Relationship Between Xylene, Rq Xylene Concentration And Heart Function In Industrial Workers In Surabaya

Introduction

As a country develops overtime, the development is also directly proportional to the high potential danger to workers; one of which is exposure to chemicals as industrial raw materials. These chemicals, if entered into the body of workers can cause illness and health problems. Some chemicals that are found in many industries are benzene, toluene, and xylene.

Xylene is a solvent with the physical properties of colorless, flammable, volatile, and has a sweet aroma. This is a natural substance that is found in the contents of kerosene, coal, and others. Today many industries use xylene as a paint thinner and ink solvent. In addition, this is also commonly found in the agricultural industry as a solvent and emulsifier.

Xylene exposure to workers can be bad for health. According to (Kurnianto, 2016), several xylene exposure pathways include breathing, digestion, eye contact, and skin. Xylene that is inhaled by workers will enter and be retained in the lungs and eventually circulated to the body through the bloodstream. Many industries use xylene as a substitute for benzene. But based on experiments conducted, xylene is more dangerous than toluene. A study (Kurnianto, 2016) conducted whose results showed that the effect of the xylene threshold appeared at the lowest dose of toluene.

Xylene concentrations below 200 ppm can cause irritation to the eyes and mucous membranes. At higher concentrations of xylene, exposure can cause narcotic effects. Exposure to xylene ingested by workers can cause interference with the stomach and toxic effects on the liver. Meanwhile, acute exposure to xylene vapors can cause lung dysfunction and cause swelling and bleeding.

One of the health problems caused by xylene exposure to workers is the disruption to the digestive system. Indigestion can attack liver function which can be seen through Serum Glutamic Oxaloacetic Transaminase (SGOT) and SPGT levels. SGOT or Serum Glutamic Oxaloacetic Transaminase or also known as AST (aspartate aminotransferase) is one of the liver enzymes. This enzyme is located in the structure of the liver, so its appearance in the blood indicates damage or disruption in liver function. SGPT or Serum Glutamic Pyruvate Transaminase or called ALT (alanine aminotransferase) is also a liver enzyme in the liver. Elevated levels of SGPT in the blood indicate symptoms of damage or impairment in liver function.

Continuous and frequent xylene exposure to workers can cause some health problems in the long run. These health problems include visual disturbances, dryness of the nose, dermatitis, and damage to the liver and kidneys (Rajan et al., 2019). This study aims to investigate the relationship between xylene, RQ xylene concentration, and heart function in industrial workers in Surabaya. The paper will begin with an introduction to xylene, its sources of exposure, and its potential health effects on humans. The second section will present the methodology of the study, including the study design, participants, and data collection methods. The third section will present the results of the study, including the relationship between xylene exposure and heart function in industrial workers in Surabaya. Finally, the paper will conclude with a discussion of the implications of the study for occupational health and safety, as well as recommendations for future research in this area.

Methods

This is an observational analytic study in several shoe industry locations including Ketintang, Kalijudan, Jemursari, AUP and Romokalisari with a quantitative approach and conducted since 2019. These locations were chosen because they represent prominent shoe industry clusters in the region, and are known to have a substantial number of workers who are potentially exposed to xylene. The design of this study is cross-sectional that is observation and measurement of variables carried out at one time. By focusing on these areas, this study aimed to capture a diverse range of workers with varying levels of xylene exposure. The present study examines the relationship between xylene concentration, RQ xylene, and liver function in workers. Primary data and secondary data are taken for analysis. Primary data are in the form of questionnaires which are distributed to workers and samples while secondary data are in the form of company profile data.

Informed consent was obtained from all participants involved in the study through a well-defined process that ensured their understanding and willingness to participate. The process included information provision, opportunity for questions, voluntary participation, consent forms, confidentiality assurance, and contact information. Informed consent is obtained through a written and oral process, and participants must sign the informed consent form voluntarily and participants must have the ability to make informed decisions. By following these steps, the study ensured that participants were fully informed about the study and their rights.

The study included workers from the shoe industry locations in Ketintang, Kalijudan, Jemursari, AUP, and Romokalisari, who had been employed there since 2019 or earlier, aged between 20 and 65 years, providing informed consent, free of known pre-existing liver diseases or conditions present during data collection, and offering complete and accurate questionnaire responses. Workers from non-specified locations, those who began employment after 2019, individuals below 20 or above 65 years of age, those with a history of liver diseases, those withholding informed consent, those unavailable during data collection, and those supplying incomplete or inaccurate questionnaire responses were excluded.

A total of 90 workers were taken as a population with 77 of them taken as samples using the accidental sampling method. Accidental sampling is a type of non-probability sampling in which the selected population is easily accessible to the researcher, and available subjects are simply entered into the study without any attempt at randomization (University of Greenwich, 2019). This is also known as grab, convenience, or opportunity sampling (Alleydog, 2023). In this method, the researcher selects the sample based on who is available and willing to participate rather than using a specific sampling technique (ResearchArticle, 2021).

The independent variables are the concentration of xylene and RQ xylene, and the dependent variable is the function of the liver as seen through the levels of SGPT and SGOT. The blood samples independent and dependent variables were then tested in the Nutrition Laboratory of Airlangga University. After the data is collected, a relationship test is then performed to see the strength of the relationship using the chi-square test on categorical data. In addition to examining relationships, researchers also find out the level of risk using the prevalence rate (PR) formula.

Results

Some characteristics of respondents include age, sex, level of education, and work area. The following table distributes the characteristics of respondents who work in the Surabaya shoe industry.

Based on Table 1, 25 (32.47%) of shoe industry workers aged 36-45 years with the majority of workers being male (61 or 79.22%) with the majority of final education level is senior high school (43 or 55.84%). Based on the working area of the shoe industry, 24 (31.17%) workers work in the shoe industry located in Romokalisari, Tambak Oso Wilangun, Surabaya.

Table 2 shows that of the five shoe industries in Surabaya, the majority (98.7%) of workers had a concentration of xylene exposure below the threshold value of 100 ppm. There is only one worker whose concentration of xylene exposure (103.59) exceeds the threshold, namely in Jemursari. Based on the risk level (RQ), 72 (93.5%) workers fall into the safe RQ category by RQ <1. There are still 5 (6.5%) workers that fell into the risk category.

Table 3 explains the distribution of SGOT rates and SGPT rates among workers. The normal rate of SGOT is 5-40 IU / L and SGPT is 5-35 IU/L. Based on these results it is known that 66 (85.7%) workers have normal SGOT levels. There were 58 (75.3%) workers with normal SGPT rate.

Based on Table 4 there is no relationship between xylene concentration and xylene risk level (p> 0.05). Table 4 shows that there were 71 (92.2%) workers who had an RQ level <1 with a concentration of exposure <100 ppm and there were 5 (6.5%) workers who had an RQ level> 1. While for concentrations> 100 ppm there is 1 (1.3%) worker with risk level of RQ <1.

According to Table 5, there was a relationship between SGOT and SGPT rates (p <0.05). Table 5 also shows that there are 55 (71.43%) workers with normal SGOT and SGPT levels. There were 11 (14.29%) employees with normal SGOT rates but SGPT rates were not normal. There were 3 (3.89%) employees with a normal SGPT rate and 8 (10.39%) employees with a normal SGPT rate.

Figure 1 shows the highest average xylene concentration (122.81 ppm) is in Jemursari; the industry with the lowest average xylen concentration was Romokalisari (4.03 ppm). The highest average SGOT level was found in AUP (61.65 IU / L) and the lowest was found in Romokalisari (20 IU/ L). The highest average SGPT level was found in the AUP industry (45.25 IU / L) and the lowest average was in Kalijudan (19.5 IU/L).

Figure 1. Graph Xylene Concentration with SGOT and SGPT levels.

Based on Figure 2, the highest average RQ was found in Romokalisari (0.54) while the lowest average was found in Jemursari (0.004). SGOT and SGPT levels are the same as those listed in Figure 1.

Figure 2. Graph RQ Xylene Concentration with SGOT and SGPT levels.

Table 6 shows the results of the cross tabulation test between xylene concentrations and SGOT levels in workers. Based on the chi square test there was no relationship between xylene concentration and SGOT levels in workers (p> 0.05). There were 66 (85.7%) workers with xylene concentration <100 ppm and normal SGOT levels; 10 (13.0%) other workers had abnormal SGOT levels. There are 1 (1.3%) workers with abnormal SGOT levels and exposed to concentrations >100 ppm. Based on the prevalence rate calculation, xylene concentration is a protective factor against damage to SGOT levels.

Based on Table 7 there is no relationship between xylene concentration and SGPT levels (p >0.05). There were 58 (75.3%) workers who were exposed to xylene concentrations <100 ppm and had normal SGPT levels and 18 (23.4%) workers who had abnormal SGPT levels. In workers exposed to xylene concentrations exceeding NAV, there is 1 worker (1.3%) who has an abnormal SGPT level. Based on the calculation of the prevalence rate workers exposed to xylene concentration are included in the protection factor will cause damage to SGPT level.

Table 8 shows no relationship between RQ xylene and SGOT levels (p> 0.05). There were 61 (79.2%) workers who had RQ level <1 and normal SGOT level and 11 (14.3%) workers who had abnormal SGOT levels. In RQ> 1 there were 5 (6.5%) workers who had normal SGOT levels. Based on the calculation of the prevalence rate of workers with RQ <1, 7.09x greater risk of damage to SGOT levels.

Based on Table 9 there was no relationship between RQ xylene and SGPT levels (p> 0.05). There were 54 (70.1%) workers who had RQ <1 and normal SGPT levels and there were 18 (23.4%) workers who had abnormal SGPT levels. For workers with RQ> 1 there were 4 (5.2%) workers with normal SGPT levels and 1 (1.3%) workers with abnormal SGPT levels. Based on the calculation of the prevalence rate, workers with RQ <1 were at a risk of 1.067x greater to experience damage to SGPT levels.

Discussion

Based on Table 1, Table 2, and Table 3 regarding the frequency distribution of respondents and workplaces, 25 (32.47%) respondents/majority were aged 36-45 years; the most gender is male (61) and the highest level of education is the high school/vocational high school (43 or 55.84%) and the majority of workers work in the Romokalisari industry (24 people/31.17%). In Table 2 regarding the distribution of xylene exposure from concentration and risk quotient (RQ), there were 76 (98.7%) workers who were exposed to xylene with a concentration of <NAV (NAB = 200 ppm). Only 1 (1.3%) workers were exposed to concentrations> threshold. Based on the results of the study there were 72 (93.5%) workers included in the RQ category <1 (safe) and 5 (6.5%) other workers included in the RQ> 1 (risk) category. In Table 3 the distribution of SGOT and SGPT levels among workers is 66 (85.7%) workers with normal SGOT levels (5-40 IU/L) and 11 (14.3%) workers who have abnormal SGOT levels. There were 58 (75.3%) workers who had normal SGPT levels and 19 (24.7%) workers with abnormal SGPT levels.

Table 4 explains the relationship between the concentration of xylene exposure and the RQ xylene category in workers. Using the chi-square test, there was no relationship between concentration and RQ (p> 0.05). This can be caused by the increase in the RQ category not only influenced by concentration but also many other factors such as nutritious food intake. Table 5 shows that from the test of the relationship between SGOT and SGPT levels, there is a relationship between SGOT and SGPT levels where the increase and decrease of SGOT levels is consistent with changes in SGPT levels (p <0.05). SGOT and SGPT levels are one of the biomarkers that are often seen to review human liver function. The increase in SGOT levels is in line with the increase in SGPT levels.

Table 6 is the result of the test of the relationship between the xylene concentration variable and SGOT levels in workers. Based on the test results of the relationship with chi square there is no relationship between xylene concentration and SGOT levels in workers. This could be influenced by factors other than concentration in the form of the duration and frequency of xylene exposure. Table 2 shows that only 1 (1.3%) worker experienced exposure above the NAV and 76 (98.7%) other workers were exposed to xylene within the NAV limit. In Table 7 there is no relationship between xylene concentration and SGPT levels (p> 0.05). In another study conducted by (Cahyana et al., 2015) xylene concentration had a strong correlation with MHA levels. MHA itself is an acid produced from xylene metabolism in the body which will be released together with urine.

Table 8 shows the test of the relationship between RQ variables and SGOT levels using the chi-square test. There was no relationship between RQ and SGOT levels in the blood (p> 0.05). Table 9 tests the relationship between RQ and SGPT levels and shows that there is no relationship between RQ and SGPT levels in workers (p> 0.05). This can be caused because the RQ of workers in the industrial area of Surabaya is still in the safe category (RQ <1); the concentration of xylene exposure is also still within the threshold. Therefore, only a few workers were found to have RQ> 1.

Research conducted by (Rusdy, 2012) with a thesis entitled Analysis of Neurotoxic Symptoms Due to Exposure of Organic Xylene Solvents to Paint Manufacturing Workers notes that 95.6% of workers are exposed to xylene in threshold values that are still relatively safe. This thesis explains the effects caused by xylene exposure in the form of neurotoxic symptoms. The test results show that there is no relationship between the concentration of xylene exposure and neurotoxic symptoms in workers (r> 0.05). This study also states that there is little evidence to suggest a chronic effect on liver function due to xylene exposure. According to (Morley et al., 1970) the chronic effects of liver function occur when workers are exposed to extreme exposure. This also supports the results of the study found that from the concentration and RQ variables there is no relationship between levels of SGOT and SGPT in workers.

Research conducted by (Irawati, 2010) also states the same thing that the IARC and EPA have not been able to determine whether xylene is carcinogenic to humans. Some health effects experienced by workers due to xylene exposure are dizziness, nausea, headaches, and loss of balance. But there are no studies that state that xylene exposure interferes with or even damages the function of the human heart. Some studies suggest that exposure to BTX (benzene, toluene, xylene) has a direct impact on the neurotoxic or nervous system in humans due to exposure that enters through the inhalation system.

Conclusion

Based on the test results of each relationship between xylene concentration, SGOT levels, and SGPT levels there was no relationship (p> 0.05). In the test of the relationship between RQ with levels of SGOT and SGPT also found no relationship (p> 0.05). In addition to seeing the relationship test, the researchers also calculated the prevalence ratio with the result of xylene concentration included in the protection factor for SGOT levels and SGPT levels in workers (PR <1). RQ is a supporting factor because in calculating the prevalence of the ratio between RQ and SGOT levels, workers classified as abnormal RQ have a 7.09x greater chance of experiencing damage to SGOT levels. Calculations with SGPT levels indicate that workers classified as abnormal RQ have a 1.06x greater chance of experiencing damage to SGPT levels. Based on the results, a review of RQ calculations for workers is needed so that the factors that cause RQ in insecure workers are known. The company should provide an enzyme-rich intake so that xylene toxins can be excreted by the body.