연작업자들의 신기능 평가에서 요중 δ-aminolevulinic acid 측정의 의의

이병국,이숙,김용배,리갑수,김화성,황규윤,장봉기,이성수,안규동 순천향대학교 산업의학연구소 1999 순천향산업의학 Vol.5 No.1

To clarify the effect of occupational lead exposure on renal function 241 lead workers working and 56 non lead workers were studied in 5 lead acid battery industries. Study variables for renal effect were urinary N-acetyl-β-D-glucosaminidase(NAG), urinary total protein(U-TP), blood urea nitrogen(BUN), serum creatinine(S-Cr), and serum uric acid(S-Ua). On the other hand, blood lead(PbB), zinc protoporphyrin in whole blood(ZPP), and delta-aminolevulinic acid in urine(δ-ALA) were selected for the variables of lead exposure. Information on age, work duration, smoking and drinking history were also obtained. The results obtained were as follows. While the mean values of lead exposure indicators of lead workers were significantly different from non-exposed ones, the mean values of BUN, U-TP and S-Cr of renal function indicators of exposed were also different from non-exposed. BUN, U-TP and NAG showed statistically significant correlation with PbB and ZPP, and NAG revealed also statistically strongly significant correlation with δ-ALA. On multiple regression using renal fuction indicators as a dependent variable and δ-ALA, age, work duration,lead exposure,smoking and drinking as independent variables, only δ-ALA contributed to NAG.

성인에서 Haemophilus influenzae 감염증의 임상양상과 미생물학적 특성

이종섭,황병연,정희진,김우주,박승철,이도현,이창규,신종희,황규잠,이영희 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.2

목적 : H. influenzae는 성인에서 흔히 호흡기 감염을 일으키는 균주로, 최근 ampicillin 내성 β-lactamase 생성 균주들이 지속적인 증가를 보이고 있어, 이에 국내 성인에서 H. influenzae에 의한 감염의 임상양상과 분리된 균주들의 미생물학적 특성을 조사하고자 하였다. 방법 : 1998년 3월부터 1999년 9월까지 고려대 구로병원에 내원한 환자중에서 H. influenzae가 분리된 68명을 대상으로 임상양상을 조사하고 항균제 감수성 검사를 시행하였다. 분리된 33주에 대해서 혈청형, 생물형, 세포외막 단백분석을 시행하였고, β-lactamase 생성여부에 따른 감염 환자군간 임상상 및 예후의 차이를 비교하였다. 결과 : 환자의 평균연령은 68세였고, 지역사회 획득감염이 전체의 85%를 차지하였다. 폐렴과 기관지염과 같은 하기도 감염이 전체환자의 75%를 차지하였고 분리 검체 역시 객담이 84%로 가장 많았다. 환자의 71%가 기저질환을 가지고 있었으며, 그 중에 만성 폐쇄성 폐질환, 심혈관 질환, 악성종양, 당뇨병이 대부분이었다. 혈청형으로는 nontypeable 형이 68%로 가장 많았고 b형은 한 예도 없었다. β-lactamase 생성율은 63.2%였고, β-lactamase 양성균주의 항균제 내성율이 음성균주에 비하여 높았으나 β-lactamase 생성 여부에 관계없이 cefotaxime, azithromycin, ciprofloxacin에 대하여 100%의 감수성을 나타내었고 cefaclor, cefuroxime에 대해서는 10% 이하의 낮은 내성율을 보여 이들 항균제들이 치료에 효과적일 것으로 사료된다. 세포외막 단백분석에서는 C형과 D형이 전체의 64%로 가장 많았으며, 혈청형과의 유의한 연관성은 보이지 않았다. 결론 : 성인에서 H. influenzae는 주로 만성 기저질환자에서 급성 호흡기감염 또는 만성 폐쇄성 폐질환의 급성 악화를 유발한다. 기존의 보고에 비해 β-lactamase 양성율이 증가하였고, 이에 따른 항균제 내성율도 증가하여 항균제의 선택에 유의하여야 할 것으로 생각된다. 세포외막 단백분석상 특정한 유형의 균주에 의해 감염이 집중적으로 발생하고 있어 향후 역학 조사의 도구로 이용할 수 있겠다. Purpose : H. influenzae is one of the common causative microorganisms of respiratory tract infections in adults. Recently. β-lactamase producing, ampicillin-resistant H. infiuenzae has become worldwide problem as well as in Korea. We studied to investigate the clinical features and microbiologic characteristics of H. infiuenzae infections in adults. Materials & Methods : From March 1998 to September 1999, 68 patients were enrolled in this study. Clinical features of H. infiuenzae infections were investigated, 68 isolates were subjected to the β-lactamase test, and 33 isolates were used for serotyping. biotyping, antibiotic susceptibility and outer membrane protein (OMP) analysis. Results : Mean age of study patients was 68 years-old and the acquisition rate in community was 85%. Pneumonia and bronchitis were the most common type of infection such as 80%, sputum was the most common clinical specimen for H. mQuenzae isolation. 70% of patients had chronic underlying diseases. Non-typeable strains were 68% and β-lactamase producing rate was 63%. There was no difference in the clinical features and prognosis of H. influenzae infection between the β-lactamase positivie and -negative groups. The susceptibility of cefotaxime, azithromycin, and ciprofloxacin was 100% and that of cefaclor, cefuroxime was under 10% in spite of β-lactamase positivity. In OMP analysis, C and D types were dominant (64%). Conclusion : H. influenzae caused acute respiratory infections in adults with chronic underlying disorders. This study shows higher β-lactamase producing rate and antibiotic-resistance rate than that were reported previously. OMP analysis shows that two major types of strains cause clinical infections intensively.

업종에 따른 연 취급 사업장의 기중 연 농도 및 연 노출 수준 평가

이병국,김용배,리갑수,안현철,김화성,이용진,황규윤,장봉기,이성수,안규동 순천향대학교 산업의학연구소 1999 순천향산업의학 Vol.5 No.1

In order to obtain an useful information for health management and biological monitoring of lead exposed workers, Authors tried to investigate air lead level and the lead exposed level of workers in lead industry according to occupational category. The subjects in our study were 2074 workers in 7 lead-using industries, and study subjects were divided into 4 occupational categories such as storage battery industry (type 1), primary smelting industry (type 2), secondary smelting industry (type 3) and litharge making industry (type 4). Blood zincprotoporphyrin concentration (ZPP), blood lead concentration (PbB) and urinary δ -aminolevulinic acid (ALAU), hemoglobin (Hb), hematocrit (Hct) were selected as the indices of lead exposure. Personal variables such as age, work duration were also collected. The results were as follows. 1. The geometric mean air lead in 9 lead-using industry was 0.1133±4.3120 ㎎/㎥, and that in type 1, 2, 3 and 4 was 0.1038±3.4952 ㎎/㎥, 0.0429±3.4329 ㎎/㎥, 0.1877±2.5123 ㎎/㎥ and 0.9961±5.2910 ㎎/㎥, respectively. 2. The mean ZPP in 9 lead-using industry was 53.1±28.0 ㎍/㎗, and that in type 1, 2, 3 and 4 was 52.0±24.8 ㎍/㎗, 48.0±16.4 ㎍/㎗, 109.8±85.6 ㎍/㎗ and 74.3±37.8 ㎍/㎗, respectively. There was significant difference in ZPP according to occupational category (P<0.01). The percents of lead workers whose ZPP were above 100 ㎍/㎗ in type 1, 2, 3 and 4 were 4.0%, 1.7%, 34.3% and 21.6%, respectively. 3. The mean PbB in lead-using industry was 26.0±11.2 ㎍/㎗, and that in type 1, 2, 3 and 4 was 25.3±11.1 ㎍/㎗, 26.7±8.8 ㎍/㎗, 50.3±15.2 ㎍/㎗ and 36.4±11.0 ㎍/㎗, respectively. There was significant difference in PbB according to occupational category (P<0.01). The percents of lead workers whose PbB were above 40 ㎍/㎗ in type 1, 2, 3 and 4 were 10.4%, 7.7% 71.9% and 43.2%, respectively. 4. While the correlation of Hb corrected PbB with ZPP was higher than non corrected PbB, the correlation of log-transformed ZPP with PbB was higher than non corrected ZPP. 5. Simple linear regressions of PbB and corrected PbB as independent variable with ZPP, log-transformed ZPP and ALAU as dependent variable were statistically significant (P0.01). Coefficient of determination of corrected PbB with other variables was higher than non corrected PbB. As the result of this study, it was suggested that reconsideration of environmental and biological monitoring program was highly recommended for secondary smelting and litharge making industry.

무보수 호흡용 보호구 착용이 2차 제련 연작업자들의 연폭로지표에 미치는 영향

이영구,황보영,리갑수,이성수,안규동,이병국 순천향대학교 산업의학연구소 1997 순천향산업의학 Vol.3 No.1

It is often impossible to improve working condition in small scaled lead industries due to inherent old work process and lack of capital to improve it. This is particularly true in secondary smelting industries in Korea. Alternative ways to protect workers in these industries are respiratory protection and job shift if at all possible to less harmful workplace. This study intended to evaluate the effect of maintenance free respirator and job shift of lead workers to other non-lead workplace on the level of lead exposure of workers in terms of blood zinc protoporphyrin as an index of lead absorption and intoxication of lead workers. Seventy three workers of one secondary smelting industry whose work duration was more than 4 months were studied. All workers were classified into 4 groups such as managemental workers(8), non-lead workers(14), lead workers(44) and shift workers(7). Personal data such as age and work duration were collected and air concentration of lead in each workplace were also measured. Blood ZPP was chosen as an index of biological monitoring and was measured regularly once a month for 5 months study period. The results obtained were as follows: 1. There were no significant differences of mean blood ZPP during 5 months study period in management workers and non-lead workers showing the range of 23.1-26.5 ㎍/100ml and 22.2-24.2 ㎍/100ml respectively. 2. Rapid reduction of mean blood ZPP from first month (203.0 ± 106.7 ㎍/ 100ml) to third month (128.4 ± 75.1 ㎍/100ml) was noticed and after 3 months period there was no further reduction of blood ZPP in lead workers. 3. The initial mean blood ZPP of shift workers who moved to non-lead workplace was 394.3 ± 114.9 ㎍/100ml and their mean blood ZPP were steadily decreased every month from 344.3 ± 98.4 ㎍/100ml of first month to129.9 ± 33.5 ㎍/100ml of 4th month). 4. The average reduction rate of blood ZPP based on initial blood ZPP was 37.0% in lead workers for 3 months period and 67.1% in shift workers for 4 months period. With above results it was observed that respiratory protection and work shift could protect lead workers from lead exposure by reducing lead exposure in secondary smelting industry which had fairly bad working condition. But for a complete prevention of lead poisoning, it has certain limitation and should be used as an interim method until fundamental engineering control of workplace.

Gilbert 증후군에서 열량 제한 시험과 Phenobarbital 자극 시험의 의의(14예)

이헌영,채경훈,정재훈,강윤세,김연수,문희석,박기오,이엄석,김선문,김석현,성재규,이병석,이강욱 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Gilbert 증후군은 인구의 7%에서까지 나타날 수 있는 매우 흔한 증후군으로서 비진행성인 양성의 만성적 경과를 치하며, 간질환의 증상과 징후가 없는 경한 비포합형 고빌리루빈혈증이 특징인 일종의 체질적인 증상으로서 혈장 빌리루빈 농도에 대한 사춘기의 영향 때문에 10대와 20대에 자주 진단이 된다. 따라서 임상적인 중요성은 미약하지만 높은 빈도가 예상되는 점에 그 중요성이 부여되어야 할 것이다. 따라서 적정한 임상적 진단법으로 기왕에 소개된 열량제한 시험과 phenobarbital 유도 시험을 시행하고 이들의 진단적 가치를 알아보기 위하여 본 연구를 시행하였다. 1990년 7월부터 1999년 4월까지 충남대학교병원에 내원하여 HBsAg, IgG anti-HBc 및 anti-HCV가 음성이고, 간 초음파 스캔에서 이상이 없으며, 혈청 AST, ALT 및 AP가 정상인 비음주자에서 경한 비포합형 고빌리루빈혈증이 있는 14예의 환자들을 대상으로 ^(99m)Tc-DISID 스캔을 시행하였으며, 기저 치 총빌리루빈 및 포합형 빌리루빈 치를 측정한 다음에 하루에 400Kcal로 48시간동안 제한한 열량 제한 시험을 시행하였고, phenobarbital을 하루 60mg씩 5일간 투여한 후에도 각각 총빌리루빈과 포합형 빌리루빈 치를 검사하여 비포합형을 구하였다. 대상 환자들은 모두 14예로서 남자가 11예(78.6%)였고 여자가 3예(21.4%)여서 3.7:1로 남자에서 많았으며, 20대가 6예(42.9%), 30대가 역시 6예(42.9%) 및 40대가 2예(14.2%)로서 2,30대가 대부분(85.8%)이었다. 열량 제한 시험 후의 총빌리루빈 치, 비포합형 및 포합형 빌리루빈 치들은 평균 각각 5.5±2.7, 4.2±2.3 및 1.3±10mg/dL 로서, 시험 전 치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg/dL 보다 유의하게(p=0.001, p=0.001, p=0.023) 상승하였다. 포합형 빌리루빈 치도 유의하게 상승하였으나 비포합형의 상승보다는 훨씬 낮아서 주로 비포합형이 증가하였다. phenobarbital 투여 중 설사가 발생하여 중단한 1예를 제외한 13예에서 열량 제한 시험 후에 상승하였던 총, 비포합형 및 포합형 빌리루빈 치가 phenobarbital 유도 시험후에는 2.0±1.1, 1.5±0.8 및 0.5±0.4mg/dL로서 열량 제한 시험 결과보다 유의하게 낮아졌고(p=0.00, p=0.000, p=0.001), 열량 제한 시험 전의 기초치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg.dL 보다도 더욱 낮아졌으며 유의한 차이(p=0.001, p=0.02, p=0.005)를 나타내었다. 14예에서 시행한 ^(99m)-Tc DISIDA 스캔에서 9예(64.3%)가 정상이었고, 5예(35.7%)에서는 심장 및 신장으로의 간외 섭취가 3예였고, 60분까지 소장 배출이 없는 배설 지연 예와 담낭 수축 불량 예가 각각 1예 씩 발견되었다. Phenobarbital 투여시험에서 민감도가 열량제한시험에 비해 더 높았다(92.3%와 50.0%). Gilbert 증후군에서 1일 400 Kcal로 48시간의 열량제한 시험과 1일 60mg의 phenobarbital을 5일간 투여하는 유도 시험은 편리하고 유용한 임상적인 진단법으로 이용할 수 있다고 생각된다. 그러나 열량 제한 시험에서는 증가 기준의 통일이 필요하다고 유추되며 phenobarbital 유도 시험이 민감도가 더 높은 것으로 생각된다. Gilbert's syndrome is very frequent and benign chronic process characterized by mild, intermittent, unconjugated hyperbilirubinemia without any symptom and sign of liver disease. Previously intoduced caloric restriction test and phenobarbital stimulation test as two appropriate clinical tests had been examined and their diagnostic values were reevaluated. Fourteen patients with mild, persistent, unconjugated hyperbilirubinemia were included. Subsequently caloric restriction has been applicated by 400 Kcal/day for 48 hours and phenobarbital has been prescribed by 60 mg/day for 5 days. Therafter serum levels of total and direct bilirubin were measured. Most of the patients were third and fourth decade(85.8%) and male predominant. Each basal serum levels of total, indirect and direct bilirubin were 3.0±0.8, 2.2±0.8 and 0.7±0.4 mg/dL. After caloric restriction test, each levels were increased significantly to 5.5±2.7, 4.2±2.3 and 1.3±1.0 mg/dL(p=0.001, p=0.001, p=0.023). After phenobarbital stimulation test for 13 patients had been practiced, increased levels of each bilirubin after caloric restriction test were decreased significantly to 2.0±1.0, 1.5±0.8 and 0.5±0.4 mg/dL(p=0.000, p=0.000, p=0.001) and these levels were significantly lower than basal levels(p=0.001, p=0.02, p=0.005). The sensitivities of caloric restriction test were 85.7%, 50.0%, and 71.4%, 35.7%(1.0, 1.5 mg increase of total bilirubin and 1.0, 1.5 mg/dL increase of indirect bilirubin). The sensitivities of phenobarbital stimulation test were 93.2% and 92.3% at criteria of 1.5 mg/dL increase of total bilirubin and indirect bilirubin. On the diagnosis of Gilbert syndrome, caloric restriction test and phenobarbital stimulation test are convenient and useful diagnostic tools in clinical face. And also phenobarbital stimulation test has higher sensitivity than caloric restriction test. Furthermore, standardization of bilirubin increment would be necessary in caloric restriction test.

연폭로 근로자들에서 흡연 및 보건행태학적 변수가 주관적 자각증상에 미치는 영향

이성수,김화성,리갑수,안규동,이병국 순천향대학교 산업의학연구소 1997 순천향산업의학 Vol.3 No.1

To investigate the effect of smoking and drinking habit on the health status of lead workers, 220 male workers in lead using industries and 210 male controls were selected for this study. Selected study variables were lead in blood (PbB), zinc protoporphyrin in blood (ZPP), delta-aminolevulinic acid in urine(DALA), hemoglobin (Hb), and hematocrit (Hct). Questionnaire for lead related symptoms (15 symptoms) and smoking and drinking habit was provided to all the workers and filled up by themselves and reconfirmed by physician. The results obtained were as follows; 1. While smoking and drinking rate of lead exposed group were 77.7% and 75.8%, respectively, those of control group were 53.3% and 35.7%, respectively. 2. Mean values of lead exposed indices of lead workers was significantly different from other group. 3. In exposed workers, there was significant differences of DALA between smoker and non-smoker. 4. The neuromuscular symptom prevalence of lead exposure was higher in lead exposed group than non-exposed group. 5. Symptom prealence of lead exposure were higher in drinking and smoking group than non-drinking and non-smoking group. 6. While logistic analysis of positive neuromuscular symptom with categorized blood lead and age, smoking, drinking as categorized independent variables indicated that only blood lead (>40㎍/㎗) was significantly contributed to dependent variable with 95% significant odd ratio confidence interval, logistic analysis of positive constitutional symptom with same categorized independent variables indicated that only age (>40years) was significantly contributed to dependent variable. And logistic analysis of total symptom with same categorized independent variables indicated that blood lead (>40㎍/㎗) and age (>40years) were significantly contributed to dependent variable.

납 폭로 근로자에서 δ-aminolevulinic acid dehydratase 유전형질이 zinc protoporphyrin 및 δ-aminolevulinic acid에 미치는 영향

이병국,황규윤,장봉기,김용배,리갑수,안현철,김화성,이성수,안규동,박종범 순천향대학교 산업의학연구소 1999 순천향산업의학 Vol.5 No.1

The inhibition of δ-aminolevulinic acid dehydratase (ALAD) in the heme synthetic pathway results in increased protophoryphyrin (ZPP) and δ-aminolevulinic acid (ALA) and is responsible for some of toxicological effects of lead. This enzyme is coded by the ALAD gene containing 2 co-dominant alleles. The polymorphisms of ALAD gene may be related to differential effects of lead on ZPP and ALA, ALAD genotype was measured in 975 Korean male lead workers, of whom 897 were homozygous for ALAD1 (ALAD 1-1 genotype) and 96 were heterozygous for ALAD2 (ALAD 1-2 genotype). Blood lead in subjects with ALAD1 was significantly higher than those with ALAD2 (p = 0.01). No difference between ALAD genotypes was found for age, exposure duration, ZPP, ALA, hemoglobin, hematocrit, body mass index, tobacco and alcohol use. After adjustment for possible confounders, ALA and ZPP became significantly elevated in ALAD1 subjects (p = 0.004 and 0.055, respectively). This result suggests that ALAD1 subjects may be more susceptible to the hematotoxicologic effects of lead than ALAD2 subjects.

전자부품 제조업 근로자들의 시력변화에 대한 연구

이용만,안규동,이성수,함정오,김화성,리갑수,이병국 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

근접작업이 시력약화의 원인이 될 수 있는가를 알아보기 위하여 전자부품을 제조하는 2개 사업장에서 1991년에서 1993년까지 입사한 근로자들 중에서 근접작업으로 인정되는 마이크로칩을 조립하는 근접작업자 306명을 조사군으로, 대조군은 세탁기 타이머 및 일반 기계기구를 조립하는 작업자 154명, 계 460명을 선정하였다. 이들 대상자는 1991년 입사자는 1993, 1994, 1995년 시력을 조사하였으며, 1992년 입사자는 1993, 1994, 1995년 3년동안 조사를 하였으며, 1993년 입사자는 1994, 1995년 2년간 시력을 조사하였다. 대상자 중에서 입사시 안경을 착용한 근로자는 82명(17.8%)이었다. 따라서 남자 근로자와 안경착용자를 제외한 여성 근로자들 335명만을 추적 조사하여 다음과 같은 결론을 얻었다. 조사군에서 입사시 시력 1.0 이상이었던 근로자의 분포는 취업 1년 후 약 25-35% 정도 감소하였으며, 2년후에는 약 40-60% 정도의 감소를 나타내었고, 3년 후 약 50-65% 정도로 감소하였고 4년후에는 약 65% 이상 감소하였다. 그러나 대조군에서는 1.0 이상의 시력을 보였던 근로자들의 비율이 취업 1년 또는 2년 후 15-30%의 감소를 보이고 있으나 그 이후에는 큰 변동이 없었다. 이들의 시력변화를 근무년수에 따라 알아보기 위하여 조사된 시력을 순위변수로 하여 Kruskall-Wallis 검정을 시행한 결과 조사군, 대조군 모두에서 근속년수에 따른 순위의 합의 평균이 년차적으로 유의하게 감소하였으나, 입사시부터 근속년수에 따른 조사군과 대조군과의 순위합의 평균에 의한 시력차 비교에서 입사시 조사군의 순위합의 평균이 유의하게 높았던 것이 근무기간에 따라 대조군의 평균이 높아지면서 통계적 유의성이 없고 대체적으로 1년 이후부터 변화가 적은 것으로 나타나 근접작업으로 인한 시력약화를 추정할 수 있었다. This study was carried out to investigate that the close distance works were associated with decreased visual acuity. 306 workers were subjects who had been recruited from 1991 to 1993 in two electronic parts manufacturing factories, and 154 workers were controls who had been employed from 1991 to 1993 in launder machine timer and general machine assembly factories. Subjects who had been employed in 1991 and 1992 were follow up from 1993 to 1995, and subjects who had been employed in 1993 were from 1994 to 1995. The male workers as well as glasses wearing workers were excluded. Only 335 female workers were followed up to study the change of visual acuity. The results were as follows; The rate of workers with visual acuity over 1.0 at recruit year in subjects group was decreased about 25-35% after 1 year, 40-60% after 2 years, 50-65% after 3 years, and 65% after 4 years. While, the rate of workers with visual acuity over 1.0 at recruit year in control group was decreased about 15-30% after 1 or 2 years, and there was no more additional visual acuity reduction after then. Kruskall-Wallis test was performed to investigate the change of visual acuity in subject and control group by work duration. The means scores of ranks in both group were significantly decreased by work duration. The mean scores of ranks in subject group at recruit year were significantly higher than those in control group at recruit year, but these differences were disappeared after 1 year work. Therefore, this suggest that close distance workers may be affected their visual acuity.

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.

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.