Lead toxicity: from overt to subclinical to subtle health effects.
Lead toxicity: from overt to subclinical to subtle health effects.
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DOI：
10.1289/ehp.9086177
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发表时间：
1990-06
影响因子：
10.4
通讯作者：
Goyer RA
中科院分区：
文献类型：
--
作者：
Goyer RA
虽然铅的毒性在几个世纪前就被认识到，但关注仅限于明显的症状：绞痛、脑病、贫血或肾脏疾病。在限制毒性方面缺乏进展的两个主要原因是，人们的兴趣仅限于职业接触，对具体的生化或代谢影响缺乏认识。在过去的15年或20年里，由于开发了检测临床上不明显的认知和行为变化的敏感措施，以及测量血红素酶活性降低的方法，亚临床效应的识别已经成为可能。这一进展是由基础和临床研究推动的，这些研究导致了对细胞毒理学的更好理解。新的认识促使降低了可接受的职业接触，如血铅从80到40到60微克/分升的范围，并建立了儿童最大推荐接触血铅水平为25微克/分升。降低汽油中的铅含量已经通过美国人的平均血液水平降低近50%来实现（NHANES II数据）。目前的研究表明，铅是影响大部分人群的一些常见疾病的致病因素，如轻微的认知和神经缺陷、高血压、先天性畸形、免疫毒性以及生长发育缺陷。对于这些疾病中的每一种，可能有多种病因因素;科学的挑战是开发敏感的方法来检测铅的特定作用。其他潜在的微妙健康影响包括少量铅对细胞增殖的影响以及铅作为致癌作用的辅助因素。（250字处删节）
Although the toxicity of lead was recognized centuries ago, concern was restricted to overt symptoms: colic, encephalopathy, anemia, or renal disease. Two major reasons for lack of progress in restricting toxicity were that interest was limited to occupational exposures and there was lack of awareness of specific biochemical or metabolic effects. Identification of subclinical effects has been possible the last 15 or 20 years because of the development of sensitive measures to detect cognitive and behavioral changes that are not apparent clinically and because of methods to measure the reduced activity of heme enzymes. This progress was driven by basic and clinical research that resulted in a better understanding of cellular toxicology. The new awareness prompted the lowering of acceptable occupational exposures, as measured by blood lead from 80 to 40 to 60 micrograms/dL range, and the establishment of maximum recommended exposures in children to a blood lead level of 25 micrograms/dL. Lowering the lead content in gasoline has been accomplished by a nearly 50% decrease in average blood levels of persons in the United States (NHANES II data). Current research implicates lead as a contributing etiologic factor in a number of common diseases affecting large portions of the population such as subtle cognitive and neurological deficits, hypertension, congenital malformations, immunotoxicity, and deficits in growth and development. For each of these disorders there may be multiple etiologic factors; the scientific challenge is to develop sensitive methodology to detect the specific role of lead. Other potential subtle health effects include the influence of small amounts of lead on cell proliferation and lead as a cofactor in carcinogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)