吸烟与职业噪声暴露对听力损失交互作用的分析  

Study of Interaction between Smoking and Occupational Noise Exposure on Hearing Loss

作　　者：李旭东[1] 李永胜[1] 郭晓[1] 刘移民[1] 肖吕武[2] 肖启华[2] 何国权[2] 吴琳[2] 

机构地区：[1]中山大学公共卫生学院,广州510080 [2]广州市职业病防治院,广州510620

出　　处：《热带医学杂志》2008年第5期441-444,共4页Journal of Tropical Medicine

基　　金：广东省自然科学基金(No.7018635);广州市医药卫生科技重点项目(No.2006-ZDi-06)

摘　　要：目的探讨吸烟与听力损失的关系以及吸烟和职业性噪声对听力损失的交互作用。方法利用回顾性队列研究,选择广州市某大型空调生产企业连续性噪声作业人员254名吸烟者为吸烟组,在相同的噪声暴露环境中选择154名不吸烟者为非吸烟组,两组间除吸烟外,其它均均衡可比。按照《作业场所噪声测量规范》(WS/T69-1996)要求对噪声暴露作业场所进行测点选择和噪声强度测量[dB(A)],并计算累积噪声暴露量(CNE)。按GB7583-87要求,对工人进行左、右耳500～6000Hz内6个频率的纯音气导听阈测试。自行设计问卷对研究对象进行调查,问卷内容包括一般情况、个人生活史、职业史、噪声暴露史、家族性耳聋史以及耳毒性药物使用史等。结果同一噪声暴露环境下,吸烟组左、右耳高频(3000～6000Hz)听阈位移均显著高于非吸烟组(P﹤0.01)。吸烟是听力损失独立的危险因素,二者间存在剂量反应关系(χ2=18.464,P﹤0.001),吸烟每天20支以上听力损失的相对危险度是不吸烟的3.464倍(95%CI:1.739～6.901)。累积噪声量达80dB(A)以上时,吸烟和职业噪声听力损失的RR值分别为3.443(95%CI:1.182～10.024)和4.667(95%CI:1.199～18.169),吸烟与职业噪声联合作用RR值为10.000(95%CI:3.526～28.360),大于两个变量独立作用之和。结论吸烟是听力损失独立的危险因素,在高强度噪声暴露情况下,吸烟和职业噪声暴露对听力损失可能存在协同作用。Objective To study the relationship between smoking and hearing loss and the interaction of smoking and occupational noise exposure on hearing loss. Methods A historical cohort study was designed to study the effect of smoking on noise induced hearing loss （NIHL） in 254 smoking workers and 154 nonsmoking workers in a large air conditioning factory. The noise level was measured according to the Directive rules for niose measurement in the work environment （WS/T 69-1996） and the cumulative noise exposure （CNE） was calculated. Hearing loss acuity was assessed by a qualified audiologist using the pure tone audiometry according to the GB7583-87 guideline. A questionnaire was designed to carry out an investigation on general state of health, life history, occupational history and history of toxic drug use. Results The hearing threshold shift of high-frequency（3 000-6 000 Hz）in smoking workers was significantly higher than that of the nonsmoking workers （P〈0.01）. There was a significant dose response relationship between smoking and hearing loss （X2=18.464,P〈0.001）. The relative risk （RR）of hearing loss in workers who had 20 cigarettes a day was 3.464 （95%CI： 1.739-6.901 ）times more than nonsmoking workers. In CNE more than 80 dB（A） group, the RR of the interaction of smoking and occupational noise exposure on hearing loss is higher than the sum of the two respectively variables RR. Conclusion Smoking is an independent risk factor of hearing loss, and there maybe have a synergistic effect of smoking and occupational noise exposure on hearing loss in high intensity occupational noise exposure.

关 键 词：吸烟 职业性噪声 听力损失 

分 类 号：R135[医药卫生—劳动卫生]