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[Re-assessment of indicators for screening lead poisoning]
Objective:
To determine the accuracy of the indicators for detecting lead poisoning.
Methods:
Blood and urine specimens in 157 workers exposed to lead were collected. Their blood levels of lead, free erythrocyte protoporphyrin (FEP), zinc protoporphyrin (ZPP), urine delta-aminolevulinic acid and activity of red cell pyrimidine 5'-nucleotidase were determined, with gold standards of blood lead levels of >or= 1.93 micromol/L and >or= 2.90 micromol/L. Accuracy assessment of the indicators mentioned above for detecting lead poisoning was based on the area under the receiver operative characteristic (AUC(ROC)) curve with a software specially for ROC curve analysis and software of Epi-Info, after determining the optimal cut-off points for the above mentioned indicators in detecting those with blood lead >or= 1.93 micromol/L and >or= 2.90 micromol/L. The sensitivity of screening in parallel for detecting those with blood lead >or= 1.93 micromol/L and >or= 2.90 micromol/L was calculated and compared.
Results:
For detecting those with blood lead level >or= 1.93 micromol/L, the area under ROC curve (AUC(ROC)) of above indicators was 0.978 for ZPP, 0.973 for red cell P5'N, 0.937 for FEP, 0.890 for urine delta-ALA (significantly different from that for ZPP with P < 0.05), and 0.845 for urine lead level (significantly different from that for ZPP with P < 0.05), respectively. For detecting those with blood lead level >or= 2.90 micromol/L, the area under ROC curve (AUC(ROC)) of above indicators was 0.975 for red cell P5'N, 0.954 for ZPP, 0.906 for FEP (significantly different from that for red cell P5'N with P < 0.05), 0.900 for urine delta-ALA (significantly different from that for red cell P5'N with P < 0.05), and 0.750 for urine lead level (significantly different from that for red cell P5'N with P < 0.05). Sensitivity of screening in parallel with ZPP and P5'N was significantly higher than that with urine levels of lead and delta-ALA.
Conclusion:
Determinations of red cell P5'N and ZPP for detecting those with blood lead >or= 1.93 micromol/L and >or= 2.90 micromol/L are more accurate.