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铅中毒筛选指标的再评价 |
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吕玲 林果为 徐麦玲 邹和建 王倩
摘要 目的 评价铅中毒筛选指标的准确性。方法 连续收集157名铅接触工人的血标本，同时测定血铅、红细胞游离原卟啉（FEP）、锌卟啉（ZPP）、尿铅、尿δ-氨基-酮戊酸（δ-ALA）,红细胞嘧啶5′核苷酸酶（P5′N）的活性。以血铅≥1.93 μmol/L、≥2.90 μmol/L为金标准，用受试者工作特征（ROC）曲线下的面积评价上述指标在血铅≥1.93 μmol/L、≥2.90 μmol/L的准确性，用ROC曲线分析软件、EPINFOR统计软件对筛选血铅≥1.93 μmol/L、≥2.90 μmol/L时平行试验的准确性进行比较。结果 血铅≥1.93 μmol/L时，根据ROC曲线下的面积（AUCROC），各指标的准确性分别为：ZPP 0.978、红细胞P5′N 0.973、FEP 0.937、尿δ-ALA 0.890、尿铅0.845，尿δ-ALA和尿铅与ZPP比较，差异有显著性；血铅≥2.90 μmol/L时，根据ROC曲线下的面积（AUCROC），各指标的准确性分别为：红细胞P5′N 0.975、ZPP 0.954、FEP 0.906、尿δ-ALA 0.900、尿铅0.750，FEP、尿δ-ALA和尿铅与红细胞P5′N比较，差异有显著性。筛选血铅≥1.93 μmol/L和≥2.90 μmol/L，联合红细胞P5′N和ZPP平行试验的敏感度显著高于联合尿铅和尿δ-ALA的平行试验。结论 血铅≥1.93 μmol/L及≥2.90 μmol/L，红细胞P5′N及 ZPP的准确性较高，联合红细胞P5′N和ZPP平行试验的敏感度较高。
关键词 铅中毒 诊断
Re-assessment of Indicators for Screening Lead Poisoning
L Ling*, LIN Guowei, XU Mailing, et al.
* Shanghai Medical University, Shanghai, 200040
Abstract Objective To determine the accuracy of the indicators for detecting lead poisoning. Methods Blood and urine specimens in 157 workers exposed to lead were collected. Their blood levels of lead, free erythrocyte protoporphyrin (FEP), zinc protoporphyrin (ZPP), urine δ-aminolevulinic acid and activity of red cell pyrimidine 5′-nucleotidase were determined, with gold standards of blood lead levels of ≥1.93 μmol/L and ≥2.90 μmol/L. Accuracy assessment of the indicators mentioned above for detecting lead poisoning was based on the area under the receiver operative characteristic (AUCROC) curve with a software specially for ROC curve analysis and software of Epi-Info, after determining the optimal cut-off points for the above mentioned indicators in detecting those with blood lead ≥1.93 μmol/L and ≥2.90 μmol/L. The sensitivity of screening in parallel for de[1] [2] [3] 下一页
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