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화학공장 근로자들의 간기능 이상 유병률 및 위험인자에 관한 연구
정해관,김정순,Cheong, Hae-Kwan,Kim, Joung-Soon 대한예방의학회 1997 예방의학회지 Vol.30 No.1
The object of this study is to evaluate the possibility of chemical-induced liver disorder among workers exposed to various chemicals and to classify the the liver function abnormalities by causes and to analyse the risk factors for each liver disorders. A cross-sectional study including questionnaire survey, physical examination, laboratory tests and ultrasonography of liver was conducted on 1,126 workers, 459 workers in a coal chemical plant(company A) and 667 workers in an insulation material manufacturing factory(company B). An industrial hygienist reviewed the chemicals used in both companies and evaluated the work environments to classify the workers by chemical exposure semiquantitatively. The results are as follows: 1. Of 459 workers in company A, 83 workers(18.1%) are classified as nonexposed, group 163(35,5%) as short-term exposure group, 155(33.8%) as intermediately exposed group and 58(12.6%) as long-term exposed group bared on the mean daily exposure to hepatotoxic chemicals evaluated by an industrial hygienist. Of 667 workers in company B, 484(72.6%) workers were classified as nonexposed and 183(35.5%) as exposed group. 2. Workers with SGOT level higher than 40 IU/l were (10.0%) in company A and 77(11.5%) in company 3, and those with SGPT level higher than 35 IU/l were 118(25.7%) in company A and 198(29.7%) in company B. The differences were not significant between companies and between exposure groups(p>0.05). Workers with $\gamma-GT$ level higher than 62 IU/l were 29(6.3%) in company A and 77(11.5%) in company B (p<0.01). The difference between exposure groups was not significant(p>0.05) within companies. Workers with liver function abnormalities(defined as SGOT higher than 40 IU/l or SGPT higher than 35 IU/l) were 338(30.0%) among 1,126 workers. Of 338 workers with live. function abnormalities 139(12.3%) had fatty liver by ultrasonography, 79(7.0%) had alcoholic liver(defined as workers with liver function abnormalities with weekly alcohol consumption greater than 280 g for more than 5 years), 54(4.8%) had hepatitis B, 12(1.1%) had hepatitis C and the other 114(33.7%) was not otherwise classified. Prevalences of alcoholic liver and fatty liver were significantly lower in company A(prevalence ratio 0.24 for alcoholic liver, p<0.001, prevalence ratio 0.76 for fatty liver, p<0.05) but prevalences of liver disorders between exposure groups within companies were not significant(p>0.05). 3. Summary prevalence ratios(SPR) of live. function abnormalities, fatty live. and other liver disorders, adjusted by age and company were not significantly higher in exposed group in any chemicals(p>0.05) but in some chemicals, SPRs were significantly lower. 4. On simple analysis of risk factors for liver function abnormalities, prevalence odds ratio(POR) of those with age between 30 and 39 was 1.54(p<0.01) and those with age ever 40 was 1.51(p<0.01). POR of those with histories of liver disorders and general anesthesia was 1.77(p<0.001) and 4.02 for those with overweight and 6.23 for those with obesity, defined by body mass index(p<0.001). 5. On logistic regression analysis, risk factors of liver function abnormality were fatty liver(POR 2.92 for grade 1, 12.15 for grade 2), presence of hepatitis B surface antigen(POR 3.62) and obesity(POR 5.38 for overweight and 16.52 for obesity). Presence of hepatitis B surface antigen(POR 0.18) was the only preventive facto. of fatty live. Company(POR 0.30) and obesity(POR 2.49 for overweight, 4.52 for obesity) were related to the alcoholic live. Obesity(POR 2.94 for overweight) was the only significant risk factor of hepatitis B and there was no significant risk factor for liver function abnormality not otherwise classified. It is concluded that the evidence of liver disorder related with chemical exposure is not evident in these factories. It is also postulated that fatty liver and alcoholic liver is most common causes of liver function abnormalities among workers and effort for w
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정해관 대한자기공명의과학회 1998 Investigative Magnetic Resonance Imaging Vol.2 No.1
Manganese is an essential element in the body. It is mainly deposited in the liver and to a lesser degree in the basal ganglia of the brain and eliminated through the bile duct. Rapid turnover of managanese in the body makes it difficult to evaluate the manganese exposure in workers, esecially in those with irregular or intermittent exposure, like welders. Therefore, conventional biomarkers, including blood and urine manganese can provide only a limited information about the long-tern or cumulative exposure to manganese. Introduction of magnetic resonance imaging (MRI) made a progress in the assessment of manganese exposure in the medical conditions related to manganese accumulation, e. g. hepatic failure and long-term total parenteral nutrition. Manganese shortens spin-lattice(T1) relaxation time on MRI due to its paramagnetic property, resulting in high signal intensity (HSI) on T1-weighted image(T1W1) of MRI. Manganese deposition in the brain, therefore, can be visualizedas an HSI in the globus pallidus, the substantia nigra, the putamen and the pituitary. clinical and epidemiologic studies regarding the MRI findings in the cases of occupational and non-occupational manganese exposure were reviewed. relationships between HSI on T1W1 of MRI and age, gender, occupational manganese exposure, and neurological dysfunction were analysed. Relationships betwen biological exposure indices and HSI on MRE werealso reviewed. Literatures were reviewed to establish the relationships between HSI, Manganese deposition in the brain, pathologic findings, and neurological dysfunction. HSI on T1W1 of MRI reflects regional manganese deposition in the brain. This relationship enables an estimation of regional manganese deposition in the brain by analysing MR signal intensity. Manganese deposition in the brain can induce a neuronal loss in the basal ganglia but functional abnormality is supposed to be related to the cumulative exposure of manganese in the brain, use of brain MRI for the assessment of exposure in a group of workers seems to be hardly rationalized, while ti can be a useful adjunct for the evaluation of manganese exposure int he cases with suspected manganese-related health problems.
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