探討年輕健康成人血中重金屬(鉛,砷,鋅,銅,硒)濃度之參考值

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Title:	探討年輕健康成人血中重金屬(鉛,砷,鋅,銅,硒)濃度之參考值
Authors:	張吉慶;Chi-Ching Chang
Contributors:	中國醫藥大學：環境醫學研究所
Keywords:	參考值;血中鉛;重金屬;ROC curve;ICP-MS;Reference value;Blood lead;Heavy metals
Date:	2008-06-26
Issue Date:	2009-08-11 16:56:17 (UTC+8)
Abstract:	背景：現行臨床上對於一般族群所使用的血中鉛參考值，大多是參考國內外文獻整理所訂定的參考值，由於近期較少這類文獻且因時間與區域的特異性，導致缺乏代表國人的參考值。因此，本研究使用後無鉛汽油年代的血中重金屬資料，來探討台灣地區族群血中鉛與其他重金屬（砷、鋅、銅、硒）的濃度與分佈狀況，以供臨床參考以及未來研究作為準則。方法：本研究蒐集中國醫藥大學環境醫學研究所與台灣大學職業性微量金屬研究實驗室近年來分析血中重金屬的資料，蒐集期間為2005~2007年，挑選423位20~29歲年輕健康成人為研究對象，其中有181位男性(42.8%)與有242位女性(57.2%)，平均年齡24.9歲、標準差2.6歲。結果：血中鉛的幾何平均濃度為1.99 μg/dL、標準差2.06；砷的幾何平均濃度為0.66 μg/dL、標準差2.55；鋅的幾何平均濃度為7.83 mg/L、標準差1.78；銅的幾何平均濃度為1.08 mg/L、標準差1.55；硒的平均濃度為幾何平均濃度為0.19 mg/L、標準差1.93。並以年齡、性別以及區域別三個因子建立一個分辨血鉛的模式，發現有很高的預測能力，其ROC curve (Receiver Operating Characteristic Curve)下的面積至少都在0.68以上。此外，以線性廻歸模式進行調整後，發現血鉛與身高有負向的趨勢，但是在統計上沒有顯著。結論：根據這些資料所呈現的值與現行臨床參考值比較，顯示現行臨床血中鉛的參考值有重新修訂的必要。由於目前沒有統一的參考值可供參考，建議政府相關單位可以列出一般族群的各類重金屬參考值供臨床以及研究做參考。 Background: The aim of this study was to provide health organizations possible reference data for the often exposed metals (Pb, As, Zn, Cu and Se), based on analyzing their distributions in a general population with the consideration of some demographic, geographic and biological factors. Methods: In this study, the blood specimens for heavy metals determinations were collected from 423 young adults aged 20-29 years (181 men, 242 women) selected by two laboratories—the Institute of Environmental Health at China Medical University and the Occupational Trace Metals Lab at National Taiwan University. Authropometric information of each participant was also obtained. ICP-MS was used to measure the concentrations of metals. Results: The geometric means of blood Pb, As, Zn, Cu and Se levels were 1.99 μg/dL (SD=2.06), 0.66 μg/dL(SD=2.55), 7.83 mg/L(SD=1.78), 1.08 mg/L (SD=1.55) and 0.19 mg/L(SD=1.93), respectively. With the consideration of the age, sex, and residential area, the reference values of the often used trace metals were recommended. In addition, age, gender and residential area specific ROC curve were established to distinguish the low lead levels from high levels, and the obtained areas under all of the curves were above 0.68, indicating a high predictive ability. People living in the central Taiwan tended to have higher blood levels of the heavy metals than those in the Northern Taiwan. Gender differences were found in most of the trace metals except Cu for subjects living in the central Taiwan, and except As and Se for those in the Northern Taiwan, in where the average levels were in males higher than in females. Conclusion: According to the above results, we recommended to establish much lower blood lead levels as safer reference values for the general population with the consideration of the age variation.
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