title: Dimethylformamide-induced liver damage among synthetic leather workers.
abstract: Prevalence of liver injury associated with dimethylformamide (DMF) exposure was determined. Medical examinations, liver function tests, and creatine phosphokinase (CPK) determinations were performed on 183 of 204 (76%) employees of a synthetic leather factory. Air concentrations of solvents were measured with personal samplers and gas chromatography. The concentration of DMF in air to which each worker was exposed was categorized. High exposure concentrations of DMF (i.e., 25-60 ppm) were significantly associated with elevated alanine aminotransferase (ALT) levels (ALT greater than or equal to 35 IU/l), a result that did not change even after stratification by hepatitis B carrier status. Modeling by logistic regression demonstrated that exposure to high concentrations of DMF was associated with an elevated ALT (p = .01), whereas hepatitis B surface antigen (HBsAg) was slightly but independently associated with an elevated ALT (p = .07). In those workers who had normal ALT values, there occurred still significantly higher mean ALT and aspartate aminotransferase (AST) activities, especially among those who were not HBsAg carriers. A significant association existed between elevated CPK levels and exposure to DMF. However, an analysis of the CPK isoenzyme among 143 workers did not reveal any specific damage to muscles. This outbreak of liver injury among synthetic leather workers is ascribed to DMF. It is recommended that the occupational standard for DMF and its toxicity among HBsAg carriers be evaluated further.
authors.affiliation: Center for the Research of Environmental and Occupational Disease, Graduate Institute of Public Health and Department of Internal Medicine, National Taiwan University, College of Medicine, Republic of China.
authors.forename: J D
authors.initials: JD
authors.lastname: Wang
authors.forename: M Y
authors.initials: MY
authors.lastname: Lai
authors.forename: J S
authors.initials: JS
authors.lastname: Chen
authors.forename: J M
authors.initials: JM
authors.lastname: Lin
authors.forename: J R
authors.initials: JR
authors.lastname: Chiang
authors.forename: S J
authors.initials: SJ
authors.lastname: Shiau
authors.forename: W S
authors.initials: WS
authors.lastname: Chang
mesh_terms: D000328:Adult; D000395:Air Pollutants, Occupational / Q000009:adverse effects* / Q000032:analysis; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D002353:Carrier State / Q000097:blood / Q000453:epidemiology; D056486:Chemical and Drug Induced Liver Injury; D003402:Creatine Kinase / Q000097:blood; D004126:Dimethylformamide / Q000009:adverse effects* / Q000032:analysis; D006509:Hepatitis B / Q000097:blood / Q000150:complications / Q000453:epidemiology; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006801:Humans; D008107:Liver Diseases / Q000097:blood / Q000453:epidemiology*; D008297:Male; D015995:Prevalence; D013624:Taiwan / Q000453:epidemiology; D013633:Tanning
chemical_list: D000395:Air Pollutants, Occupational; D006514:Hepatitis B Surface Antigens; D004126:Dimethylformamide; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D003402:Creatine Kinase