GBZ 37-2002 Diagnostic criteria for occupational chronic lead poisoning
Some standard content:
1CS13.100
National Occupational Health Standard of the People's Republic of China GBZ37-2002
Diagnostic Criteria of Occupational Chronic Lead Poisoning2002-04-08 Issued
2002-06-01 Implementation
Ministry of Health of the People's Republic of China
Article 6.1 of this standard is recommended, and the rest are mandatory. This standard is formulated in accordance with the "Law of the People's Republic of China on the Prevention and Control of Occupational Diseases". In case of any inconsistency between the original standard GB11504-1989 and this standard, this standard shall prevail.
Based on nationwide investigations and research, combined with the progress of domestic and foreign literature, this revision mainly includes the following aspects: 1. Change the "lead absorption" in the original standard to "observation object". 1. The urine lead index was adjusted from the original 0.39μmol/L (0.08mg/L) to 0.34μmol/L (0.07mg/L) to facilitate the prevention of lead poisoning. 2. Based on clinical experience, the urine lead diagnostic starting point value was adjusted from the original 0.39μmol/L (0.08mg/L) to 0.58umol/L (0.12mg/L) to reduce false positives. 3. Based on the survey of 3588 cases, the concepts of occupational exposure limit (acceptable upper limit) and diagnostic lower limit (diagnostic value) were introduced, and the diagnostic value was used as the basis for diagnostic grading. The original standard for mild poisoning diagnostic starting point was greatly modified, which not only reflects the role of a single indicator, but also highlights the importance of comprehensive diagnosis of multiple indicators, making the diagnosis more reasonable. 4 Oral chelating agent dithiothioate is added to the treatment principles. 5. In the original standard, a variety of determination methods are listed as appendices of the standard. Since most of them are the same as the standardized methods that have been unanimously recognized, they are simplified.
Appendix A of this standard is an informative appendix.
This standard is proposed and managed by the Ministry of Health of the People's Republic of China. This standard is drafted by Xi'an Central Hospital, and the participating drafting units are: Occupational Health and Poisoning Control Institute of China Center for Disease Control and Prevention, Yangpu District Central Hospital of Shanghai, Jiangxi Institute of Labor Hygiene and Occupational Diseases, Shenyang Institute of Labor Hygiene and Occupational Diseases, Department of Health of Hunan Medical University, Guangxi Institute of Occupational Disease Prevention and Control, Sichuan Institute of Labor Hygiene and Occupational Disease Prevention and Control, Shanghai Center for Disease Control and Prevention, Zhuzhou Refinery Workers' Hospital, Shaoxing Epidemic Prevention Station, Gansu Baiyin Company Labor Hygiene Institute, Shanghai Sixth People's Hospital, Jingdezhen Institute of Labor Hygiene and Occupational Diseases Prevention and Control, Zhenjiang Health and Epidemic Prevention Station, Zhejiang Center for Disease Control and Prevention, and Statistics Research Office of China Center for Disease Control and Prevention. This standard is interpreted by the Ministry of Health of the People's Republic of China. Diagnostic criteria for occupational chronic lead poisoning
GBZ37-2002
Occupational chronic lead poisoning is a systemic disease caused by exposure to lead smoke or lead dust, with the main symptoms being obstruction of the nervous, digestive and hematopoietic systems.
1 ScopebZxz.net
This standard specifies the diagnostic criteria and treatment principles for occupational chronic lead poisoning. This standard applies to the diagnosis and treatment of occupational chronic lead poisoning. The diagnosis and treatment of non-occupational chronic lead poisoning can also be used as a reference.
2 Normative references
The clauses in the following documents become clauses of this standard through reference in this standard. For any dated referenced document, all subsequent amendments (excluding errata) or revisions are not applicable to this standard. However, the parties to an agreement based on this standard are encouraged to study whether the latest versions of these documents can be used. For any undated referenced document, the latest version shall apply to this standard.
GB/T16180 Identification of the degree of disability caused by work-related injuries and occupational diseases of employees 3 Diagnostic principles
Diagnosis can only be made based on the exact occupational history and clinical manifestations mainly related to the nervous, digestive and hematopoietic systems and relevant laboratory tests, with reference to the work environment investigation and comprehensive analysis, and by excluding similar diseases caused by other reasons. 4 Observation subjects
Those with a history of close lead contact, no clinical manifestations of lead poisoning, and one of the following manifestations: a) Urine lead ≥0.34μmol/L (0.07mg/L, 70μg/L) or 0.48μmol/24h (0.1mg/24h, 100μg/24h);
b) Blood lead ≥1.9μmol/L (0.4mg/L, 400μg/L); c) Urine lead ≥1.45μmol/L (0.3mg/L, 300μg/L) and <3.86μmol/L (0.8mg/L, 800μg/L) after diagnostic lead removal test.
5 Diagnosis and classification standards
5.1 Mild poisoning
5.1.1 Blood lead ≥2.9μmol/L (0.6mg/L, 600μg/L) or urine lead ≥0.58μmol/L (0.12mg/L, 120μg/L); and those with one of the following manifestations can be diagnosed as mild poisoning: Urine 8-amino-r-ketovaleric acid ≥61.0μmol/L (8mg/L, 8000μg/L); a)
Red blood cell free protoquinoline (EP) ≥3.56μmol/L (2mg/L, 2000μg/L); b)
Red blood cell zinc protoquinoline (ZPP) ≥2.91umol/L (13.0μg/gHb). d) Symptoms such as abdominal pain, bloating, and constipation. 5.1.2 Diagnostic lead removal test: If the urine lead is ≥3.86umol/L (0.8mg/L, 800μg/L) or 4.82umol/24h (1mg/24h, 1000μg/24h), it can be diagnosed as mild lead poisoning. 5.2 Moderate poisoning
On the basis of mild poisoning, the patient has one of the following manifestations: a)
Abdominal colic:
Anemia:
Mild toxic peripheral neuropathy.
5.3 Severe poisoning
Those with one of the following symptoms:
Lead paralysis;
Toxic encephalopathy;
Treatment principles
Treatment principles
Poisoned patients should be treated with metal chelating agents for lead removal according to specific conditions, such as injection of calcium disodium edetate, sodium dithiothioate, etc., or oral administration of dithiothioate, supplemented by symptomatic treatment. The subjects under observation can also undergo lead removal treatment as appropriate. 6.2 Other treatments
The subjects under observation
can continue their original work, and be reexamined once every 3 to 6 months or undergo lead removal tests to determine whether they are mild lead poisoning. 6.2.2 Mild and moderate poisoning
After recovery, they can resume their original work without being transferred from lead work. Severe poisoning
must be transferred from lead work, and given treatment and rest according to the condition. If labor capacity assessment is required, it shall be handled in accordance with GB/T16180.
Instructions for the correct use of this standard
See Appendix A (Informative Appendix).
Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
A.1 This standard applies to chronic poisoning caused by exposure to lead smoke or lead dust in production. Non-occupational adult chronic lead poisoning can also be used as a reference.
A.2 There are many laboratory indicators for lead poisoning, and there are often multiple detection methods for various indicators. Due to the influence of factors such as methods, instruments, and regions, their normal reference values have also been different in the past. The occupational exposure limit and diagnostic value were obtained through a nationwide survey of 3,188 people under unified methods and strict quality control conditions. According to the original standard, after collective discussion, they were diagnosed as lead absorption group, poisoning group, and normal lead exposure group. After statistical processing and on-site verification results, it was proposed. That is, the boundary between the normal lead exposure group and the lead absorption group is the occupational exposure limit, and the boundary between the lead absorption group and the lead poisoning group is the diagnostic value. The promotion and application of these two values also require consistent testing methods, strict quality control, and coordination of multiple indicators. Avoid drawing conclusions based on the results of a single test of a single indicator. There are chemical and instrumental methods for checking urine lead, but as long as strict quality control is implemented, the results should be consistent. For ease of operation, it is recommended to use a wide-mouth polyethylene plastic bottle to collect a morning urine sample of about 100 ml, but special attention should be paid to the contamination of urine lead and blood lead during sampling and testing.
A.3 The basic provisions of the original standard are correct and were basically adopted during this revision, but some of the laboratory indicator data for lead poisoning have been adjusted in this revision based on the occupational exposure limit. The specific values are shown in the table below. A.4 The typical manifestations of lead colic are well known to primary care doctors. It is necessary to combine occupational history and on-site conditions, and diagnose only after excluding diseases with similar symptoms caused by other reasons. A.5 The diagnostic lead expulsion test is mainly used for some lead workers who have been working in an excessive environment for a long time, have clinical symptoms, and the lead laboratory test indicators are still lower than the occupational exposure limit (see the table below), or are under observation. The drug can be edetate disodium calcium 1.0g, divided into two intramuscular injections or added to glucose for slow intravenous injection or intravenous drip. It is recommended to collect 24 hours of urine for lead determination. The urine lead value of the diagnostic lead removal test should refer to this standard and be determined in combination with the specific situation. A.6 Lead removal treatment commonly uses calcium disodium edetate, sodium disuccinate injection and disulfide succinate capsules (DMSA) for oral administration. Generally, one course of treatment is 3 to 4 days, and the medication is stopped for 3 to 4 days between two courses of treatment. The dosage and course of treatment should be determined according to the specific situation of the patient and the type and dosage of the drug. It is generally recommended that the treatment of mild lead poisoning should not exceed 3 to 5 courses. A.7 The laboratory test index values of lead are shown in the following table: Table A.1
Blood zinc protophylline (ZPP) μmol/L (μg/gHb) Blood protophylline (EP) μmol/L (μg/L)
Blood lead (PbB) μmol/L (μg/L)
Urine lead (PbB) μmol/L (ug/L)
Lead laboratory test index values
Occupational exposure limit
Urine 8-amino-r-ketovaleric acid (ALA) μmol/L (ug/L) Diagnostic value
2.91(13.0)
3.56(2000）
2.9（600）
0.58(120)
61.0(8000)
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