Objectives: The screening and identification of occupational liver or other organ-system injury related to long-term, low-level solvent exposure are difficult in clinical practice. We studied the feasibility of the use of common laboratory tests combined with a detailed exposure history.
Methods: The relationships between laboratory tests and exposure to organic solvents were studied in regression modelling adjusted to age, alcohol consumption, gender and body mass index (BMI). The subjects were 29 solvent-exposed workers and 19 referents. Laboratory tests included serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), carbohydrate-deficient transferrin (CDT), alkaline phosphatase (ALP), creatinine, cholesterol, HDL-cholesterol, triglycerides, blood glucose and total and conjugated bilirubin. Positive hepatitis serology, systemic diseases or medications with known hepatic effects and current pregnancy were exclusion criteria. The main exposures of each subject were identified. Current solvent exposure status, exposure during the past 3 months, exposure during the past 5 and 10 years, and total life-time exposure were recorded.
Results: AST (P=0.0031), ALT (P=0.0015) and cholesterol (P=0.0110) correlated positively with cumulative solvent exposure in the past 5 years, total bilirubin with current exposure (P=0.0380), and glucose with exposure in the past 5 (P<0.0001) and 10 (P=0.0003) years. Triglycerides correlated positively with exposure in the past 5 (P=0.0025) and 10 (P=0.0059) years and with life-time exposure (P=0.0005). Creatinine correlated negatively with exposure in the past 10 years (P=0.0300) and life-time exposure (P=0.0005). Most laboratory values were within the normal range.
Conclusions: These results suggest a multi-system health effect of solvents. The laboratory data had some similarities with those in the metabolic syndrome. The screening and diagnostics of solvent-related conditions should be based on a thorough work history and a set of carefully selected laboratory tests. No single test seems sufficient for this purpose.