铅作业工人血压和心电图改变及驱铅治疗对其的影响研究

摘要

目的 研究铅对作业工人心电、血压变化的影响以及驱铅治疗对铅中毒作业工人心电和血压的逆转作用.方法 选择某铅冶炼厂确诊为中毒并进行驱铅治疗的职工191例,监测治疗前后的血铅、锌卟啉(ZPP)、尿δ-氨基乙酰丙酸(δ-ALA)、粪卟啉、心电图和血压.结果 不同血铅水平[(364.8±28.1)、(502.7±59.9)、(735.3±108.5)μg/L]组的铅作业人员ZPP[(15.6±10.1)、(18.9±11.7)、(26.3±13.2) μg/gHb]、δ-ALA[(15.1±10.8)、(12.9±9.2)、(20.6±13.0)mg/L]、粪卟啉水平间差异有统计学意义(P＜0.01),同时收缩压[(118.3±11.8)、(122.7±15.4)、(133.1±12.5) mm Hg]和心电图异常率(50.00%、38.68%、61.64%)间差异亦有统计学意义(P＜0.05);EDTA驱铅治疗可降低铅暴露对象的血铅、ZPP、δ-ALA及粪卟啉水平;EDTA治疗后,血铅400～μg/L组和＞600 μg/L组铅中毒患者的收缩压降低(P＜0.01),血铅＞600 μg/L组心电图异常也明显下降(P＜0.01),且高血压总患病率及心电图总异常率均有降低(P＜0.01);不同疗程治疗剂量的疗效间差异无统计学意义(P＞0.05).结论 铅可导致收缩压升高,且高血压患病率、心电图异常率上升,而驱铅治疗可降低收缩压、高血压患病率和心电图异常率.%Objective To study effects of lead poisoning on electrocardiogram and blood pressure in the lead exposure workers, and reverse effects of chelation therapy. Methods Diagnosed 191 lead poisoning workers were selected and gave 20% calcium disodium EDTA ( EDTA ) intravenous drip of lead treatment, while the blood lead, zinc porphyrin ( ZPP ), 8 - ALA, coproporphyrin were detected, electrocardiogram ( ECG ) and blood pressure were examined before and after lead treatment. Results In the different level of blood lead workers [ ( 364. 8 ± 28. 1 ), ( 502. 7 ± 59. 9 ), ( 735. 3 ± 108. 5 ) μg/L ], their con-tentofZPP[ (15.6±10. 1), ( 18.9 ±11.7), ( 26. 3 ± 13. 2 ) μg/gHb ], 8 - ALA [ ( 15. 1 ±10.8), (12.9 ±9.2), (20.6±13.0) mg/L], coproporphyrin and level of systolic pressure [ ( 118. 3 ± 11. 8 ), ( 122. 7 ± 15. 4 ), ( 133. 1 ± 12. 5 ) mm Hg ], and the prevalence rate of abnormal rate of ECG ( 50. 00% , 38. 68% , 61. 64% ) were obvious differences ( P < 0. 05 ); Chelation therapy could decreased level of blood lead, ZPP, 8 - ALA and coproporphyrin; EDTA had the effectiveness on systolic pressure in 400 μLg/L ~ and > 600 μg/L group and abnormal rate of ECG in > 600 μg/L group, in addition EDTA had decreased total abnormal rate of ECG and total rate of hypertension; there was no significance difference between the different courses and doses of treatment. Conclusion Lead could increase systolic pressure, the prevalence rate of hypertension and abnormal rate of ECG and chelation therapy EDTA had the effectiveness on both abnormal electrocardiogram and hypertension of lead poisoning workers.