GANGGUAN OTONOM PADA PEKERJA TERPAJAN TIMBAL KRONIK BERDASARKAN PEMERIKSAAN SYMPATHETIC SKIN RESPONSE DAN FAKTOR FAKTOR YANG MEMPENGARUHI

Introduction: Lead has toxic property to the nervous system. Inorganic lead could damage peripheral nerve system causing neuropathy. Autonomic neuropathy in lead exposed workers is often sub clinical. However, sympathetic skin response (SSR) abnormality was found in asymptomatic chronically exposed to lead workers. Method: This is a cross sectional study to find out the SSR characteristics in lead exposed workers and their influencing factors. Subjects who met the eligibility criteria where examined for blood lead level and SSR. Subjects were then analyzed according to age, education, working time, working risk, use of self protection device, milk consumption habit, working period, and lead blood level. Result: There were 61 subjects participated in this study, aged 20 – 50 years old. All subjects were male. Thirty five subjects were classified as high risk and 26 as moderate risk. Average age was 42.3 ± 6.8 years old. Subjects have been working for an average of 20.3 ± 6.8 years. Highest blood lead levels, 50.93 µg//dl and 26.58 µg/dl, were found in two workers who worked in storage battery service. The average value of the remaining subjects’ blood lead level was 13.9 µg/dl, still under 20 µg/dl which is the safety level according to WHO. Autonomic disorder was experienced by 12 workers (19.7%) with either high or moderate risk. SSR abnormality was significantly associated with the presence of autonomic disorder (P = 0.000; OR = 83.70; 95%CI = 14.59 – 480.0). Age, education, working time, working risk, use of self protection device, milk consumption habit, and working period were statistically not associated with SSR abnormality. Two highest odds ratio were no milk consumption habit (3.75) and working period ≥ 21 years (2.29) although statistically not significant From ROC analysis we found that on blood lead level 12.6 μg/dl, the sensitivity to find SSR abnormality was 53.6% and the specificity was 36.4%. Twenty three subjects (37.7%) have abnormal SSR. Conclusion: SSR was more sensitive in detecting autonomic disorder in chronically exposed to lead workers. SSR abnormality was found in lower blood lead level than the safe standard from WHO. Although statistically not significant, milk consumption habit of two glasses a day tends to have protective property while working period ≥ 21 years tends to associate with SSR abnormality. I tended to like