摘 要 鉛對人體所造成之健康危害，從古至今為公共衛生所重視之主 題。鉛由於具延展性、抗腐蝕性、導電性佳及低成本等優點，因此鉛 目前仍被工業界廣泛地應用，已造成對作業場所勞工潛在性之健康影 響。為了暸解職業性鉛暴露對鉛蓄電池工廠作業勞工所造成之健康危 害，本研究分為橫斷性研究及縱貫性研究兩部分，在橫斷性研究方 面，選取某鉛蓄電池工廠63 位勞工，依其血鉛值15μg/dL 分為高暴 露組及低暴露組，並選取一所國中34 位教師當作對照組，三組血中 鉛平均濃度分別為高暴露組34.71 μg/dL 、低暴露組9.27 μg/dL 、對照 組3.06 μg/dL ，具有顯著性之差異（P <0.01 ），並比較三組鉛暴露指 標與血液生化值、免疫功能與骨質測定之相關。在一般血液、生化值 測定，鉛暴露組顯示白血球有偏低現象且具顯著意義，紅血球及血色 素呈正相關，尤其男性鉛暴露組之血色素具統計意義(P<0.01)。鉛暴 露組較對照組之免疫功能具有顯著性降低（P <0.05 ）。在骨質測定方 面，骨質衰減率(BUA)與鋅原紫質(r=-0. 2252)、血中鉛(r=-0.2819)均 呈負相關且具顯著意義。環境測定則以裝配組為最高，經取對數值 後，三組間鉛粉塵與鋅原紫質、血中鉛及尿中鉛均具統計上顯著之差 異。另外，在縱貫性研究方面，以四種相關回歸模式及廣義估計量(GEE) 探討血中鉛含量變化與其他生化指數變化的相關性之結果，前一年血 中鉛與同年肝功能(ALT)呈正相關（P<0.05）；而以血中鉛的變化解釋 其他血液生化值的變化，發現紅血球及血球比容之變化，分別與血中 鉛變化呈正相關，而與肌酐酸則成相反變化趨勢；考量血中鉛的延遲 效應則均未達統計上顯著意義。 因此針對鉛蓄電池工廠作業環境的改善及健康促進計劃介入，應 持續執行及宣導，增進勞工良好個人衛生習慣及穿戴防護具，以減少 鉛暴露所造成之健康影響。 關鍵語：鉛蓄電廠、血中鉛、血液生化值、骨質測定、免疫功能; ABSTRACT Health effects caused by lead have been fully discussed concerning to public health. In addition to the its extensiveness, anticorrosion, conductivity and less expensiveness, lead is still wildly used by various industrial at present time. Due to the well documented and numerous toxic effects of lead on various target organs, a number of studies have shown that acute and chronic exposure to inorganic lead may result in impairment of hematological and immune functions. But there are no available studies among lead workers in Taiwan. The objective of this study to conduct both cross-sectional and longitudinal study to evaluate the health effects among lead battery manufacturing workers. 63 workers are selected and classified based on blood lead levels (BLL) at 15 μg/dL and 34 subjects, were teachers from a junior high school, were selected as the control which BLL was 3.06 μg/dL. Subjects with hematology, immune functions and bone mineral density were evaluated and correlated with blood lead levels. Four regression models using generalized estimating equation (GEE) were used to investigate the association between health effects and BLL. The results showed the significant difference between BLL and hemoglobin in male groups and immunological parameters in exposure group was significant lower than the control group. Take log transformation of environmental monitoring, there is the significant correlation between environmental and biological monitoring of lead. ALT level was found to be positively associated with the previous year’s BLL but the negative association with creatinine in blood. Moreover, the positive correlation between erythrocytes and hematocrit and BLL by GEE model. Therefore, it is necessary to take several protective strategies such as improvement of the workplace, encouragement of wearing personal protective equipment and enforcement of an intervention of health promotion plan upgraded the personal hygiene among lead workers in order to decrease BLL and health effects.
