OBJECTIVES--To identify any differences in hepatic function between workers exposed to carbon tetrachloride and controls, and to identify the best variable with which to examine any effects. METHODS--In a cross sectional study of hepatic function in workers occupationally exposed to carbon tetrachloride, 135 exposed employees were compared with 276 non-exposed controls. The exposed group was taken from three sites in the north west of England and the control group included non-exposed workers from one of these sites and another site located nearby. Demographic and alcohol consumption data were collected from both groups by questionnaire. Each member of the study group was allotted a notional estimated exposure to carbon tetrachloride, calculated from historic personal monitoring data and job category. A fasting sample of blood was taken from all participants and analysed for a variety of biochemical and haematological variables. The techniques of univariate and multivariate analysis of variance were used to investigate the effect on biochemical and haematological indices of a range of factors. RESULTS--Multivariate analysis of variance of four core liver function variables, alanine transaminase, aspartate transaminase, alkaline phosphatase, and gamma-glutamyl transferase, showed a significant difference between exposed and non-exposed workers. The univariate analyses identified increases in only alkaline phosphatase and gamma-glutamyl transferase within the exposed group and these did not show a significant dose-response relation. Univariate analysis of variance did show effects of alcohol and age on several variables. Significant differences between exposed and control groups for three haematological variables, haemoglobin, packed cell volume, and red blood count, were thought not to be due to the effects of exposure. Clinical review of exposed subjects with abnormal results did not show clinically evident disease that could have been associated with exposure to carbon tetrachloride. Also, a follow up study conducted three years after the cross sectional study at the site with highest exposures to carbon tetrachloride showed no evidence of any further changes in liver function variables. CONCLUSIONS--The most sensitive statistical methods have shown significant differences in the liver function variables measured between people exposed to carbon tetrachloride and the control group. The interpretation of the data collected was that these differences may be due to exposure to carbon tetrachloride but this was not clearly shown. Furthermore, the changes found have not given rise to any clinical disease.
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