Health Survey And Genetic Damage Research Of VCM Contacted Workers Employed By A Chemical Plant In Tian Jin

Objective Vinyl Chloride Monomer(VCM) is a kind of chemical which target organs is liver,the damage of VCM to workers varies from liver disease to genetic damage. Recently,as exposure limit of VCM has turned down, way of exposure has changed to low concentration exposure in VCM occupational workers and the prevalence of fatty liver is higher than the general population. Liver biopsy is the “gold standard”, but it is an invasive examination, the practicality is not good. VCM professional people usually take ultrasound as the only mean for fatty liver diagnosis. Fatty liver index(FLI), a newly fatty liver predictive method, has been tested for validation not only in European but also in Asian. So far, there is no related validation and application in VCM occupational exposure crowd. We expect to use the liver enzymes-alanine aminotransferase(ALT), aspartate aminotransferase(AST), γ-glutamyl transferase(GGT), and FLI to forecast the fatty liver disease in VCM occupational exposure crowd, seeking for the best indicator. Another impaction of VCM is genetic damage.We describe the genetic damage of this special crowd by micronucleus using CBMN,then explore the major risk factors of genetic damage.Content and Method1. By dealing with the data of questionnaire survey and physical examination, we get to know the health condition of workers.2. Seek for the risk factors of ranking first disease in order to explore the emphasis in disease prevention.3. Use liver enzyme indicators(ALT, AST, GGT) to predict fatty liver disease, and then, select the best predictive indicator.4. Explore the indicate effect of FLI in VCM occupational workers, evaluate its predictive effect.5. Selecting 113 workers who have higher VCM exposure concentration for CBMN to explore their situation of genetic damage, and then, explore the dangerous factors.Results1. In our research, fatty liver has the highest prevalence, hypertension and hyperlipidemia are in turn the second and third. Prevalence of fatty liver is always the highest in groups, grouping by all kinds of factors, such as age, gender, etc.2. By risk factor analysis, we find out that in addition to the VCM exposure,metabolism-associated diseases, such as over-weight, hyperlipidemia, also have effects on fatty liver disease in VCM exposed workers.3. As heavy drinking have an effect on GGT, we exclude the heavy drinking ones.The ROC curve is used to search for the best thresholds. Use the high-normal of liver enzymes(ALT、AST、GGT) and the best thresholds to forecast fatty liver, respectively.Results show that the high-normal has a very good specific degree, but the sensitivity is disappointing. Both methods have the same result in ranking as GGT(29)ALT(29)AST.4. FLI has a good AUC of 0.914(95%CI, 0.877-0.951), it can well diagnose fatty liver disease with the accuracy of 0.842. By comparing with the constituent parts of FLI, the diagnosis effect turns out that FLI(29)BMI(29)WC(29)GGT(29)TG.5. We analysis risk factors for genetic damage, it turned out that gender, age, smoking,alcohol intake have no significant effect. Multiple logistic regression analysis showed that only VCM exposure entered into regression equation. The risk that genetic damage occurs in middle dose and high dose group are 4.133(95%CI, 1.380- 12.379)and 5.667 times(95%CI, 1.847-17.382) compared with low dose group.Conclusion1. Prevalence of fatty liver is the highest, which followed by hyperlipidemia and hypertension.2. Risk factors of fatty liver disease announce that prevention of fatty liver disease should take occupational protection and metabolism related indicators both into account under the condition of low VCM concentration exposure.3. Indicators of liver enzymes did not stand out in fatty liver prediction. Take predictive effect into consideration, GGT is more suitable. High-normal of liver enzymes seems to be inappropriate, threshold reduction should be considered.4. Take prediction effect into consideration, FLI has a better effect in fatty liver prediction.It is able to predict fatty liver in VCM occupational group. It has a better accuracy compared with other indicators and is beneficial to self-monitoring.5. VCM cumulative exposure concentration has a certain influence on genetic damage.The higher cumulative concentration of VCM exposure, the greater risk of genetic damage occurrence there will be. We fail to prove that gender, age, smoking and alcohol intake have influences on genetic damage, this may due to the small number of our study crowd.