THE EFFECTS OF RETAINED LEAD BULLETS ON BODY LEAD BURDEN

残留铅弹对人体铅负荷的影响

• 批准号: 6195278
• 负责人: STEPHEN J ROTHENBERG
• 金额: $ 44.88万
• 依托单位: CHARLES R. DREW UNIVERSITY OF MED & SCI
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-08-01 至 2003-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6195278
• 关键词: X ray; blood chemistry; clinical research; environmental exposure; foreign body reaction; human morbidity; human subject; injury; lead; lead poisoning; longitudinal human study; outcomes research; questionnaires; radiofluorescent probe; statistics /biometry

Numerous case reports have demonstrated lead poisoning with potentially fatal consequences can result from retained lead projectiles following firearm injuries. To assess the impact of retained projectiles on subsequent lead exposure, one cannot rely on self-selected cases presenting with symptoms of lead intoxication. The long-term goal of this project is to reduce the morbidity associated with body lead burden as a result of retained bullets from firearm injuries. The proposed investigation seeks to identify risk factors of elevated blood lead levels for individuals with retained lead bullets, establish appropriate protocols for lead testing, develop indications for bullet removal and provide guidelines for the appropriate management of fragments not removed. The study design included follow-up of 300 patients with retained lead bullets/bullet fragments presenting for acute care of firearm injury at large publicly owned Level 1 Trauma Center. A baseline blood level is measured as soon after patient stabilization as possible and repeated at intervals of 3, 6 and 12 months. Medical history regarding prior firearms injuries and other retained projectiles is taken, along with a screening and risk factor questionnaire to determine other sources of lead (occupational/recreational) to which the patient might have been or at present be exposed. The patient will have K- shell X ray florescence determination of bone lead in the tibia and calcaneus in order to determine past lead exposure not revealed by medical history and risk factor questionnairer. Multivariate models of blood level are made for each patient visit using risk factor and bone lead concentration data. Determinations will be made if changes in blood lead, adjusted for risk factors and bone lead concentration, from one 3 month period to the next can be significantly predicted by the coded location and fragmentation data of projectiles and presence or absence of fractures. The variables of location, fragmentation, fracture and total time during which the projectile was retained in the body will be tested using logistic regression. This will determine odds ratios of elevated lead at various concentrations (greater than 15 mug/dL, greater than 25 mug/dL, greater than 40 mug/dL, etc.) due to these factors. Data will also be analyzed in the framework of the general linear model (GML), with a repeated measure design. Principal interest will be in increasing trend of blood level as a function of fragmentation location, fracture and duration variables.

许多案例报告表明，火器伤害后残留的铅弹可能导致铅中毒，并可能导致致命后果。为了评估残留弹丸对随后铅暴露的影响，不能依赖于自我选择的出现铅中毒症状的病例。该项目的长期目标是减少因火器伤害留下的子弹而造成的与身体铅负担有关的发病率。拟议的调查旨在确定携带残留铅弹的个人血铅水平升高的危险因素，建立适当的铅检测方案，制定取出子弹的适应症，并为未取出的碎片的适当管理提供指导。研究设计包括随访300名在大型公立一级创伤中心接受火器损伤急性护理的残留铅弹/子弹碎片患者。在患者病情稳定后尽快测量基线血水平，并每隔3、6和12个月重复一次。记录有关先前火器伤害和其他遗留弹丸的病史，同时进行筛查和风险因素调查表，以确定患者可能已经或目前可能接触到的其他铅源（职业/娱乐）。患者将接受K- shell X射线荧光测定胫骨和跟骨的骨铅，以确定病史和危险因素问卷未显示的既往铅暴露情况。使用危险因素和骨铅浓度数据，为每位患者的就诊建立了血液水平的多变量模型。如果从一个3个月到下一个3个月期间的血铅变化（根据危险因素和骨铅浓度进行调整）可以通过弹丸的编码位置和碎片数据以及是否存在骨折进行显著预测，则可以做出决定。使用逻辑回归测试弹丸在体内停留的位置、碎片、断裂和总时间等变量。这将决定不同浓度（大于15马克杯/分升，大于25马克杯/分升，大于40马克杯/分升等）铅升高的优势比。数据也将在一般线性模型（GML）的框架内进行分析，并采用重复测量设计。主要关注的是血药浓度随骨折部位、骨折和持续时间的变化趋势。