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: 6525222
• 负责人: STEPHEN J ROTHENBERG
• 金额: $ 37.75万
• 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/6525222
• 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.

大量病例报告表明，铅中毒可能是由于枪支受伤后保留的铅弹性弹出物而造成的。 为了评估保留的弹丸对随后的铅暴露的影响，不能依靠出现铅中毒症状的自选病例。 该项目的长期目标是减少由于枪支受伤保留子弹而导致的与身体潜在客户负担相关的发病率。 拟议的调查旨在确定保留铅子弹的个体血液铅含量升高的危险因素，为铅测试建立适当的方案，制定符号的指示，并为未移除的碎片的适当管理提供指南。研究设计包括对300例保留铅子弹/子弹碎片的随访，以急性护理1级创伤中心的急性护理枪支受伤。 患者稳定后尽快测量基线血液水平，并以3、6和12个月的间隔重复。 关于先前枪支伤害和其他保留的弹丸的病史以及筛查和风险因素问卷，以确定患者可能已经或目前暴露于患者的其他铅（职业/娱乐活动）。 患者将在胫骨和跟骨中的骨铅的k-壳X荧光测定，以确定病史和风险因素问卷调查者未揭示的过去铅暴露。 使用危险因素和骨头铅浓度数据为每个患者进行血液水平的多变量模型。 如果从一个3个月到下一个的危险因素和骨头铅浓度调整血液铅的变化，可以通过弹丸的编码位置和碎片数据以及裂缝的存在或不存在裂缝的碎片来预测，将做出决定。 将弹丸保留在体内的位置，碎片，断裂和总时间的变量将使用逻辑回归进行测试。 由于这些因素，这将确定各种浓度（大于15 mug/dl，大于25 mug/dl，大于40 mug/dl等）的铅的优势比。 还将在一般线性模型（GML）的框架中分析数据，并重复测量设计。 主要的兴趣将在血液水平的趋势中增加，这是分裂位置，断裂和持续时间变量的函数。