Common Symptoms of Cadmium Workers in the Taoyuan Area - A Demonstration of Dose Response

桃園地區鎘作業員工常見的症狀及其劑量效應關係

涂醒哲(Shing-Jer Twu) ； 黃一純(I-Shun Hwang) ； 江昭興(Chau-Hsing Chiang) ； 鄭玉娟(Yu-Juen Cheng)

《The Kaohsiung Journal of Medical Sciences》 3卷9期 (1987/09) Pp. 605-611

https://doi.org/10.6452/KJMS.198709.0605

摘要

鎘是一種用途廣泛的金屬，其急慢性中毒的事件在外國已報告很多。雖然病理變化上以肺及腎臟的病變為主，但有不少病人雖然血清中鎘的濃度升高，且有胸痛、呼吸困難、頭暈等症狀。甚至有鎘推積在腎臟的證據，但卻查無肺腎功能的異常。因此對於症狀的掌握也是早期發現鎘危害的重要方式之一。
本研究針對桃園地區三家製造塑膠安定劑之鎘作業工廠的員工，依其暴露於鎘的期間分成未露群、暴露五年以下及暴露五年或五年以上三組，調查其各種症狀，並以Mantel-Haenszel統計方法對年齡作校正及檢驗其暴露量和症狀之間之劑量效應關係。
結果顯示：胸痛或胸悶、咳嗽、胃腸不適（包括噁心、嘔吐、腹痛、腹瀉）、鼻子或喉嚨受刺激、四肢及背部的骨頭或關節痛等五種症狀有隨著露量之增加而增加的趨勢，其中尤以咳嗽及胸痛胸悶的特異性較高。喪失嗅覺是特異性最高的一種症狀，但有些症狀的人數較少，其隨暴露量增加而罹患率增加之趨勢未達統計學上的意義。其他特異性較高的症狀如厲害腹痛、便秘、口中有金屬味道、發抖或流汗等也均有明顯但未達統計意義的劑量效應，以上十種症狀均可視為鎘作業所引起的症狀，可用來作鎘作業員工的危害指標。至於背部及四肢酸痛、頭痛頭暈、呼吸困難疲勞或心跳很快等三種症狀，則不是特異性太低就是沒有隨著暴露量增加而罹患率增加的現像，均不適宜作為鎘危害的症狀指標。

並列摘要

Cadmium poisoning has been widely reported. The main pathological changes are those found in the lungs and kidneys. In spite of the dose response relationship of the blood cadmium level and the prevalence of symptoms, and the large amount of cadmium detected in the kidney, no significant renal or pulmonary dysfunction can be observed in some of the previous studies. The detection of symptoms, though subjective, is one method of recognizing early damage due to cadmium exposure.
In this study, we surveyed 137 subjects from three cadmium factories making stabilizer of polyvinylchloride. The subjects were divided by cadmium exposure to nonexposure, exposure less than five years and exposure equal to or more than five years. The analysis of dose response was performed by extended Mantel-Haenszel method.
The results showed a positive trend in the symptoms of chest pain/tightness, cough, GI upset: nausea/pain/diarrhea/vomiting, irritation of nose/throat, bone joint pain in extremities/back. Among these specificity is high in symptoms of chest pain/tightness and cough.
The highest specificity was in the symptom of anosmia. But the trend was not of major significance. Other symptoms with positive, but statistically nonsignificant trend, included severe abdominal pain, constipation, metallic taste, and chill/sweating. The ten symptoms mentioned above can be used as indicators of cadmium exposure. Three symptoms such as aching in extremities/back, headache/dizziness and shortness of breath/weakness/palpitation, either nonspecific or with no dose effect, were not suitable for use in the detection of cadmium damage.

並列關鍵字

cadmium ； symptom ； dose response