尿常规和尿酶在慢性职业铬盐暴露工人肾损伤评价中的应用  

Urinary routine and enzymes in the evaluation of renal injury in occupational workers chronically exposured to chromate

作　　者：吴永华[1] 冯慧敏 张济[3] 崔丽艳[1] 王天成[1] 贾光[2] WU Yonghua;FENG Huimin;ZHANG Ji;CUI Liyan;WANG Tiancheng;JIA Guang(Department of Clinical Laboratory,Peking University Third Hospital,Beij ing 100191,China;Department of Occupational ＆ Environmental Health Sciences,School of Public Health,Peking University Health Science Center,Beijing 100191,China;the Center for Disease Premention and Control of Jinan,Jinan,Shandong 250001,China)

机构地区：[1]北京大学第三医院检验科,北京100191 [2]北京大学医学部公共卫生学院劳动卫生与环境卫生学系,北京100191 [3]济南市疾病预防控制中心,济南250001

出　　处：《国际检验医学杂志》2018年第14期1668-1671,共4页International Journal of Laboratory Medicine

基　　金：国家自然科学基金资助项目(30571550;81273043;81673118)

摘　　要：目的分析铬盐暴露工人尿铬(U-Cr)水平及尿常规、尿沉渣、尿酶,探讨尿常规、自动尿沉渣分析和尿酶测定在职业铬盐暴露工人肾损伤检查中的意义,为铬盐职业接触人群的监测提供辅助方法。方法选择115名职业铬暴露工人和60名非铬盐接触者,分别测定尿铬、尿干化学、尿沉渣、尿γ-谷氨酰转肽酶(GGT)、乳酸脱氢酶(LDH)、碱性磷酸酶(ALP)、天门冬氨酸氨基转移酶(AST)和N-乙酰-β-氨基葡萄糖苷酶(NAG)活性。结果铬盐暴露工人平均U-Cr水平为17.41μg/g肌酐,显著高于对照组的1.52μg/g肌酐,差异有统计学意义(P<0.05);与对照组比较,铬盐暴露工人尿干化学检查无显著差异,尿沉渣分析显示其尿中小圆形上皮细胞(SRC)、上皮细胞(EC)和结晶(X′TAL)较对照组明显增多,差异有统计学意义(P<0.05),而红细胞(RBC)、白细胞(WBC)、管型(Cast)、病理管型(Path)、细菌数(Bact)差异无统计学意义(P>0.05);尿酶检测显示铬盐暴露工人尿GGT和尿NAG活性较对照组显著增高,差异有统计学意义(P<0.05),但尿AST、LDH和ALP活性与对照组相比差异无统计学意义(P>0.05)。相关分析表明铬盐暴露组U-Cr与尿X′TAL、尿比密(SG)和RBC呈显著正相关,但与尿WBC、EC、SRC、Bact、Cast等指标无显著相关性;U-Cr水平与尿NAG、AST、LDH活性显著相关,但与尿GGT和ALP活性无显著相关性。结论长期职业铬暴露工人尿EC、SRC和X′TAL和尿NAG、GGT酶活性增加,尿X′TAL和尿SG增高可能与尿中铬盐水平升高有关;尿NAG和GGT酶活性增加显示可能有某种程度的肾小管损伤。尿常规分析和尿NAG酶活性测定对职业铬盐暴露工人肾损伤的监测具有一定辅助作用。Objective To analyze the levels of urine chromium（U-Cr）,urine routine,urine sediment and urine enzyme in workers exposed to chromate salt,and to explore the significance of urine routine,automatic urine sediment analysis and urine enzyme determination in the examination of renal injury in occupational chromium salt exposed workers,and provide an auxiliary method for monitoring the occupational exposure of chromate salts.Methods 115 occupational chromium exposed workers and 60 people withou chromate salt contact were enrolled in the study,the activity of urine chromium,urine dry chemistry,urine sediment,urine gamma glutamyl transaminopeptidase（GGT）,lactate dehydrogenase（LDH）,alkaline phosphatase（ALP）,aspartate aminotransaminase（AST）and N-acetyl-beta aminoglucosidase（NAG）were determined.Results The average U-Cr level of occupational chromate exposed workers group was significantly higher than that of control group（17.41 mg/g Cre vs.1.52 mg/g Cre,P〈0.05）;the urinary sediment analysis showed that the small and medium round epithelial cells（SRC）,the epithelial cells（EC）and the crystallization（X′TAL）in chromate exposed workers were significantly higher than those in control group,and differences were statistically significant（P〈0.05）,while there were no significant difference in urine erythrocyte（RBC）,leukocyte（WBC）,tube type（Cast）,pathological tube type（Path）and bacterial count（Bact）（P〉0.05）.The urine gamma glutamyl transaminopeptidase（GGT）and urine N-acetyl-beta aminoglucosidase（NAG）activities in chromate exposed workers were also significantly higher than those in control group,and the difference was statistically significant（P〈0.05）.However,there was no significant difference in urine aspartate amino acid transfer enzyme（AST）,lactate dehydrogenase（LDH）and alkaline phosphatase（ALP）activity between the two groups（P〉0.05）.The correlation analysis showed that U-Cr in chromate exposure group was positively correla

关 键 词：铬盐 工人 尿铬 尿沉渣 

分 类 号：R446.12[医药卫生—诊断学]