RU2545911C1 - Method for predicting high risk of industrial and occupational diseases in chemical workers employed in harmful working environment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention described a method for predicting the high risk of industrial and occupational diseases in chemical workers employed in harm involving measuring the total antioxidant status in blood serum, which is also analysed for quantitative content of lipid peroxidation products; if an increase of lipid peroxidation products of more than 4.31 mcmole/l and a decrease of total antioxidant status of less than 1.3 mcmole/l are observed, the high risk of industrial and occupational diseases is predicted.

EFFECT: using the invention simplifies and reduces the examination time, as well as labour inputs and material expenses.

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Description

The present invention relates to medicine, namely to occupational medicine, occupational health, and can be used to determine the high risk of development of industrial diseases due to workers of the chemical complex engaged in harmful working conditions.

The chemical complex is the basic sector of the global economy. According to experts, the estimated annual growth rate of the global chemical industry will be 2.7%, and by 2030 the volume of chemical products consumed will be more than $ 4 billion [E. Barkhatova Trends in the development of the chemical sector of the world economy. / E.I. Barkhatova / Bulletin of the Irkutsk State Economic Academy. 2011. No3. S.111-114].

Currently, Russian enterprises produce about 1.1% of the global chemical output [V. Andreev. Chemical and biological safety as part of the national security of Russia / V.G. Andreev, V.V. Baranenko // Scientific and analytical journal Observer. - Observer 2012.V.270. - No. 7. - S. 23-36].

The capacities of Russian manufacturers do not currently fully cover the needs of the population for chemical products. In this regard, the construction of new factories of the chemical industry is planned in the Russian Federation, which implies an increase in the employment of a significant number of the able-bodied population.

At the same time, a hygienic assessment of working conditions, carried out in a number of chemical industries, established that the working conditions of workers in the main professions (apparatchiks, repairmen, electricians) correspond to the harmful class [A. Pershin. Hygienic characteristics of the physical factors of the working environment in chemical production in the climatic conditions of Western Siberia / A.N. Pershin // Bulletin of the East Siberian Scientific Center SB RAMS. 2006. No3. S.63-66; Pershin A.N. Hygienic assessment of working conditions and the health status of chemical workers in Western Siberia depending on the types of technological processes and the structure of professions / A.N. Pershin, T.E. Pomytkina // Medicine in Kuzbass. 2010. No4. S.37-42; Assessment and management of occupational health risks of workers in organic synthesis production: Abstract. dis. for a job. scientist step. Cand. biol. Sciences: specialty 14.00.50 - occupational medicine / Zotova Tatyana Maratovna; [Research Institute of Occupational Medicine RAMS. - Moscow: 2008. - 24 p.: Ill .; 21 pp.]

A number of studies have shown that among workers in chemical industries there is an increase in the prevalence of a high risk of developing industrial and production-related diseases, such as diseases of the nervous system, cardiovascular system, diseases of the gastrointestinal tract [Meshchakova N.M. The dynamics of health disorders in workers of modern chemical industries / N.M. Meshchakova, M.P. Dyakovich, S.F. Shayakhmetov, E.V. Sorokina // Bulletin of the East Siberian Scientific Center SB RAMS. 2012. No. 2 - 2. P.87-91], in connection with which it is necessary to develop new methods for diagnosing a high risk of industrial-caused and occupational diseases in workers of the chemical complex engaged in harmful working conditions.

There is a method of assessing occupational health risks for workers, which consists in conducting a periodic medical examination of workers [Collection of Occupational health risks for workers. Leadership / Ed. N.F. Izmerova, E.I. Denisova. - M.: Trent, 2003. - S. 71-89]. However, conducting a periodic medical examination, the order of which is established in this collection, does not provide for the determination of peroxidation products and the general antioxidant status of workers. In addition, this method is quite laborious, requires large energy and material costs.

A known method for diagnosing a high risk of industrial-caused and occupational diseases in workers, including during a preliminary and periodic medical examination, conducting biochemical studies to determine the activity of ALT, ACT, GGT, alkaline phosphatase, bilirubin content [Order of the Ministry of Health and Social Development of the Russian Federation of April 12, 2011 N 302n “On approval of lists of harmful and (or) hazardous production factors and work, during the performance of which mandatory preliminary and periodic medical examinations are carried out ( examinations), and the procedure for conducting mandatory preliminary and periodic medical examinations (examinations) of workers engaged in hard work and in work with harmful and (or) dangerous working conditions ”]. However, the implementation of this method does not provide for the determination of peroxidation products and the general antioxidant status in workers. In addition, this method is quite time-consuming and complicated, requires large energy and material costs.

The prototype of the invention is a method for determining the degree of dependence of the disease on work, which consists in carrying out a hygienic assessment of working conditions, then a comprehensive assessment of the health status of workers, including clinical and functional research methods, epidemiological and medico-static studies, then a quantitative assessment of the relative risk and etiological share as a measure of production condition for the main studied indicators of health disorders. With relative risk values of up to 1, 4 and an etiological fraction of less than 33%, they are assessed as general diseases, with a relative risk of 1.5 to 5 and an etiological fraction of 33-80%, they are estimated as industrial-caused diseases, with a relative risk of above 5 and etiological - a share of 81-100% - as occupational diseases [RF patent No. 2189589, 2002].

The disadvantage of this method is its complexity and complexity, as well as the fact that this method is performed according to the results of a retrospective analysis, taking into account the obtained morbidity and prevalence of occupationally caused and occupational diseases.

The objective of the invention is to develop a method that allows you to determine the high risk of industrial-caused and occupational diseases in workers of the chemical complex engaged in harmful working conditions.

The technical result when using the invention is to simplify and reduce the time of the study, reducing the complexity and material costs.

The proposed method for predicting a high risk of industrial-caused and occupational diseases in workers of the chemical complex engaged in harmful working conditions is as follows. In blood serum, the quantitative content of lipid peroxidation products (lipid peroxidation) and total antioxidant status (AOS) are determined. With a simultaneous increase in the quantitative content of peroxides in lipids of more than 4.31 μmol / L and a decrease in the total antioxidant status of less than 1.3 mmol / L, workers in the chemical complex are diagnosed with a high risk of developing occupationally caused and occupational diseases.

The advantage of the proposed method is that the invention provides for the determination of a high risk of the development of occupationally caused and occupational diseases in a particular employee, taking into account the individual state of his body with the aim of pre-nosological diagnosis of industrial and occupational diseases at the stage of premorbid changes.

Determination of peroxides in serum lipids

To assess the intensity of peroxidation processes in our work, we determined the quantitative content of lipid peroxidation products in blood serum. Blood from a vein is collected in a test tube. After 20 minutes, the blood is centrifuged at 1500 rpm for 15 min at + 4 ° C to separate the blood serum, which is immediately subjected to analysis.

Reagents and their preparation. 1. Sulfuric acid, 0.1 N. 2. Phosphoric tungsten acid (PVA), 10%. 3. Thiobarbituric acid (TBA) - 0.67%. Prepared before use by heating and mixed with glacial acetic acid (1: 1). 4. N-butanol (hch).

1. To 0.25 ml of blood serum add 5 ml of 0.1 N sulfuric acid, 0.5 ml of a 10% solution of FVC, mix, incubated for 5 minutes at room temperature, then centrifuged at 1500 rpm for 5 minutes. Simultaneously with the test samples, a blank sample is put (without blood serum), all other stages are carried out in parallel with the test samples.

2. The supernatant is drained, 4 ml of distilled water is added to the precipitate, 1.0 ml of a solution of thiobarbituric acid is added, stirred and incubated in a water bath for 60 min at 95 ° C.

3. After the time has elapsed, the samples are cooled, 4 ml of n-butanol are added to the sample and extracted for 1 min on a vortex. To separate the layers, the samples are centrifuged for 5 min in test tubes with plugs at 1500 rpm.

4. Immediately after centrifugation, 3 ml of the supernatant is taken and the optical density of the experimental sample is measured against a blank at two wavelengths of 535 and 570 nm in a cuvette with a layer thickness of 1 cm. The measurement is carried out no later than 1.5 hours after centrifugation.

5. The calculation of the content of lipid peroxidation products in blood serum is carried out according to the formula

C = (D535-D570 / 0.156) × 16,

Where

C is the content of lipid peroxidation products in the experimental sample, μmol / l;

D535 is the optical density of the experimental sample at 535 nm;

D570 - optical density of the experimental sample at 570 nm;

0.156 is the molar extinction coefficient of the malonic dialdehyde - TBA complex in l / µmol / cm;

16 - serum dilution ratio.

Reference values 1.43-4.31 μmol / L.

Determination of general antioxidant status.

In order to determine the overall antioxidant status in the work, a kit is used to determine the general antioxidant status of Randox Laboratories LTD, Ardmore, Diamond Road, Crumlin, Co. Antrim, United Kingdom BT 29 4 QY

Blood from a vein in an amount of 3 ml is collected in a test tube. The tube is centrifuged at 2000 rpm for 15 minutes to obtain blood serum, which is subjected to analysis.

Method Description

2,2-amino-di- (3-ethylbenzothiazoline sulfonate) inhibits with peroxidase (methemoglobin) and H ₂ O ₂ with the formation of the ABTS radical cation, which has a blue color and is determined at a wavelength of 600 nm.

Reagent preparation:

1. Prepare the reagents. 1) R2: 10 ml of R1 buffer is dissolved in R2 (stable for 48 hours).

2) R3: 1 ml of substrate R3 + 1.5 ml of buffer R1 (stable for 24 hours)

3) standard solution ready in each set.

Reaction

Take 20 μl of blood serum, dissolve in 1 ml of R2, mix well and measure A1 at λ = 600 nm. Immediately add 200 μl of R3, mix and simultaneously turn on the timer, incubation is carried out at 37 °. The optical density is determined exactly after 3 minutes at λ = 600 nm (A2). For each series, a test is carried out, a standard (ready-made in a set), a blank (distilled water).

Calculation of activity of total antioxidant status.

a) calculate ΔA = A2-A1 for the sample

ΔA = A2-A1 for the standard

ΔA = A2-A1 for the form (distilled water).

b) determine the factor for calculating the values of the total antioxidant status

Factor = conc. standard / (ΔA form - ΔA standard)

c) Determine the total antioxidant status:

Mmol / L = Factor × (ΔA Form - ΔA Samples)

Reference values: 1.3-1.77 mmol / L

With an increase in the quantitative content of peroxides in serum lipids (lipid peroxidation more than 4.31 mmol / l) and a decrease in the overall antioxidant status (AOS less than 1.3 mmol / l), chemical workers predict a high risk of developing occupationally caused and occupational diseases.

According to the results of sanitary and hygienic studies at the enterprises of the chemical complex, the authors found that at these enterprises there is a complex of harmful production factors of the working environment and the labor process (chemical factor, physical factor (exposure to noise, physical stress, microclimate, etc.), severity and the intensity of the labor process.The working conditions of workers in the main profession in accordance with the level of harmful production factors of the working environment and the labor process corresponded harmful class of working conditions 3 (class 3.1-3.3). The working conditions of workers in the auxiliary profession corresponded to the permissible class of working conditions (class 2) (according to Guide R 2.2.2006-05 “Guidelines for the hygienic assessment of working environment and labor process factors. Criteria and classification working conditions ”).

In this regard, the authors compared the biochemical parameters of workers of these groups.

According to the results of biochemical studies, it was found that among the employees of the main profession engaged in the production of the chemical complex, in blood serum, in contrast to the workers of the auxiliary profession, there is a almost 3 times more frequent change in the levels of lipid peroxidation (p <0.01) and AOS (p <0.001) (table 1). To achieve the goal of the study, the authors studied the indicators of LP and AOS in workers of the main profession in dynamics: both before and after the diagnosis of an employee of a work-related and occupational disease.

According to the results of biochemical studies, it was found that before the onset of work-related and occupational diseases, workers in the main profession showed an increase in LP and a decrease in AOS (table 2). It should be noted that a group of workers in the main profession who subsequently revealed a work-related and occupational disease, at the time of conducting biochemical studies (before the occurrence of work-related and occupational diseases) in 100% of cases there was a simultaneous increase in lipid peroxidation products and a decrease in AOS. Those. Occurrence of work-related and occupational diseases was preceded by a simultaneous increase in lipid peroxidation products and a decrease in AOS (table 3).

For workers who did not have any industrial-related and occupational diseases, there was no simultaneous increase in lipid peroxidation products and a decrease in AOS both at the time of biochemical studies and subsequently.

The proposed method is illustrated by the following clinical material:

Example No. 1. Worker A., employed in a chemical complex, work experience - 4 years.

Product content LPO = 5.52 μmol / L, AOC = 1.19 mmol / L.

There is a high risk of development of occupationally caused diseases; treatment and prophylactic measures are necessary.

Example No. 2. Worker B., employed in a chemical complex, work experience - 3 months.

Product content LPO = 6.42 μmol / L, AOC = 1.9 mmol / L.

A high risk of developing occupationally determined diseases has not been identified.

Example No. 3. Worker V., employed in a chemical complex, work experience - 1 year.

Product content LPO = 4.21 µmol / L, AOC = 1.1 mmol / L.

A high risk of developing occupationally determined diseases has not been identified.

Example No. 4. Worker G., employed in a chemical complex, work experience - 3 years.

Product content LPO = 1.3 μmol / L, AOC = 1.9 mmol / L.

A high risk of developing occupationally determined diseases has not been identified.

Example No. 5. Worker D., employed in a chemical complex, work experience - 3 years.

Product content LPO = 1.1 μmol / L, AOC = 1.5 mmol / L.

A high risk of developing occupationally determined diseases has not been identified.

Table 1 Biochemical parameters in workers of a chemical complex before the occurrence of an industrial or occupational disease Indicators Options Employee groups main profession (n = 50) auxiliary profession (n = 50) FLOOR, µmol / l M ± m 4.44 ± 0.02 *** 2.58 ± 0.4 P ± m 44.0 ± 7.1 ** 16.0 ± 5.2 AOS, mmol / l M ± m 1.1 ± 0.08 *** 1.6 ± 0.09 P ± m 50.0 ± 7.1 *** 18.0 ± 5.5 Occupational or occupational disease No no Note: LPO - lipid peroxidation, AOS - total antioxidant status, M - mathematical expectation, m - standard error of the mean, P - frequency of deviation of indicators per 100 employees, *** - significance of differences between groups (p <0.001), ** - significance of differences between groups (p <0,01)

table 2 Biochemical indicators in workers in the main profession of the chemical complex Indicators Options Workers with an identified work-related or occupational disease (n = 15) Workers without an established work-related or occupational disease (n = 35) FLOOR, µmol / l M ± m 5.85 ± 0.002 *** 4.33 ± 0.09 P ± m 100.0 ± 0.0 48.6 ± 8.6 AOS, mmol / l M ± m 1.3 ± 0.10 1.3 ± 0.07 P ± m 100.0 ± 0.0 51.4 ± 8.6 Note: POL - lipid peroxidation, AOS - total antioxidant status, M - mathematical expectation, m - standard error of the mean, P - frequency of deviation of indicators per 100 employees, *** - significance of differences between groups (p <0.001)

Table 3 Identification of a high risk of occupationally determined and occupational diseases High risk of industrial and occupational diseases Enhancing FLOOR Products AOS reduction there is + + No - - + - - +

Claims (1)

A method for predicting a high risk of industrial-caused and occupational diseases in workers of the chemical complex working in harmful working conditions, including determining the total antioxidant status in blood serum, characterized in that the quantitative content of lipid peroxidation products is also determined in blood serum while increasing the quantitative lipid peroxides of more than 4.31 μmol / l and a decrease in the total antioxidant status of less than 1.3 m mol / l predict a high risk of development of occupationally determined and occupational diseases.