Results of common laboratory tests in solvent-exposed workers
Tóm tắt
The screening and identification of occupational liver or other organ-system injury related to long-term, low-level solvent exposure are difficult in clinical practice. We studied the feasibility of the use of common laboratory tests combined with a detailed exposure history. The relationships between laboratory tests and exposure to organic solvents were studied in regression modelling adjusted to age, alcohol consumption, gender and body mass index (BMI). The subjects were 29 solvent-exposed workers and 19 referents. Laboratory tests included serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), carbohydrate-deficient transferrin (CDT), alkaline phosphatase (ALP), creatinine, cholesterol, HDL-cholesterol, triglycerides, blood glucose and total and conjugated bilirubin. Positive hepatitis serology, systemic diseases or medications with known hepatic effects and current pregnancy were exclusion criteria. The main exposures of each subject were identified. Current solvent exposure status, exposure during the past 3 months, exposure during the past 5 and 10 years, and total life-time exposure were recorded. AST (P=0.0031), ALT (P=0.0015) and cholesterol (P=0.0110) correlated positively with cumulative solvent exposure in the past 5 years, total bilirubin with current exposure (P=0.0380), and glucose with exposure in the past 5 (P<0.0001) and 10 (P=0.0003) years. Triglycerides correlated positively with exposure in the past 5 (P=0.0025) and 10 (P=0.0059) years and with life-time exposure (P=0.0005). Creatinine correlated negatively with exposure in the past 10 years (P=0.0300) and life-time exposure (P=0.0005). Most laboratory values were within the normal range. These results suggest a multi-system health effect of solvents. The laboratory data had some similarities with those in the metabolic syndrome. The screening and diagnostics of solvent-related conditions should be based on a thorough work history and a set of carefully selected laboratory tests. No single test seems sufficient for this purpose.
Tài liệu tham khảo
Bacon BR, Farahvash MJ, Janney CG, Neuschwander-Tetri BA (1994) Nonalcoholic steatohepatitis: an expanded clinical entity. Gastroenterology 107:1103–1109
Baker EL (1994) A review of recent research on health effects of human occupational exposure to organic solvents. J Occup Med 36:1079–1092
Behrens UJ, Worner TM, Lieber CS (1988) Changes in carbohydrate-deficient transferrin levels after alcohol withdrawal. Alcohol Clin Exp Res 12:539–544
Bell H, Tallaksen C, Sjaheim T, Weberg R, Raknerud N, Orjasaeter H, Try K, Haug E (1993) Serum carbohydrate-deficient transferrin as a marker of alcohol consumption in patients with chronic liver diseases. Alcohol Clin Exp Res 17:246–252
Brautbar N, Williams J 2nd (2002) Industrial solvents and liver toxicity: risk assessment, risk factors and mechanisms. Int J Hyg Environ Health 205:479–491
Brodkin CA, Daniell W, Checkoway H, Echeverria D, Johnson J, Wang K, Sohaey R, Green D, Redlich C, Gretch D (1995) Hepatic ultrasonic changes in workers exposed to perchloroethylene. Occup Environ Med 52:679–685
Brodkin CA, Moon JD, Camp J, Echeverria D, Redlich CA, Willson RA, Checkoway H (2001) Serum hepatic biochemical activity in two populations of workers exposed to styrene. Occup Environ Med 58:95–102
Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA (1998) The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med 158:1789–1795
Caldwell DJ, Armstrong TW, Barone NJ, Suder JA, Evans MJ (2000) Hydrocarbon solvent exposure data: compilation and analysis of the literature. AIHAJ 61:881–894
Chen J-D, Wang J-D, Tsai S-Y, Chao W-I (1997) Effects of occupational and nonoccupational factors on liver function tests in workers exposed to solvent mixtures. Arch Environ Health 52:270–274
Cotrim HP, Andrade ZA, Parana R, Portugal M, Lyra LG, Freitas LA (1999) Nonalcoholic steatohepatitis: a toxic liver disease in industrial workers. Liver 19:299–304
Eskenazi B, Bracken MB, Holford TR, Grady J (1988) Exposure to organic solvents and hypertensive disorders of pregnancy. Am J Ind Med 14:177–188
Falck-Ytter Y, Younossi ZM, Marchesini G, McCullough AJ (2001) Clinical features and natural history of nonalcoholic steatosis syndromes. Semin Liver Dis 21:17–26
Gao B (2002). Interaction of alcohol and hepatitis viral proteins: implication in synergistic effect of alcohol drinking and viral hepatitis on liver injury. Alcohol 27:69–72
Goeser T (2002) Clinical aspects of the different forms of viral hepatitis and their treatment. Semin Thromb Hemost 28 [Suppl 1]:37–46
Goh VH, Chia SE, Ong CN (1998) Effects of chronic exposure to low doses of trichloroethylene on steroid hormone and insulin levels in normal men. Environ Health Perspect 106:41–44
Gordon AJ, Maisto SA, McNeil M, Kraemer KL, Conigliaro RL, Kelley ME, Conigliaro J (2001) Three questions can detect hazardous drinkers. J Fam Pract 50:313–320
Groop L, Orho-Melander M (2001) The dysmetabolic syndrome. J Intern Med 250:105–120
Guzelian P, Mills S, Fallon HJ (1988) Liver structure and function in print workers exposed to toluene. J Occup Med 30:791–796
Kossler F (1991) Trichloroethylene interactions with muscle cells. J Appl Toxicol 11:189–194
Kotseva K, Popov T (1998) Study of cardiovascular effects of occupational exposure to organic solvents. Int Arch Occup Environ Health 71 [Suppl]:S87–91
Lang CH, Kimball SR, Frost RA, Vary TC (2001) Alcohol myopathy: impairment of protein synthesis and translation initiation. Int J Biochem Cell Biol 33:457–473
Lee DH, Ha MH, Christiani DC (2001) Body weight, alcohol consumption and liver enzyme activity—a 4-year follow-up study. Int Journal Epidemiol 30:766–770
Lonardo A, Bellini M, Tondelli E, Frazzoni M, Grisendi A, Pulvirenti M, Della Casa G (1995) Nonalcoholic steatohepatitis and the “bright liver syndrome”: should a recently expanded clinical entity be further expanded? (letter) Am J Gastroenterol 90:2072–2073
Lundberg I, Nise G, Hedenborg G, Högberg M, Vesterberg O (1994) Liver function tests and urinary albumin in house painters with previous heavy exposure to organic solvents. Occup Environ Med 51:347–353
Lundqvist G, Flodin U, Axelson O (1999) A case–control study of fatty liver disease and organic solvent exposure. Am J Ind Med 35:132–136
Marchesini G, Brizi M, Morselli-Labate AM, et al (1999) Association of nonalcoholic fatty liver disease with insulin resistance. Am J Med 107:450–455
Marchesini G, Brizi M, Bianchi G, Tomassetti S, Bugianesi E, Lenzi M, McCullough AJ, Natale S, Forlani G, Melchionda N (2001) Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes 50:1844–1850
Ministry of Social Affairs and Health (2001) Occupational exposure limits 2000 (in Finnish). HTP-arvot 2000. Sosiaali- ja Terveysministeriö. Työsuojelusäädöksiä 2000:3. Tampere
National Public Health Institute (2001) KTL B 10/2001. Infectious diseases in Finland 2000. The National Infectious Diseases Register, http://www.ktl.fi/ttr/tt_en_2000.pdf
Pedersen LM, Nygaard E, Nielsen OS, Saltin B (1980) Solvent-induced occupational myopathy. J Occup Med 22:603–606
Poulsen P, Vaag A, Kyvik K, Beck-Nielsen H (2001) Genetic versus environmental aetiology of the metabolic syndrome among male and female twins. Diabetologia 44:537–543
Preedy VR, Paice A, Mantle D, Dhillon AS, Palmer TN, Peters TJ (2001) Alcoholic myopathy: biochemical mechanisms. Drug Alcohol Depend 63:199–205
Ribeiro-Filho FF, Faria AN, Kohlmann O Jr, Ajzen S, Ribeiro AB, Zanella MT, Ferreira SR (2001) Ultrasonography for the evaluation of visceral fat and cardiovascular risk. Hypertension 38:713–717
Ryysy L, Häkkinen A-M, Goto T, Vehkavaara S, Westerbacka J, Halavaara J, Yki-Järvinen H (2000) Hepatic fat content and insulin action on free fatty acids and glucose metabolism rather than insulin absorption are associated with insulin requirements during insulin therapy in type 2 diabetic patients. Diabetes 49:749–758
Tomei F, Giuntoli P, Biagi M, Baccolo TP, Tomao E, Rosati MV (1999) Liver damage among shoe repairers. Am J Ind Med 36:541–547
Tossavainen A, Jaakkola J (1994) Occupational exposure to chemical agents in Finland. Appl Occup Environ Hyg 9:28–31
Venables WN, Ripley BD (2001) Modern applied statistics with S-PLUS, 3rd edn. Springer, New York
Warnes TW, Jain SK, Smith A (2000) Hepatotoxic effects of workplace exposures. In: Baxter PJ, Adams PH, Tar-Ching A, Cockcroft A, Harrington JM (eds) Hunter’s diseases of occupations, 9th edn. Arnold, London
White RF, Proctor SP (1997) Solvents and neurotoxicity. Lancet 349:1239–1243
Woo J, Henry JB (1996) Metabolic intermediates and inorganic ions. In: Henry JB Clinical diagnosis and management by laboratory methods. Saunders, Philadelphia, pp 162–193
Xiao JQ, Levin SM (2000) The diagnosis and management of solvent-related disorders. Am J Ind Med 37:44–61