematocrit(Hct) were selected for the variables of lead exposure. Information on age, sex, work duration of lead workers were also obtained. Fifteen symptom questionnaires of lead
exposure
were provided to the lead workers and filled up by themselves and reconfirmed by medical doctor during interview.
The cross-sectional observation of lead workers for 1992 and 1993 revealed that only the mean of NAG was significantly increased by the increase of PbB for two year study and the mean of BUN was significantly increased by the increase of PbB only
in
1992 study, but there were significant mean differences of NAG and BUN between blood lead below 60㎍/㎗ and above 60㎍/㎗. On the other hand, there were no significant mean differences of indices of renal effect by the increase of ZPP, but the
increase
of DALA made the significant differences of means of NAG for two year study and made those of BUN, S-Cr and S-Ua in 1992 study.
The frequency of workers whose value of renal function indicators were over the normal criteria (BUN>20mg/㎗; S-Cr>1mg/㎗; S-Ua>7.0mg/㎗; NAG>8.0U/liter; U-TP>8.0mg/㎗) by the level of PbB, ZPP and DALA were calculated.
While only frequency of over the normal criteria of NAG by the level of PbB showed dose-response relationship for two each year study, that of NAG and S-Ua by the level of DALA showed dose-response relationship in 1992 study and there was no
significant
renal indices who showed dose-response relationship with the level of ZPP.
In the longitudinal observation of 148 lead workers for one year follow up there was significant increase of mean PbB(p<0.01) for one year study period, and there wee significant decrease of mean value of ZPP, Hb and Hct(p<0.01). Among the
indices
of
renal effect, there was significant increase of mean of S-Ua and significant decrease of mean of S-Cr for one year study period
In the high lead absorption workers whose blood lead were over 60㎍/㎗, the proportion of abnormal value of NAG and U-TP were increased by the one year study period. While ZPP and DALA showed significant correlation with PbB in both in both year,
only
NAG among indices of renal effect has statistically significant correlation with PbB in 1993 but not in 1992.
There were no mean differences of prevalence of 15 lead related symptoms between two year. The most frequent symptom was fatigue and the most rare symptom was colicky pain around umbricus. There was no dose-response relationship between lead
related
symptoms and lead exposure indices.
With above results, NAG was found to be most reliable indicator who showed dose-response relationship with lead exposure. It is highly recommended that the addition of NAG measurement for battery of renal effect test in the medical surveillance
of
lead
workers.
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