铁矿工人尘肺发病及影响因素分析  

The study of the characteristics and influencing factors of pneumoconiosis among workers exposed to dusts in an iron mine

作　　者：关宏宇[1,2] 张浩[1] 苏良平[2] 刘跃伟[1] 翁少凡[1] 陈卫红[1] 

机构地区：[1]华中科技大学同济医学院公共卫生学院劳动卫生与环境卫生学系,环境与健康教育部重点实验室,武汉430030 [2]武钢大冶铁矿职工医院

出　　处：《中华劳动卫生职业病杂志》2012年第1期36-40,共5页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：国家自然科学基金资助项目（30972451）

摘　　要：目的 分析铁矿接尘工人尘肺的发病规律及影响因素,为铁矿工人尘肺防制提供依据.方法 以某铁矿1960年至1974年在册且工作1年以上的所有接尘工人建立队列,随访至2003年底.尘肺诊断由职业病诊断小组确定.采用Cox比例风险模型分析危险因素.结果 队列接尘工人3647名,累积接尘132 574.4人年.诊断尘肺316例,人年发病率为0.24％.1960年前开始接尘者中发现尘肺274例（86.7％）,人年发病率为0.40％,明显高于1960年后开始接尘工人尘肺人年发病率（43例,0.07‰）.尘肺发病平均潜伏期是（26.0±7.3）年.尘肺晋级年限分别为0＋晋Ⅰ期（5.3士3.2）年,Ⅰ晋Ⅱ期为（6.6±5.2）年,Ⅱ晋Ⅲ期为（1 1.3±5.0）年,随诊断年代的推后,各期晋级年限均有延长趋势.164例尘肺为脱尘后诊断,平均脱尘8.3年.铁矿工尘肺发病危险度随累积接尘量增加而上升,呈明显的接触剂量-反应关系.尘肺患者年平均累积接尘量为（173.7±91.6）mg/m3,远高于非尘肺接尘工人（112.1±64.8）mg/m3.除累积接尘量外,影响尘肺发病风险因素包括肺结核（HR=5.9,P＜0.01）、吸烟（HR=1.7,P＜0.01）.结论 累积接尘量与尘肺发病之间存在明显的剂量-反应关系,并发结核、吸烟是影响尘肺发病的危险因素.Objective To analyze the prevalence characteristics and influence factors of pneumoconiosis of workers exposed to dusts in an iron mine,to provide the base of preventive measures for pneumoconiosis of iron mine.Methods The subjects of cohort study were all workers exposed to dusts for at least one year registered in an iron mine during 1960 to 1974,and followed-up to the end in 2003.The cases with pneumoconiosis were diagnosed by the local diagnosis group of pneumoconiosis,according to the national diagnostic criteria of pneumoconiosis.The risk factors were analyzed with Cox risk model.Results A total of 3647 miners were included in the cohort study and were followed up by 132 574.4 person years.There were 316 cases with pneumoconiosis,and the incidence of pneumoconiosis for a year was 0.24‰.There were 274 cases（86.7%）with pneumoconiosis in workers exposed to dusts before 1960,the incidence of pneumoconiosis for a year was 0.40‰,which was significantly higher than that（0.07‰）of workers exposed to dusts after 1960.The average latency of pneumoconiosis was 26.0±7.3 years.The average durations of upgrade from stage 0＋ to Ⅰ,Ⅰ to Ⅱand Ⅱ to Ⅲ were 5.3±3.2,6.6±5.2 and 11.3±5.0 years,respectively.However,164 cases with pneumoconiosis were diagnosed after ceasing exposure to dusts for mean 8.3 years.The risk of pneumoconiosis in iron miners increased with exposure doses,and there was an obvious dose-effect relationship.The average cumulative exposure dose of cases with pneumoconiosis was173.7 ±91.6 mg/m3 ·y,which was significantly higher than that （112.1 ±64.8mg/m3 ·y）of workers without pneumoconiosis.Also the tuberculosis（HR =5.9,P〈0.001）and smoking（HR=1.7,P〈0.01）were the main risk factors.Conclusion There was an obvious dose-effect relationship between the cumulative exposure dose and pneumoconiosis incidence.Tuberculosis and smoking were the main risk factors influencing the pneumoconiosis incidence.

关 键 词：尘肺 职业暴露 队列研究 危险因素 

分 类 号：R135.2[医药卫生—劳动卫生]