BIOMARKERS OF DOSE AND EFFECT IN ADULT LEAD POISONING

成人铅中毒仍然是一种常见和严重的疾病， 美国的 最近对儿童和成人的研究提出了新的 对成人暴露的担忧，以前认为没有 健康风险。 公共卫生从业人员和决策者必须重新认识 关于低剂量铅暴露安全性的长期假设。 临床医生照顾铅吸收增加的患者 关于临床干预的风险和益处的紧迫问题 这是目前的知识无法回答的。 关于既往接触后果的研究和 临床干预将需要使用更敏感和更具体的 铅剂量和铅效应的标记物。 一种重要的剂量新标志--X线骨铅测量 荧光（PbXRF）和两个新的生物标志物的影响，肾铅结合 蛋白质（RLBP）和羧基-铜和尿卟啉（CCUP）最近 变得可用。 这些新的生物标志物似乎更准确， 比以前可用的生物标志物更特异和灵敏。 一个多- 一个由研究人员组成的纪律小组提出了三项密切相关的研究， 验证这些新的生物标志物作为长期健康影响的预测因子 在铅中毒后，确定其在临床研究中的用途， 对身体铅负荷升高的个体进行干预， 评估其对具有以下水平的人群研究的敏感性： 吸收低于目前使用的生物标志物的范围。

Lead poisoning in adults remains a common and serious illness in the United States. Recent studies on children and adults have raised new concerns about adult exposures that were previously felt to be without health risk. Public health practitioners and policy makers must readdress long held assumptions about the safety of lower dose exposure to lead. Clinicians caring for patients with increased lead absorption bare faced with urgent questions about risks and benefits of clinical interventions which cannot be answered with present knowledge. Studies of the consequences of previous exposures and controlled trials of clinical intervention will require the use of more sensitive and specific markers of lead dose and lead effect than have been heretofore available. An important new marker of dose, bone lead measurement by x-ray fluorescence (PbXRF), and two new biomarkers of effect, renal lead binding protein (RLBP) and carboxy-copro and uroporphyrins (CCUP) have recently become available. These new biomarkers appear to be more accurate, specific and sensitive than previously available biomarkers. A multi- disciplinary team of investigators propose three closely linked studies to validate these new biomarkers as predictors of long term health effects after lead intoxication, to establish their use in studies of clinical interventions in individuals with elevated body burdens of lead, and to assess their sensitivity for studies of populations with levels of absorption below the range of currently used biomarkers.