【摘要】 目的　评价红细胞嘧啶 5′核苷酸酶筛选职业性铅中毒的准确性。方法　连续性收集15 7名铅接触工人及 30名健康对照组的血标本 ,同时测定红细胞嘧啶 5′核苷酸酶 (P5′N)的活性、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)。以血铅≥ 1.93μmol/L、≥2 .90 μmol/L为金标准 ,用Receiver OperatingCharacteristic (ROC)曲线下的面积 (AUCROC)评价上述指标的准确性。在ROC曲线上制定各指标筛选血铅≥ 1.93μmol/L、≥ 2 .90 μmol/L的最佳临界点 ,用EPINFOR统计软件比较 3种平行试验的敏感度。结果　筛选血铅≥ 1.93μmol/L ,红细胞P5′NROC曲线下的面积明显大于尿铅、尿δ ALA ;联合红细胞P5′N和ZPP平行试验的敏感度高于联合尿铅和尿δ ALA的平行试验 (P <0 .0 5 )。筛选血铅≥ 2 90 μmol/L ,红细胞P5′NROC曲线下的面积明显大于FEP、尿铅、尿δ ALA ;联合红细胞P5′N和ZPP平行试验的敏感度高于联合FEP与ZPP的平行试验以及联合尿铅与尿δ ALA的平行试验 (P <0 .0 5 )。结论　红细胞P5′N筛选铅中毒的准确性较高 ,联合红细胞P5′N与ZPP的平行试验筛选铅中毒的敏感度最高。更多还原

【Abstract】 Objective To determine the diagnostic value of red cell P5′N for detecting occupational lead poisoning. Methods Red cell pyrimidine 5′ nucleotidase, blood lead and urine lead levels, free erythrocyte protoporphyrin (FEP), zinc protoporphyrin (ZPP) and urine δ aminolevulinic acid levels were determined in 157 lead exposed workers and 30 non exposed healthy people. According to the golden standard; i.e. blood lead ≥1 93 μmol/L and ≥2.90 μmol/L, the diagnostic value of red cell P5′N and other indicators for detecting blood lead ≥1.93 μmol/L and ≥2.90 μmol/L was compared by receiver operative characteristic curve (ROC) software. After determining the optimal cut points of the above indicators for detecting the blood lead ≥1.93 μmol/L and ≥2 90 μmol/L, the sensitivity of the parallel tests for detecting the blood lead ≥1.93 μmol/L and ≥2.90 μmol/L was calculated and compared by EPINFOR software. Results For detecting blood lead level ≥1.93 μmol/L, the areas under ROC curve (AUC ROC ) of P5′N was significantly larger than that of urinary lead and urinary δ ALA ( P <0.05). The sensitivity of parallel tests with ZPP and P5′N was significantly larger than that of parallel tests with Upb and Uδ ALA. For detecting blood lead level ≥2.90 μmol/L,the areas under ROC curve (AUC ROC )of P5′N was significantly larger than that of urinary lead, FEP and urinary δ ALA ( P <0.05). The sensitivity of parallel tests with P5′N and ZPP was significantly larger than that of parallel tests with Upb and Uδ ALA, and that of parallel tests with ZPP and FEP ( P <0.05). Conclusion For detecting blood lead ≥1.93 μmol/L and ≥2.90 μmol/L, red cell P5′N is more accurate. It is worth being applied in detecting occupational lead poisoning. For detecting blood lead≥1.93 μmol/L and ≥2.90 μmol/L, the parallel tests with P5′N and ZPP are more accurate.更多还原