우리나라 연노출 근로자들의 체내 총 연부담과 건강영향에 대한 단면연구

황보영,리갑수,김용배,이성수,안규동,이병국 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

목적 : 직업적 연노출 근로자들과 대조군을 대상으로 총 체내 연부담량 (혈중연량, 경골연량, 착화연량 등)과 이들이 인체에 미치는 건강영향의 관련성을 규명. 방법 : 조사 변수는 체내 총연부담 (혈중 연량, XRF를 이용한 경골연량, DMSA 착화연량)과 이들의 인체에 대한 영향(ALAU, creatinine 청소율, 혈색소, 혈압, 연관련 증상)들이었다. 조사대상은 연노출자 775명과 대조군 135명이었다. 결과 : 연노출 근로자들의 혈중 연량은 대조군보다 높았고 (31.7 ㎍/㎗ vs 5.3 ㎍/㎗), 경골연량도 높았다 (36.4 ㎍/g bone mineral vs. 5.8 ㎍/g bone mineral). 4시간 DMSA착화연량은 연노출군에서 186.2 ㎍이었고, 대조군은 조사되지 않았다. 혈색소와 적혈구용적치는 대조군이 높았으며 (14.2 g/㎗ vs. 15.3 g/㎗과 42.4% vs. 44.7%), 소변 ALA, ZPP와 BUN은 노출군에서 높았다 (각각 2.1 ㎎/ℓ vs. 1.6 ㎎/ℓ, 79.7 ㎍/㎗ vs. 38.5 ㎍/㎗, 14.4 vs. 13.1). 크레아티닌 청소율은 노출군에서 114.3 ㎖/min였다. 근육신경계 증상과 일반적인 연관련 증상은 노출군에서 높았다. 경골연량, 흡연량, 음주횟수, 신장, 연령들이 혈중 연량에 영향을 주는 변수로 확인되었다. 경골연량에 영향을 미치는 변수는 혈중 연량, 직력, 혈구용적치, 키 등이었다. DMSA 착화연량에 영향을 주는 요소는 혈중 연량, 크레아티닌 청소율, 연령, 경골연량이었다. 뇨중 ALA와 관련있는 변수는 DMSA착화연량, ZPP, 경골연량, 연령, 체중 등이었다. 크레아티닌 청소율에 영향을 주는 것은 DMSA 착화연량과 소변의 ALA량이었다. DMSA착화연량은 수축기 혈압에 영향을 미치는 것으로 나타났으며, 일반적인 연중독증상과 부의 관련성이 있는 것으로 나타났다. 결론 : DMSA 착화연량은 뇨중 ALA농도, 크레아티닌 청소율, 수축기 혈압, 일반적인 연중독 증상에 영향을 미치는 것으로 나타나 DMSA 착화연량이 생물학적 활성을 갖는 지표임이 확인되었다.

65세 이상의 노령층에서 고지혈증의 위험요인

김용배,장원기,황보영,김화성,안규동,이병국,이용진,김세훈,김승수,김승훈,김영록,김웅빈,이성수 순천향의학연구소 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

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연노출 남자 근로자들의 간기능 지표에 관한 연구

황보영,김용배,리갑수,이성수,안규동,이병국 大韓産業醫學會 2002 대한직업환경의학회지 Vol.14 No.3

목적 : 연취급 근로자들에서 연노출이 간기능에 미치는 영향을 알아보기 위하여 시도되었다. 방법 : 모 1차 제련업체에서 연을 취급하는 남자 근로자들 중 B형 간염 항원 보균자 및 간장질환 경험이 있는 근로자를 제외한 274명을 대상으로 하였고, 대조군은 B형 간염 항원 및 간장질환 경험이 없으면서 과거 직업력상 연을 취급하는 직장에 근무한 적이 없는 제조업체 생산직 근로자 113명을 대상으로 하였다. 연노출의 지표로서는 혈중 연량, 혈중 zinc protoporhourin, 요중 δ-aminolevulinic acid 등을 측정하였고, 간기능의 지표로서 aspartate aminotransferase(SGOT), alanine aminotransferase(SGPT), γ-glutamyltransferase(γ-GTP)를 측정하였며, 또한 간기능에 영향을 줄 수 있는 혼란변수로서 연령, 흡연량(pack-year), 음주량(주간 평균 마신 술을 2홉들이 소주병수로 환산), 체질량지수(BMI) 및 연 노출기간을 조사하였다. 간기능 지표(SGOT, SGPT, γ-GTP)의 결과를 각각의 기준치(reference value)에 의거 정상과 비정상으로 판정한 후, 각 비정상 결과에 대한 각 변수들의 영향을 로지스틱 회귀분석하였고, 또한 간기능 지표(SGOT, SGPT, γ-GTP)에 연노출 지표가 미치는 영향을 확인하기 위하여 혈중 연 농도, 혈중 ZPP, 요중 δ-ALA를 각각 독립변수로 하여 다중회귀분석을 실시하였으며, 혼란변수로서 연령, 체질량지수, 흡연량 및 음주량, 연 노출기간 등이 포함되었다. 최종모델은 동일한 혼란변수를 포함하도록 하였다. 결과 : 비정상 SGOT(>35 IU/L)에 대한 로지스틱 회귀분석 결과, 혈중연 농도의 비차비는 1.04(95 % CI, 1.008-1.066)였으며, 음주량(비차비 1.28 : 95 % CI, 1.054-1.549)과 체질량지수(비차비 1.24: 95 % CI, 1.075-1.421) 역시 유의한 변수로 나타났다. SGOT를 종속변수로 하고 연령, 체질량지수(BMI), 연노출 근무기간 그리고 흡연량 및 음주량을 통제한 중회귀분석에서 혈중 연농도는 SGOT를 유의하게 증가시키는 것으로 나타났다(p<0.05). 결론 : 연은 연노출 남자 근로자의 간기능 지표 중 SGOT에 유의한 영향을 미칠 수 있는 것으로 나타났다. Objectives: To evaluate the effects of lead on the liver function indices in male lead wokers. Methods: The study comprised of 274 lead workers and 113 non-lead workers who were confirmed not to have HBsAg (Hepatitis B surface Antigen). Blood lead (PbB), blood zinc protoporphrin (ZPP) and urinary δ-aminolevulinic acid (ALAU) were selected as parameters for monitoring exposure to lead while aspartate aminotransferase (SGOT), alanine aminotransferase (SGPT) and γ-glutamyltransferase (γ-GTP) were chosen as parameters for monitoring liver function. Demographic information, such as age, smoking and drinking histories were collected. The duration of work for the lead workers, and their BMI(body mass index), were also obtained. Result: After adjusting for possible confounders {age, BMI, work duration, smoking (pack-year) and drinking (bottles of Soju consumed per week)}, blood lead was observed to be a signficant variable from the logistic regression analysis of the abnormalities of SGOT(>35 IU/L), with an odds ratio of 1.04 (95% CI, 1.008-1.066). The amount of alcohol drunk (odds ratio 1.28: 95% CI, 1.054-1.549) and BMI (odds ratio 1.24: 95% CI, 1.075-1.421) were also aignificant variables. From the multiple linear regression analyses, blood lead was signficantly, and positively, associated with SGOT (p<0.05). Conclusions : These findings suggest that exposure to lead may have an effect on SGOT in male lead workers.

연취급 근로자들의 사회 심리적 스트레스가 연노출 수준에 미치는 영향

김용배,황보영,김화성,이성수,안규동,이병국 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

Objectives : This study was carried out to assess psychosocial distress of lead workers and to examine the effect of psychosocial distress on lead exposure indices. Methods : The study design was cross-sectional and research subjects were 246 lead workers in primary smelting industry. General characteristics, job characteristics and social support were obtained by self-administered questionnaire and history taking. Psychosocial distress was measured using PWI(Psycosocial Well-being Index), a 45-item self-administered instrument. Blood lead(PbB), zinc protoporphyrin(ZPP), δ-aminolevulinic acid in urine(ALAU) were selected as indicators of lead exposure. Results : The crude odds ratio of group whose PbB was 20-39 ㎍/㎗ was 3.475(95% CI : 1.243-6.404) and that of group whose PbB was above 40 ㎍/㎗ was 7.586(95% CI : 1.487-15.611). The odds ratio of each group adjusted age, wages, job characteristics, social support, smoking and alcohol drinking habit were still significant. Conclusions : Our results supported the association between lead exposure and psychosocial distress. The inclusion of psychosocial distress measurement as a special health examination for lead workers is highly recommended for the effective prevention of stress in lead workers.

골다공증의 위험인자 : 아산시 지역 주민을 대상으로

김용배,장원기,황보영,김화성,안규동,이병국,이용진,이남수,이상건,이상범,이상우,이선정,이성수 순천향대학교 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

Objective : As the average lifespan of human increases, osteoporosis and osteoporosis-related fractures have become major health care problems. Despite recent advances in medical treatment, few studies have assessed the recognition of osteoporosis in general adults. This study examined the recognition of osteoporosis and analyzed the relating factors. Method : A population-based sample of 1086 adults in Asan-city, Korea was investigated with questionnaires and height, weight, Information regarding the general characteristics(gender, age, economic state), lifestylef exercise, smoking, alcohol),medical history(progestin, GH, steroid, calcitonin, PTH), demographic parameter, obesity, stress, and family history was collected through an interview using a structural questionnaire. The level of obesity was measured by the body mass index(BMI). BMD(Bone mineral density) at the lumbar spine and femoral neck was measured by dual energy X-ray absorptiometry. Osteoporosis was considered to be T-score below -2.5. Results : The prevalence of osteoporosis increased progressively with age, decreased with BMI and predominant in women by the result of x^(2) -test, T-test. Age, weight, BMI were significantly correlated with osteoporosis by the result of Pearson correlation ana1ysis(P<0.05). And age, gender, BMI, family history of osteoporosis were proved to be significant risk factors of osteoporosis by the result of multiple logistic regression(P<0.05). Conclusion : These results suggest that age, gender, BMI might be the most important risk factors of osteoporosis. And the history taking about family history of osteoporosis is helpful for diagnosing osteoporosis.

고요산혈증의 위험인자 : 아산시 지역 주민을 대상으로

김용배,장원기,황보영,김화성,안규동,이병국,이용진,이종은,이준숙,이찬구,이한정,이성수 순천향대학교 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

Objective : Serum uric acid has now been identified as a marker for a number of metabolic and hemodynamic abnormalities. The aim of this study is to evaluate risk factors which influence hyperuricemia in the citizens of Asan. Method : The study design was cross-sectional and research subjects were 1086 citizens of Asan. General characteristics, cigarette smoking, alcohol consumption, and past history were obtained by interview using a structural questionnaire. Also, we measured height, weight and blood pressure, and serum uric acid of the subjects. Results : The mean serum uric acid level was 5.27 ㎎/㎗ in men and 4.01 ㎎/㎗, in women, In the multiple logistic regression analysis, statically significant risk factors of hyperuhcemia were gender, body mass index, blood lead concentration, and serum creatinine. Conclusion : Our results suggest that gender, body mass index, blood lead concentration, and serum creatinine might be the most important risk factors of hyperurcemia. Education program as well as routine check-up for serum uric acid was highly recommended for the effective prevention of hyperuricemia.

연노출 남자 근로자 코호트에서 고혈압 발생률에 관한 연구

황보영,김용배 순천향의학연구소 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

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새로운 연노출의 효과지표로서의 혈장 δ-aminolevulinic acid 측정의 유용성

이금원,황보영,김용배,리갑수,이성수,장봉기,함정오,안규동,이병국 순천향대학교 산업의학연구소 2001 순천향산업의학 Vol.7 No.1

To evaluate the usefulness of the measurement of plasma δ - aminolevulinic acid (ALAP) as a new effect indicator of lead exposure, the association of ALAP with blood lead, DMSA chelatable lead and bone lead with a special emphasis of genetic interaction of ALAD polymorphism was studied with 419 lead exposed workers and 85 non-lead exposed workers. Lead workers were recruited from storage battery industries, secondary smelting industries and other lead using industries and non-lead workers selected from electronic refrigerator manufacturing industry. Blood lead, DMSA chelatable lead and bone lead were chosen for parameters of lead exposure. Plasma and urinary ALA were selected for the effect parameter of lead intoxication. Information for age, smoking, drinking habit and body mass index were also obtained. Job duration for lead workers was also collected. The overall prevalence of the variant allele, ALAD type 1-2 or 2-2(ALAD2) in lead exposed workers was 10.0% (42 out of 419 lead workers) which was not differed from control workers (9.4% : 8 out of 85). The means blood lead and DMSA chelatable lead of lead workers with ALAD 1(ALAD type 1-1) were lower than those of lead workers with ALAD2, but the differences were not statistically significant. On the other hand, the mean of tibia lead of lead workers with ALADI was higher than that of lead workers with ALAD2, but the difference was not statistically significant. DMSA chelatable lead showed highest correlation with log transformed plasma ALA(LALAP)(r=0.682) and blood lead and tibia lead had r=0.650, r=0,402 correlation coefficient with LALAP respectively On the other hand. log transformed urinary ALA(LALAU) had lower correlation coefficient with all three parameters of lead exposure than LALAP. The equation of robustic simple linear regression of blood lead on LALAP was LALAP=2.0439+0.0165PbB in ALADI lead workers and LALAP=2.031+0.0121PbB in ALAD2 lead workers. ALAD genotype in the multiple regression analysis of blood lead with LALAP after adjusting for possible confounders(sex, ago, BMI, smoking and drinking status and job duration) showed significant main effect on LALAP resulting lower LALAP in ALAD2 lead workers than ALADI lead workers. On the other hand, effect modification of ALAD genotype was observed in the multiple regression analysis of tibia lead with LALAP after adjusting for possible confounders, but there was no significant effect of ALAD genotype in the multiple regression analysis of DMSA chelatable lead with LALAP after covariate adjustment. With above results, plasma ALA was found to be a useful effect parameter of lead exposure compared with urinary ALA. It was also observed that ALAD polymorphism made significant effect on the association of blood and tibia lead with ALAP. Thc lower plasma ALA in ALAD2 lead workers suggested supportive effect of ALAD2 in lead exposure.

납 노출자에 ALAD 및 VDR 유전자의 다형성이 혈중 납과 혈압과의 관련성에 미치는 영향

리갑수,황보영,김용배,김화성,이성수,안규동,이병국 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

To evaluate the effect of ALAD and VDR polymorphism on the relationship of blood lead with blood pressure in lead exposed workers, 801 lead exposed workers were selected. Blood lead was selected as parameters of lead dose and systolic and diastolic blood pressure using Random Zero Sphygmomanometer were chosen as blood pressure. ALAD and VDR genotype of each subject was assayed. Demographic information such as sex, age, education, past and family history, and personal habit of smoking and drinking were collected. Job duration of lead exposed workers was also obtained. The means of age and work duration of the subjects were 40.4±10.1 years and 8.2±6.5 years. The means of systolic blood pressure and diastolic blood pressure of the subjects were 123.2±16.3 mmHg and 75.8±11.9 mmHg. The overall prevalence of hypertension was 9.7%. ALAD2, the variant allele, in lead exposed workers was 10% and ALAD1 was 90%. For VDR genotype, the Bb or BB genotypes were 11.2%, while the bb genotype was 88.8%. The mean blood lead of subjects was 25.4±10.9 ㎍/㎗ (range 8.0-65.6). In the multiple regression analysis, blood lead was the significant positive predictor of systolic blood pressure and not the significant negative predictor of diastolic blood pressure after adjusting for possible confounders (age, sex, body mass index, use of anti-hypertensive drugs, drinking and smoking habits, VDR and ALAD genotypes. Also the subjects with the VDR Bx had 2.9 mmHg higher than those with the VDR bb (p=0.09). There was no interaction of VDR and ALAD genotypes between blood lead and systolic blood pressure. In multiple logistic regression analysis, the Odd's ratio of VDR genotype(BB or Bb vs. bb) for hypertension was 1.7 (95% confidence interval: 0.8-3.2). This study suggests that blood lead increases systolic blood pressure controlling covariates.

납노출지표와 적혈구내 protein kinase C 활성도의 연관성

황규윤,황보영,안현철,김용배,리갑수,이성수,안규동,이병국 大韓産業醫學會 2001 대한직업환경의학회지 Vol.13 No.4

목적 : Protein kinase C는 칼슘-인지질 의존형인산화 효소로 'H VJ'tfO에서 납에 의하여 활성화되지만, 납에 노출된 인체내에서 그 영향을 평가한 경우는 얼다. 본 연구의 목적은 납에 직업적으로 노출되는 근로자를 대상으로 납 노출이 적혈구막의 단백질내에서 PKC 활성에 의한 인산화 수준에 영향을 주는지 알아보고자 하였다. 방법 : 1998년부터 국내 납 근로자를 대상으로 납에 의한 건강 영향조사가 4년간의 코호트 연구로 실행하였다. 1차년도에 630명의 납 근로자와 135명의대조군이 조사되었고 이들중 본 연구에서는 직업적노출이 되는 사업장에 근무하는 212명의 근로자를대상하였다. 156명의 남자와 56명의 여자 근로자를 대상으로 인구학적, 과거병력, 직업력 등을 구조화된 설문과 면접으로 조사되었고 납 노출 평가는 혈중 납농도 및 ZPP, 경골중 납농도를 측정하였다. PKC의 활성도는 적혈구막 단백질내 PKC 의존형인산화 수준으로 평가하였다. 적혈구막 단백질인spectrin과 band 4.9의 후인산화수준을 측정하여각 납 노출지표(혈중 납, ZPP, 경골중 납. 노출기간)와의 관련성은 다중회귀분석을 이용하였다. 결과 : 조사대상자의 평균(SD) 연령은39.1(10.0)세, 근무기간은 8.1(6.5)년 이었으며, 경골중 납농도는 범위가 0.8에서 290.8 trg Pb/gbone mineral로 평근(SD) 34.4(35.2) rig Pb/gbone mineral이었다. 적혈구막 단백질의 후인산화수준은 개인간 변이가 매우 컸으며, spectrin은 평균(SD) 540 7(304.1), band 4.9 SfkDa는198.6(78.2), 48 kDa는 247.7(83.3) PSL이었다.경골중 납농도와 노출 기간은 이들 후인산화 수준과역상관성을 보였으나(p(0.05), 혈중 납 농도와 ZPP는 상관성이 없었다(p)0.05). 가능성 있는 혼란변수를 통제한 상태에서도 경골중 납 농도와 노출기간은 이들 후인산화수준과 유의한 회귀계수를 나타내었다. 결론 : 만성적 납 노출에 의하여 적혈구내 PKC활성도는 영향을 받아 증가되어있는 것으로 평가되어 적혈구막 단백질의 인산화수준은 납의 노출지표로 이용될 수 있을 것이다. 납의 신경독성은 부분적으로 PKC의 활성도왁 관련되어 있을 기전을 배제하기 어렵기 때문에 PfC 활성도와 신경행동학적 기능과의 관련성 평가가 진행되어야 할 것이다. Objectives : Protein kinase C(PKC) , a calcium and phospholipid dependent enzyme, is activated by lead in vitro at picomolar concentrations. However, the effect of lead on PKC has never been studied in a human population. The purpose of the study was to evaluate whether lead exposure was associated with PKC mediated-phosphorylation in erythrocytes among lead workers. Methods : Two hundred and twelve lead workers were studied. To determine the levels of phosphorylation ir vivo, an in vivo back phosphorylation technique was used by adding PKC and γ-32P to preparations of erythrocyte membranes. We measured back phosphorylations of erythrocyte membrane proteins, spectrin, and 52 kDa and 48 kDa, as an indirect measure of PKC activation if vivo. Results : The mean(SD) age and exposure duration was 39.1(10.0) years and 8.1(6.5) years, respectively. Tibial lead ranged from 0.8 to 290.8 μg Pb/g bone mineral with a mean (SD) of 34.4(35.2) μg Pb/g bone mineral. The means(SD) of back phosphorylation levels of the three proteins were 540.7(304.1), 198.6(78.2), and 247.7(83.3) photostimulated luminescence units (PSL), respectively, by phosphoimager. After adjustment for potential confounding factors, tibial lead and exposure duration were significantly and inversely associated with back phosphorylation levels. One unit of increase in tibial lead (1 μg Pb/g bone mineral) is associated with a decline in spectrin, band 4.9 52 kDa, and band 4.9 48 kDa back phosphorylation levels by 1.4(p〈0.05), 0.34(p〈0.05), and 0.47(p〈0.01), respectively However, there were no associations between the back phosphorylation levels and either blood lead or ZPP levels. Conclusions : These findings suggest that the PKC activity in erythrocytes is increased by chronic lead exposure and that erythrocyte membrane protein phosphorylation may be a biomarker of lead exposure.